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The Impact of the COVID-19 Omicron Variant on Immunocompromised Patients: ICU Admissions and Increased Mortality
Jan Pander1, Fabian Termorshuizen2,3, Dylan W de Lange4,5
1AstraZeneca BV, PO Box 93015, 2509 AA, Den Haag, The Netherlands.
Insights
Immunocompromised patients with COVID-19 in the ICU had higher mortality rates during the Omicron variant period. This highlights the ongoing risk of COVID-19 for immunocompromised individuals, necessitating targeted protective measures.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Immunology
Background:
- The COVID-19 pandemic caused by SARS-CoV-2 variants poses a global health challenge.
- The Omicron variant showed decreased mortality, but immunocompromised individuals remained at high risk due to limited vaccine efficacy.
- This study addresses the critical need to understand COVID-19 outcomes in immunocompromised populations.
Purpose of the Study:
- To compare mortality rates in intensive care units (ICUs) between immunocompromised and non-immunocompromised COVID-19 patients during the Omicron variant period in The Netherlands.
- To assess the specific risks faced by immunocompromised individuals with COVID-19 compared to non-immunocompromised patients and historical viral pneumonia cohorts.
Main Methods:
- Analysis of ICU admissions data from the Dutch National Intensive Care Evaluation (NICE) registry (February 2022-December 2023).
- Categorization of patients into immunocompromised and non-immunocompromised groups based on medical records.
- Logistic regression analysis adjusted for key demographic and clinical factors, with comparison to a 2017-2019 viral pneumonia cohort.
Main Results:
- Immunocompromised patients constituted 29.5% of COVID-19 ICU admissions.
- Significantly higher in-hospital (ORadj=1.56) and ICU mortality (ORadj=1.64) were observed in immunocompromised COVID-19 patients.
- Immunocompromised COVID-19 patients exhibited higher mortality than immunocompromised patients with other viral pneumonias.
Conclusions:
- COVID-19 during the Omicron period remains a significant threat to immunocompromised individuals, evidenced by higher ICU mortality.
- Specific and effective protective measures are crucial for this vulnerable population.
- Findings underscore the continued public health importance of addressing COVID-19 in immunocompromised groups.
Introduction:
The corona virus disease 19 (COVID-19) pandemic has presented a global health challenge, and several consecutive variants of the severe acute respiratory syndrome-corona virus-2 (SARS-CoV-2) virus have been dominant. Previous studies highlighted decreased mortality rates during the predominance of the omicron variant; however, severely immunocompromised individuals remained at high risk due to limited vaccine response. This study aims to compare mortality rates during the omicron period between immunocompromised and non-immunocompromised patients in intensive care units (ICUs) in The Netherlands.
Methods:
Utilizing data from the Dutch National Intensive Care Evaluation (NICE) registry, this study analyzed ICU admissions due to COVID-19 from February 2022 to December 2023. Patients were categorized as immunocompromised based on recorded immunologic insufficiencies or associated conditions. A historical cohort of viral pneumonia patients from 2017 to 2019 was used for comparison. Logistic regression analyses, adjusted for age, gender, body-mass index (BMI), and acute physiology and chronic health evaluation IV (APACHE-IV) mortality risk, compared in-hospital and ICU mortality and length of stay between groups. A sensitivity analysis excluded early omicron period admissions to assess the consistency of findings.
Results:
Among 1491 patients admitted to the ICU due to COVID-19, 29.5% were immunocompromised, showing significantly higher in-hospital adjusted odds ratio (ORadj = 1.56, 95% CI 1.20-2.04) and ICU mortality (ORadj = 1.64, 95% CI 1.25-2.17) compared to non-immunocompromised patients. The historical cohort exhibited lower mortality rates for immunocompromised individuals compared to the COVID-19 cohort. Sensitivity analysis confirmed these trends, with slight attenuation of odds ratios.
Conclusion:
Immunocompromised patients admitted to the ICU due to COVID-19 during the omicron period had higher mortality than non-immunocompromised patients. Additionally, immunocompromised patients with COVID-19 had higher mortality than immunocompromised patients with other viral pneumonias. Our results provide additional evidence that COVID-19 is still a significant health concern to immunocompromised individuals, which warrants specific and effective measures to protect this vulnerable group.
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