Frontiers in Medicine (Sep 2023)

The role of immune suppression in COVID-19 hospitalization: clinical and epidemiological trends over three years of SARS-CoV-2 epidemic

  • Marta Canuti,
  • Marta Canuti,
  • Marta Canuti,
  • Maria Cristina Monti,
  • Chiara Bobbio,
  • Antonio Muscatello,
  • Toussaint Muheberimana,
  • Sante Leandro Baldi,
  • Sante Leandro Baldi,
  • Francesco Blasi,
  • Francesco Blasi,
  • Ciro Canetta,
  • Giorgio Costantino,
  • Giorgio Costantino,
  • Alessandro Nobili,
  • Flora Peyvandi,
  • Flora Peyvandi,
  • Mauro Tettamanti,
  • Simone Villa,
  • Simone Villa,
  • Stefano Aliberti,
  • Stefano Aliberti,
  • Mario C. Raviglione,
  • Mario C. Raviglione,
  • Andrea Gori,
  • Andrea Gori,
  • Andrea Gori,
  • Alessandra Bandera,
  • COVID-19 Network Study Group,
  • Bosari Silvano,
  • Scudeller Luigia,
  • Fusetti Giuliana,
  • Rusconi Laura,
  • Dell’Orto Silvia,
  • Prati Daniele,
  • Valenti Luca,
  • Giovannelli Silvia,
  • Manunta Maria,
  • Lamorte Giuseppe,
  • Ferarri Francesca,
  • Mangioni Davide,
  • Alagna Laura,
  • Bozzi Giorgio,
  • Lombardi Andrea,
  • Ungaro Riccardo,
  • Ancona Giuseppe,
  • Zuglian Gianluca,
  • Bolis Matteo,
  • Iannotti Nathalie,
  • Ludovisi Serena,
  • Comelli Agnese,
  • Renisi Giulia,
  • Biscarini Simona,
  • Castelli Valeria,
  • Palomba Emanuele,
  • Fava Marco,
  • Fortina Valeria,
  • Liparoti Arianna,
  • Pastena Andrea,
  • Alberto Peri Carlo,
  • Saltini Paola,
  • Viero Giulia,
  • Itri Teresa,
  • Ferroni Valentina,
  • Pastore Valeria,
  • Massafra Roberta,
  • Curri Maria Teresa,
  • Rizzo Alice,
  • Scarpa Stefano,
  • Giommi Alessandro,
  • Bianco Rosaria,
  • Chitani Grazia Eliana,
  • Gualtierotti Roberta,
  • Ferrari Barbara,
  • Rossio Raffaella,
  • Boasi Nadia,
  • Pagliaro Erica,
  • Massimo Costanza,
  • Caro Michele De,
  • Giachi Andrea,
  • Montano Nicola,
  • Vigone Barbara,
  • Bellocchi Chiara,
  • Carandina Angelica,
  • Fiorelli Elisa,
  • Melli Valerie,
  • Tobaldini Eleonora,
  • Spotti Maura,
  • Terranova Leonardo,
  • Misuraca Sofia,
  • D’Adda Alice,
  • Fiore Silvia Della,
  • Pasquale Marta Di,
  • Mantero Marco,
  • Contarini Martina,
  • Ori Margherita,
  • Morlacchi Letizia,
  • Rossetti Valeria,
  • Gramegna Andrea,
  • Pappalettera Maria,
  • Cavallini Mirta,
  • Buscemi Agata,
  • Vicenzi Marco,
  • Rota Irena,
  • Solbiati Monica,
  • Furlan Ludovico,
  • Mancarella Marta,
  • Colombo Giulia,
  • Colombo Giorgio,
  • Fanin Alice,
  • Passarella Mariele,
  • Monzani Valter,
  • Rovellini Angelo,
  • Barbetta Laura,
  • Billi Filippo,
  • Folli Christian,
  • Accordino Silvia,
  • Maira Diletta,
  • Hu Cinzia Maria,
  • Motta Irene,
  • Scaramellini Natalia,
  • Fracanzani Anna Ludovica,
  • Lombardi Rosa,
  • Cespiati Annalisa,
  • Cesari Matteo,
  • Lucchi Tiziano,
  • Proietti Marco,
  • Calcaterra Laura,
  • Mandelli Clara,
  • Coppola Carlotta,
  • Cerizza Arturo,
  • Grasselli Giacomo,
  • Galazzi Alessandro,
  • Monti Igor,
  • Galbusera Alessia Antonella

DOI
https://doi.org/10.3389/fmed.2023.1260950
Journal volume & issue
Vol. 10

Abstract

Read online

Specific immune suppression types have been associated with a greater risk of severe COVID-19 disease and death. We analyzed data from patients >17 years that were hospitalized for COVID-19 at the “Fondazione IRCCS Ca′ Granda Ospedale Maggiore Policlinico” in Milan (Lombardy, Northern Italy). The study included 1727 SARS-CoV-2-positive patients (1,131 males, median age of 65 years) hospitalized between February 2020 and November 2022. Of these, 321 (18.6%, CI: 16.8–20.4%) had at least one condition defining immune suppression. Immune suppressed subjects were more likely to have other co-morbidities (80.4% vs. 69.8%, p < 0.001) and be vaccinated (37% vs. 12.7%, p < 0.001). We evaluated the contribution of immune suppression to hospitalization during the various stages of the epidemic and investigated whether immune suppression contributed to severe outcomes and death, also considering the vaccination status of the patients. The proportion of immune suppressed patients among all hospitalizations (initially stable at <20%) started to increase around December 2021, and remained high (30–50%). This change coincided with an increase in the proportions of older patients and patients with co-morbidities and with a decrease in the proportion of patients with severe outcomes. Vaccinated patients showed a lower proportion of severe outcomes; among non-vaccinated patients, severe outcomes were more common in immune suppressed individuals. Immune suppression was a significant predictor of severe outcomes, after adjusting for age, sex, co-morbidities, period of hospitalization, and vaccination status (OR: 1.64; 95% CI: 1.23–2.19), while vaccination was a protective factor (OR: 0.31; 95% IC: 0.20–0.47). However, after November 2021, differences in disease outcomes between vaccinated and non-vaccinated groups (for both immune suppressed and immune competent subjects) disappeared. Since December 2021, the spread of the less virulent Omicron variant and an overall higher level of induced and/or natural immunity likely contributed to the observed shift in hospitalized patient characteristics. Nonetheless, vaccination against SARS-CoV-2, likely in combination with naturally acquired immunity, effectively reduced severe outcomes in both immune competent (73.9% vs. 48.2%, p < 0.001) and immune suppressed (66.4% vs. 35.2%, p < 0.001) patients, confirming previous observations about the value of the vaccine in preventing serious disease.

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