COVID-19 Disease Severity Among People With HIV Infection or Solid Organ Transplant in the United States: A Nationally-Representative, Multicenter, Observational Cohort Study

Background: The United States currently has more confirmed cases of COVID-19 than any other country in the world. Given the variability in COVID-19 testing and prevention capability, identifying factors associated with mortality in patients requiring mechanical ventilation is critical. This study aimed to identify which demographics, comorbidities, markers of disease progression, and interventions are associated with 30-day mortality in COVID-19 patients requiring mechanical ventilation. Methods: Adult patients with a confirmed diagnosis of COVID-19 admitted to one of the health system’s intensive care units and requiring mechanical ventilation between March 9, 2020 and April 1, 2020, were included in this observational cohort study. We used Chi-Square and Mann-Whitney U tests to compare patient characteristics between deceased and living patients and multiple logistic regression to assess the association between independent variables and the likelihood of 30-day mortality. Results: We included 85 patients, of which 20 died (23.5%) within 30 days of the first hospital admission. In the univariate analysis, deceased patients were more likely ≥60 years of age (p < 0.001), non-Hispanic (p = 0.026), and diagnosed with a solid malignant tumor (p = 0.003). Insurance status also differed between survivors and non-survivors (p = 0.019). Age ≥60 and malignancy had a 9.5-fold (95% confidence interval 1.4-62.3, p = 0.020) and 5.8-fold higher odds ratio (95% confidence interval 1.2-28.4, p = 0.032) for 30-day mortality after adjusted analysis using multivariable logistic regression, while other independent variables were no longer significant. Conclusions: In our observational cohort study of 85 mechanically ventilated COVID-19 patients, age, and a diagnosis of a solid malignant tumor were associated with 30-day mortality. Our findings validate concerns for the survival of elderly and cancer patients in the face of the COVID-19 pandemic in the United States, where testing capabilities and preventative measures have been inconsistent. Preventative efforts geared to patients at risk for intensive care unit mortality from COVID-19 should be explored.

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Chagas Disease: A Proposal for Testing Policy for Solid-Organ Transplant in the United States

Progress in Transplantation ◽

10.7182/pit2013712 ◽

2013 ◽

Vol 23 (3) ◽

pp. 272-277 ◽

Cited By ~ 6

Author(s):

James A. Wallace ◽

Linda Miller ◽

Andrew Beavis ◽

Carlos A. C. Baptista

Keyword(s):

United States ◽

Chagas Disease ◽

Organ Transplant ◽

The United States ◽

Solid Organ Transplant ◽

Solid Organ

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Contribution of solid organ transplant recipients to the pediatric non-hodgkin lymphoma burden in the United States

Cancer ◽

10.1002/cncr.30923 ◽

2017 ◽

Vol 123 (23) ◽

pp. 4663-4671 ◽

Cited By ~ 7

Author(s):

Elizabeth L. Yanik ◽

Meredith S. Shiels ◽

Jodi M. Smith ◽

Christina A. Clarke ◽

Charles F. Lynch ◽

...

Keyword(s):

United States ◽

Hodgkin Lymphoma ◽

Organ Transplant ◽

The United States ◽

Solid Organ Transplant ◽

Solid Organ ◽

Transplant Recipients ◽

Organ Transplant Recipients ◽

Non Hodgkin Lymphoma ◽

Solid Organ Transplant Recipients

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COVID-19 Disease Severity among People with HIV Infection or Solid Organ Transplant in the United States: A Nationally-representative, Multicenter, Observational Cohort Study

10.1101/2021.07.26.21261028 ◽

2021 ◽

Author(s):

Jing Sun ◽

Rena C. Patel ◽

Qulu Zheng ◽

Vithal Madhira ◽

Amy L. Olex ◽

...

Keyword(s):

United States ◽

Disease Severity ◽

Multinomial Logistic Regression ◽

Organ Transplant ◽

Immune Dysfunction ◽

The United States ◽

Solid Organ Transplant ◽

Solid Organ ◽

Mild Disease ◽

Comorbidity Burden

Background Individuals with immune dysfunction, including people with HIV (PWH) or solid organ transplant recipients (SOT), might have worse outcomes from COVID-19. We compared odds of COVID-19 outcomes between patients with and without immune dysfunction. Methods We evaluated data from the National COVID-19 Cohort Collaborative (N3C), a multicenter retrospective cohort of electronic medical record (EMR) data from across the United States, on. 1,446,913 adult patients with laboratory-confirmed SARS-CoV-2 infection. HIV, SOT, comorbidity, and HIV markers were identified from EMR data prior to SARS-CoV-2 infection. COVID-19 disease severity within 45 days of SARS-CoV-2 infection was classified into 5 categories: asymptomatic/mild disease with outpatient care; mild disease with emergency department (ED) visit; moderate disease requiring hospitalization; severe disease requiring ventilation or extracorporeal membrane oxygenation (ECMO); and death. We used multivariable, multinomial logistic regression models to compare odds of COVID-19 outcomes between patients with and without immune dysfunction. Findings Compared to patients without immune dysfunction, PWH and SOT had a greater likelihood of having ED visits (adjusted odds ratio [aOR]: 1.28, 95% confidence interval [CI] 1.27-1.29; aOR: 2.61, CI: 2.58-2.65, respectively), requiring ventilation or ECMO (aOR: 1.43, CI: 1.43-1.43; aOR: 4.82, CI: 4.78-4.86, respectively), and death (aOR: 1.20, CI: 1.19-1.20; aOR: 3.38, CI: 3.35-3.41, respectively). Associations were independent of sociodemographic and comorbidity burden. Compared to PWH with CD4>500 cells/mm3, PWH with CD4<350 cells/mm3 were independently at 4.4-, 5.4-, and 7.6-times higher odds for hospitalization, requiring ventilation, and death, respectively. Increased COVID-19 severity was associated with higher levels of HIV viremia. Interpretation Individuals with immune dysfunction have greater risk for severe COVID-19 outcomes. More advanced HIV disease (greater immunosuppression and HIV viremia) was associated with higher odds of severe COVID-19 outcomes. Appropriate prevention and treatment strategies should be investigated to reduce the higher morbidity and mortality associated with COVID-19 among PWH and SOT.

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