Clinical characteristics of immunocompromised patients infected with the SARS-CoV-2 Omicron variant

In a recent study posted to the medRxiv* preprint server, researchers examined the characteristics and outcomes of coronavirus disease 2019 (COVID-19) in immunocompromised patients.

Study: Clinical characteristics and outcome of immunocompromised patients with COVID-19 caused by the Omicron variant: a prospective observational study. Image Credit: Gorodenkoff/Shutterstock
Study: Clinical characteristics and outcome of immunocompromised patients with COVID-19 caused by the Omicron variant: a prospective observational study. Image Credit: Gorodenkoff/Shutterstock

Various studies have reported that illness after a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant infection is less severe than other variants. However, there is a lack of knowledge regarding the different aspects of Omicron infection in immunocompromised patients.

About the study

In the present study, researchers investigated the characteristics and disease outcomes in immunocompromised patients diagnosed with SARS-CoV-2 Omicron infection.

Participants eligible for the study fulfilled the following criteria:

(1) a proven Omicron infection between 13 December 2021 and 3 February 2022 or a positive polymerase chain reaction (PCR) or an antigen self-test for SARS-CoV-2 Omicron variant infection diagnosed after 9 January 2022;

(2) solid organ (kidney, liver, lung, heart, or multi-organ) transplant recipients (SOTR) or immunocompromised state after the use of anti-CD20 therapy to treat auto-immune or hematological disease or an allogeneic hematopoietic stem cell transplantation (alloHSCT) recipient treated with immunosuppressives to prevent or treat graft versus host disease (GVHD);

And (3) follow-up of a minimum of two weeks post-symptom onset.

The team collected demographic data, clinical history, existing comorbidities, medication history, COVID-19 vaccination status, hospitalization status, route to diagnosis, clinical features, antibody titer before and after SARS-CoV-2 diagnosis, treatment-related data, and the clinical outcomes. The health status of the patients was scored using the clinical frailty scale (CFS), which was based on the clinical examination of the Canadian study of health and aging.

Additionally, the symptom duration was evaluated by contacting all the SARS-CoV-2-infected patients via telephone up to 14 March 2022. The variant and the sublineage responsible for the SARS-CoV-2 infection were identified by detecting the variant-specific single-nucleotide polymorphisms (SNPs) via PCR.

The hospitalized SARS-CoV-2 patients who required supplemental oxygen were treated with dexamethasone. Patients with c-reactive protein (CRP) levels of more than 74 mg/L were treated with tocilizumab and at least 6 l  oxygen per minute, while all the hospitalized immunocompromised patients were administered sotrovimab.

Furthermore, all SOTR, alloHSCT, and B-cell depleted patients were considered to be fully vaccinated against SARS-CoV-2 when they were administered three vaccine doses of a messenger ribonucleic acid (mRNA) vaccine.  

Results

The study results showed that 114 SARS-CoV-2 Omicron-infected, immunocompromised patients were eligible to be included in the study between December 2021 and February 2022. Among these, 100 patients were SOTRs, including 43 kidney, 19 liver, 16 lung, 17 heart, and five multi-organ transplant recipients, while 14 patients were immunocompromised. Almost 46% of the total patients were infected with the Omicron variant, while 85% were infected with the BA.1. variant.

Approximately 54% of the patients reported rhinitis, 53% had a cough, 46% had malaise, 40% had a fever, 40% reported a headache (40%), 36% suffered from a sore throat, 22% had fatigue, 14% reported gastrointestinal complaints, 10% had myalgia, while one patient reported no symptoms. With respect to comorbidities, 65% of the patients had arterial hypertension, 29% had chronic kidney disease, 28% reported diabetes mellitus type 2, and 15% had either heart failure or atherosclerotic cardiovascular disease.

Of the eligible patients, 23 were hospitalized, immunocompromised patients. Among these patients, 35% and 30% required supplemental oxygen and high-flow nasal cannula therapy, respectively. Furthermore, 64% of these patients were treated with sotrovimab, 74% with dexamethasone, 35% with anti-interleukin-6 (IL6) therapy, and 13% with methylprednisolone pulse therapy, while none of the patients needed mechanical ventilation.

The team noted that the median duration of hospital admission was 11 days and 48% of the patients were hospitalized for over 10 days. Among 65% of the hospitalized immunocompromised patients were diagnosed with COVID-19 at least 46 hours before hospitalization. Interestingly, 70% of the patients were seronegative at hospitalization despite 78% of the patients being fully vaccinated. In this cohort, the median symptom duration was 14 days; however, 25% of the patients had not fully recovered even 68 days after symptom onset.

Among COVID-19-infected lung transplant recipients, before treatment with sotrovimab was initiated, 69% of the patients required hospitalization, and 64% needed supplemental oxygen, including four patients who required a minimum of five l/min, four required 15 l/min, and one patient succumbed. However, after the implementation of sotrovimab administration, only 7% of the patients were hospitalized. Moreover, factors associated with hospitalization included being of higher age, lower immunoglobulin G titers, being a lung transplant recipient, having more comorbidities, and a higher CFS score.        

To summarize, the study findings showed that among the vaccinated immunocompromised patient cohort, SARS-CoV-2 Omicron caused low mortality rates. 

*Important notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:
Bhavana Kunkalikar

Written by

Bhavana Kunkalikar

Bhavana Kunkalikar is a medical writer based in Goa, India. Her academic background is in Pharmaceutical sciences and she holds a Bachelor's degree in Pharmacy. Her educational background allowed her to foster an interest in anatomical and physiological sciences. Her college project work based on ‘The manifestations and causes of sickle cell anemia’ formed the stepping stone to a life-long fascination with human pathophysiology.

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