Abstract
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.
Keywords: COVID-19; clinical outcomes; immunosuppression; prescription medicines.
【저자키워드】 COVID-19, Immunosuppression, clinical outcomes, prescription medicines., 【초록키워드】 Treatment, coronavirus disease, Coronavirus disease 2019, mechanical ventilation, severity, Immunosuppression, risk, discharge, clinical outcomes, cohort study, immunosuppressive drugs, Clinical outcome, Probability, Hospital mortality, Patient, Prescriptions, Prednisone, Hospital admission, health system, Admission, mechanism, in-hospital mortality, tacrolimus, Propensity score, Immunosuppressed, mycophenolate, chronic, mycophenolate mofetil, retrospective cohort study, interquartile range, Medicines, no significant differences, 95% CI, no significant difference, 95% confidence interval, hazard ratio, median age, individual, study period, entire cohort, laboratory-confirmed, IMPROVE, defined, survived, adults hospitalized, immunosuppressive drug, the median, with COVID-19, 【제목키워드】 drug, clinical, chronic, System,