Non-severe immunosuppression might be associated with a lower risk of moderate-severe acute respiratory distress syndrome in COVID-19: a pilot study.

Monreal, Enric; de la Maza, Susana Sainz; Gullón, Pedro; Natera-Villalba, Elena; Chico-García, Juan Luis; Beltrán-Corbellini, Álvaro; Martínez-Sanz, Javier; García-Barragán, Nuria; Buisán, Javier; Toledano, Rafael; Alonso-Canovas, Araceli; Pérez-Torre, Paula; Matute-Lozano, María Consuelo; López-Sendón, Jose Luis; García-Ribas, Guillermo; Corral, Íñigo; Fortún, Jesús; Montero-Errasquín, Beatriz; Manzano, Luis; Máiz-Carro, Luis; Costa-Frossard, Lucienne; Masjuan, Jaime

PROBLEM The role of immunosuppression among Coronavirus disease 2019 (COVID-19) patients has not been elucidated and management may be challenging. METHODS Observational study with confirmed COVID-19 patients. The primary endpoint was development of moderate-severe acute respiratory distress syndrome (ARDS). Time to moderate-severe ARDS, the need for mechanical or non-invasive ventilation (MV/NIV), death, and a composite of death or MV/NIV were secondary endpoints. RESULTS Of 138 patients included, 27 (19.6%) were immunosuppressed (IS) and 95 (68.8%) were male, with a median (IQR) age of 68 (54-78) years. A significantly lower proportion of IS patients (25.9%) compared to non-IS patients (52.3%) developed moderate-severe ARDS, in both unadjusted (0.32 (95%CI, 0.13-0.83, p=0.017) and adjusted (aOR 0.25 [95%CI, 0.08-0.80], p=0.019) analyses. After stratifying by pathologies, only IS patients with autoimmune diseases remained significant (aOR 0.25 [95%CI, 0.07-0.98], p=0.046). Non-significant trends towards a longer time to moderate or severe ARDS, a lower need for MV/NIV, and a lower risk of death or MV/NIV were detected among IS. CONCLUSIONS In our cohort of COVID-19 patients, non-severe immunosuppression was associated with a lower risk of moderate-severe ARDS, especially among AD. This suggests a potential protective effect from a hypothesized hyper-inflammatory response. This article is protected by copyright. All rights reserved.