Associations of nirmatrelvir-ritonavir treatment with death and clinical improvement in hospitalized patients with COVID-19 during the Omicron wave in Beijing, China: a multicentre, retrospective cohort study

Clinical Outcomes of Hospitalized Immunocompromised Patients With COVID-19 and the Impact of Hyperinflammation: A Retrospective Cohort Study

Purpose

Immunocompromised patients are at increased risk for severe outcomes from COVID-19 due to their altered immune responses, yet their inflammatory profiles and the interplay between immunosuppression remain poorly understood. We aimed to illustrate the inflammation profile and clinical outcomes of hospitalized immunocompromised patients with COVID-19.

Methods

We conducted a retrospective study using a multicenter database and included adult hospitalized patients with Corona virus disease 2019 (COVID-19) in China's late 2022 COVID-19 wave. Crude and adjusted 28- and 60-day mortality was compared between the two groups. Inflammatory phenotypes were evaluated by serum interleukin-6 (IL-6) and C-reactive protein (CRP) level. The interplay between overt inflammation and immunosuppression was analyzed.

Results

Among the 4078 included patients, 348 (8.5%) were immunocompromised. Immunocompromised patients had lower crude mortality but higher adjusted mortality at 28-day (hazard ratio [HR] = 1.55; 95% CI 1.08 to 2.23) and 60-day (HR = 1.47; 95% CI 1.05 to 2.06). Besides, immunocompromised patients had a higher risk of developing hyperinflammation (odd ratio [OR] =1.92; 95% CI 1.47 to 2.50, p <0.001). Moreover, hyperinflammation mediated a major part of the deleterious survival effect of immunosuppression on COVID-19.

Conclusion

Immunodeficiency not only increases short-term mortality risk but also predisposes patients to hyperinflammation. The complex interplay between immunosuppression, hyperinflammation, and COVID-19 outcomes warrants more detailed profiling of inflammation and immunity in this population.

Prehospital Pandemic Respiratory Infection Emergency System Triage score can effectively predict the 30-day mortality of COVID-19 patients with pneumonia

BACKGROUND

Coronavirus disease 2019 (COVID-19) patients with pneumonia should receive the guidance of initial risk stratification and early warning as soon as possible. Whether the prehospital Pandemic Respiratory Infection Emergency System Triage (PRIEST) score can accurately predict the short-term prognosis of them remains unknown. Accordingly, we aimed to assess the performance of prehospital PRIEST in predicting the 30-day mortality of patients.

METHODS

This retrospective study evaluated the accuracy of five physiological parameters scores commonly used in prehospital disposal for mortality prediction using receiver operating characteristic curves and decision curve analysis. Cox proportional hazard regression analysis was conducted to evaluate independent predictors associated with the 30-day mortality.

RESULTS

A total of 231 patients were included in this study, among which 23 cases (10.0%) died within 30 days after admission. Compared with survivor patients, non-survivor patients had greater numbers of comorbidities, signs and symptoms, complications, and physiological parameters scores and required greater prehospital care (p < 0.05). When the PRIEST score was >12, the sensitivity was 91.3%, and the specificity was 77.4%. We found that the area under the curve of the PRIEST score (0.887, p < 0.05) for mortality prediction was greater than that of the quick Sequential Organ Failure Assessment (0.724), CRB-65 (0.780), Rapid Emergency Medicine Score (0.809), and National Early Warning Score 2 (0.838). Moreover, prehospital PRIEST scores were positively correlated with numbers of comorbidities and numbers of prehospital treatment measures. The 30-day survival rate of patients with PRIEST scores ≤12 (98.8%) significantly exceeded that of patients with PRIEST scores >12 (69.1%) (p < 0.001). Prehospital PRIEST scores >12 (HR = 7.409) was one of the independent predictors of the 30-day mortality.

CONCLUSIONS

The PRIEST can accurately, quickly, and conveniently predict the 30-day mortality of COVID-19 patients with pneumonia in the prehospital phase and can guide their initial risk stratification and treatment.