The usage of the immunosuppressant agents and secondary infections in patients with COVID-19 in intensive care unit: a retrospective study

ABSTRACT

Introduction: It's known that immunosuppressant agents such as pulse methylprednisolone (PMP), dexamethasone (DXM) and interleukin- blockers (IL-B) are used in COVID-19 [1-3]. The aim of this study is to investigate the effect of these immunosuppressant agents on secondary infections in patients with COVID-19 in intensive care units (ICU). Methods: This study was retrospectively designed and all data between March 2020 and October 2021 of six tertiary ICU was evaluated. All patients were divided by three groups as Group I (GI, no immunosuppressant or MP ≤ 1.0 mg/kg), Group II (GII, PMP and/or DXM) and Group III (GIII, only IL-B and PMP and/or DXM). Demographic data, PaO2/FiO2 (P/F) ratio, C-reactive protein (CRP) and procalcitonin, hemogram parameters, ferritin and d-dimer, culture results and outcomes were recorded. For comparison between GI-GII and GI-GIII, propensity score matching (PSM) was used by matching 14 parameters [age, gender, BMI, CCI, APACHE II, P/F ratio, CRP, procalcitonin, hemogram parameters, ferritin, d-dimer and invasive mechanical ventilation (IMV) requirements]. Results: 412 ICU patients were included in the study (GI = 118, GII = 184, GIII = 110). Mortality rates were 27.1%, 39.7% and 55.5% respectively. After PSM, in GII and GIII, the number of ( +) tracheal cultures, ( +) bloodstream cultures, detected different microorganisms during ICU period, neuropathy, tracheotomized patients, duration of IMV and length of ICU stay were significantly higher than GI. Mortality rate and ( +) CMV-DNA-PCR were similar in GI and GII whereas they were significantly higher in GIII than GI. Conclusions: The usage of immunosuppressant agents in COVID-19 causes increased secondary infections. Moreover, increased secondary infections appear as a reason for prolonged ICU stay and duration of IMV, and also, increased mortality.