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

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          Abstract

          The role of immunosuppression among coronavirus disease 2019 (COVID-19) patients has not been elucidated and management may be challenging. This observational study included confirmed COVID-19 patients. The primary endpoint was the development of moderate-severe acute respiratory distress syndrome (ARDS). Time to moderate-severe ARDS, the need for mechanical or noninvasive ventilation (MV/NIV), death, and a composite of death or MV/NIV were secondary endpoints. 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 = .017) and adjusted (aOR, 0.25; 95% CI, 0.08-0.80; p = .019) analyses. After stratifying by pathologies, only IS patients with autoimmune diseases remained significant (aOR 0.25; 95% CI, 0.07-0.98; p = .046). Nonsignificant trends toward 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. In our cohort of COVID-19 patients, nonsevere 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.

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          Contributors
          (View ORCID Profile)
          (View ORCID Profile)
          Journal
          Journal of Medical Virology
          J Med Virol
          Wiley
          0146-6615
          1096-9071
          November 09 2020
          Affiliations
          [1 ]Department of Neurology Hospital Universitario Ramón y Cajal, Universidad de Alcalá IRYCIS Madrid Spain
          [2 ]Public Health and Epidemiology Research Group, Universidad de Alcalá Madrid Spain
          [3 ]Department of Infectious Diseases Hospital Universitario Ramón y Cajal, Universidad de Alcalá IRYCIS Madrid Spain
          [4 ]Department of Geriatrics Hospital Universitario Ramón y Cajal, Universidad de Alcalá IRYCIS Madrid Spain
          [5 ]Department of Internal Medicine Hospital Universitario Ramón y Cajal, Universidad de Alcalá IRYCIS Madrid Spain
          [6 ]Department of Neumology Hospital Universitario Ramón y Cajal, Universidad de Alcalá IRYCIS Madrid Spain
          Article
          10.1002/jmv.26656
          33165922
          4bab1b4f-3432-4ca2-921f-432fdd158dab
          © 2020

          http://onlinelibrary.wiley.com/termsAndConditions#vor

          http://doi.wiley.com/10.1002/tdm_license_1.1

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