Adverse COVID-19 outcomes in immune deficiencies: Inequality exists between subclasses.
Allergy
; 77(1): 282-295, 2022 01.
Article
in English
| MEDLINE | ID: covidwho-1327507
ABSTRACT
BACKGROUND:
Genetic deficiencies of immune system, referred to as inborn errors of immunity (IEI), serve as a valuable model to study human immune responses. In a multicenter prospective cohort, we evaluated the outcome of SARS-CoV-2 infection among IEI subjects and analyzed genetic and immune characteristics that determine adverse COVID-19 outcomes.METHODS:
We studied 34 IEI patients (19M/15F, 12 [min 0.6-max 43] years) from six centers. We diagnosed COVID-19 infection by finding a positive SARS-CoV-2 PCR test (n = 25) and/or a lung tomography scoring (CORADS) ≥4 (n = 9). We recorded clinical and laboratory findings prospectively, fitted survival curves, and calculated fatality rates for the entire group and each IEI subclass.RESULTS:
Nineteen patients had combined immune deficiency (CID), six with predominantly antibody deficiency (PAD), six immune dysregulation (ID), two innate immune defects, and one in the autoinflammatory class. Overall, 23.5% of cases died, with disproportionate fatality rates among different IEI categories. PAD group had a relatively favorable outcome at any age, but CIDs and IDs were particularly vulnerable. At admission, presence of dyspnea was an independent risk for COVID-related death (OR 2.630, 95% CI; 1.198-5.776, p < .001). Concerning predictive roles of laboratory markers at admission, deceased subjects compared to survived had significantly higher CRP, procalcitonin, Troponin-T, ferritin, and total-lung-score (p = .020, p = .003, p = .014, p = .013, p = .020; respectively), and lower absolute lymphocyte count, albumin, and trough IgG (p = .012, p = .022, p = .011; respectively).CONCLUSION:
Our data disclose a highly vulnerable IEI subgroup particularly disadvantaged for COVID-19 despite their youth. Future studies should address this vulnerability and consider giving priority to these subjects in SARS-Cov-2 therapy trials.Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Primary Immunodeficiency Diseases
/
COVID-19
/
Immunologic Deficiency Syndromes
Type of study:
Cohort study
/
Experimental Studies
/
Observational study
/
Prognostic study
Limits:
Adolescent
/
Humans
Language:
English
Journal:
Allergy
Year:
2022
Document Type:
Article
Affiliation country:
All.15025
Similar
MEDLINE
...
LILACS
LIS