Association Between Chronic Use of Immunosuppresive Drugs and Clinical Outcomes From Coronavirus Disease 2019 (COVID-19) Hospitalization: A Retrospective Cohort Study in a Large US Health System
Association Between Chronic Use of Immunosuppresive Drugs and Clinical Outcomes From Coronavirus Disease 2019 (COVID-19) Hospitalization: A Retrospective Cohort Study in a Large US Health System
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DOI：
10.1093/cid/ciaa1488
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发表时间：
2021-12-01
影响因子：
11.8
通讯作者：
Alexander, G. Caleb
中科院分区：
文献类型：
--
作者：
Andersen, Kathleen M.;Mehta, Hemalkumar B.;Alexander, G. Caleb
背景资料。目前尚不清楚长期使用免疫抑制药物是否会加剧或改善2019年冠状病毒病(新冠肺炎)的严重程度，两者都有可信的机制。对2020年3月4日至8月29日在大型学术卫生系统中确诊或疑似新冠肺炎的2121名连续入院的成人进行了回顾性队列研究，调整了与倾向评分相混淆的稳定化治疗权重的逆概率。慢性免疫抑制被定义为入院时有效的免疫抑制药物处方。结果包括机械通气、住院死亡率和住院时间。在研究期间，有2,121名患者入院接受实验室确诊(1967，93%)或疑似新冠肺炎(154，7%)，年龄中位数为55岁(四分位数范围，40-67岁)。其中，108例(5%)在新冠肺炎之前被归类为免疫抑制，主要是强的松(每天7.5毫克)、他克莫司或霉酚酸酯。在整个队列中，311人(15%)接受了机械通气；中位(四分位数范围)住院时间为5.2(2.5-10.6)天，1927人(91%)存活出院。调整后，免疫抑制组和对照组在机械通气风险(危险比[HR]，0.79；95%可信区间[CI]，0.46-1.35)、住院死亡率(HR，0.66；95%CI，0.28-1.55)和住院时间(HR，1.16；95%CI，0.92-1.47)方面没有显著差异。在同一美国医疗系统中，长期使用免疫抑制药物与住院治疗新冠肺炎的成年人的临床结果恶化或改善无关。
Background. It is unclear whether chronic use of immunosuppressive drugs worsens or improves the severity of coronavirus disease 2019 (COVID-19), with plausible mechanisms for both.Methods. Retrospective cohort study in 2121 consecutive adults with acute inpatient hospital admission between 4 March and 29 August 2020 with confirmed or suspected COVID-19 in a large academic health system, with adjustment for confounding with propensity score-derived stabilized inverse probability of treatment weights. Chronic immunosuppression was defined as prescriptions for immunosuppressive drugs current at the time of admission. Outcomes included mechanical ventilation, in-hospital mortality, and length of stay.Results. There were 2121 patients admitted with laboratory-confirmed (1967, 93%) or suspected (154, 7%) COVID-19 during the study period, with a median age of 55 years (interquartile range, 40-67). Of these, 108 (5%) were classified as immunosuppressed before COVID-19, primarily with prednisone (>7.5 mg/day), tacrolimus, or mycophenolate mofetil. Among the entire cohort, 311 (15%) received mechanical ventilation; the median (interquartile range) length of stay was 5.2 (2.5-10.6) days, and 1927 (91%) survived to discharge. After adjustment, there were no significant differences in the risk of mechanical ventilation (hazard ratio [HR],.79; 95% confidence interval [CI],.46-1.35), in-hospital mortality (HR,.66; 95% CI,.28-1.55), or length of stay (HR, 1.16; 95% CI,.92-1.47) among individuals with immunosuppression and counterparts.Conclusions. Chronic use of immunosuppressive drugs was neither associated with worse nor better clinical outcomes among adults hospitalized with COVID-19 in one US health system.