Objective: To analyze the clinical features of COVID-19 infection in hospitalized immunocompromised patients in comparison with immunocompetent patients. Methods: A single-center retrospective observational study was conducted on 213 inpatients diagnosed with COVID-19 in the Peking University People's Hospital between December 2022 and October 2023. They were divided into an immunocompromised group (102 patients, 47.9%) and an immunocompetent group(111 patients, 52.1%), and clinical data were compared between the two groups. The immunocompromised group was further divided into death group (18 cases, 17.6%) and non-death group (84 cases, 82.4%). The differences in laboratory examination findings were compared. Further analysis was performed on the lymphocyte subset differences between the death group(10 patients, 9.8%) and the non-death group (36 patients, 35.3%) with complete data. Results: The proportion of severe and critical cases and the mortality rate, were significantly higher in the immunocompromised group than the immunocompetent group (47.1% vs. 40.5%, 18.6% vs. 9.0%, 17.6% vs. 9.0%,P<0.05). The immunocompromised group had lower vaccination rate (26.5% vs. 44.1%, P<0.05). Hypertension, kidney disease and infections were more common in the immunocompromised group (63.7% vs. 48.6%, 30.4% vs. 9.0%, 49.0% vs. 19.8%, all P<0.05). CT findings of consolidation (40.2% vs. 18.9%), rate of antiviral treatment (48.0% vs. 30.6%) and the positive duration of viral nucleic acid [median 14(7.0, 19.3) days vs. 9(7.0, 18.0) days] were higher in the immunocomprised group (all P<0.05). Lactate dehydrogenase (LDH), procalcitonin (PCT), interleukin-6 (IL-6) and ferritin were higher in the immunocompromised group than those in the immunocompetent group (all P<0.05). In the death group, neutrophils (NEU), C-reactive protein (CRP), PCT, IL-6, ferritin and D-dimer were higher, while lymphocytes (LY), CD4+T-cells, CD8+T-cells, B-cell counts and hemoglobin (HGB) were significantly lower than those in the non-death group (all P<0.05). Conclusions: More than 60% of patients in the immunocompromised group were classified as severe or critical type, with a higher mortality rate and decreased ability to clear severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Decreases in total lymphocytes, CD4+T lymphocytes, CD8+T lymphocytes, and B lymphocytes, along with elevated levels of procalcitonin, ferritin, and D-dimer, indicated poor prognosis.
目的： 分析免疫功能低下状态患者罹患新型冠状病毒感染（coronavirus disease 2019，COVID-19）的临床特征，并与免疫功能正常患者进行比较。 方法： 采取单中心回顾性观察性研究方法，纳入于2022年12月至2023年10月在北京大学人民医院确诊为COVID-19的213例住院患者，分为免疫功能低下组（102例，47.9%）和免疫功能正常组（111例，52.1%），比较两组间的临床资料。将免疫功能低下组分为死亡组（18例，17.6%）和非死亡组（84例，82.4%），对两组的实验室检查指标进行比较，进一步对其中数据完整的死亡组（10例，9.8%）和非死亡组（36例，35.3%）的淋巴细胞亚群进行差异分析。 结果： 免疫功能低下组重型、危重型比例以及病死率均高于免疫功能正常组（47.1% vs. 40.5%、18.6% vs. 9.0%、17.6% vs. 9.0%，P<0.05）。与免疫功能正常组相比，免疫功能低下组接种疫苗比例偏低（26.5% vs. 44.1%，P<0.05），多合并高血压、肾脏疾病及感染（63.7% vs. 48.6%、30.4% vs. 9.0%、49.0% vs. 19.8%，均P<0.05），影像学表现实变影比例、接受抗病毒治疗比例和核酸阳性持续时间均偏高［40.2% vs. 18.9%、48.0% vs. 30.6%、14（7.0，19.3）d vs. 9（7.0，18.0）d，均P<0.05］，乳酸脱氢酶、降钙素原、白细胞介素-6和铁蛋白水平显著高于免疫功能正常组（均P<0.05）。死亡组的中性粒细胞、C反应蛋白、PCT、IL-6、铁蛋白和D-二聚体水平均显著高于非死亡组（均P<0.05），但淋巴细胞、CD4+T细胞、CD8+T细胞、B细胞计数和血红蛋白均显著低于非死亡组（均P<0.05）。 结论： 免疫功能低下状态患者重型和危重型超过60%，病死率较高，机体清除新冠病毒能力下降。淋巴细胞总数、CD4+T细胞、CD8+T细胞和B细胞减少，降钙素原、铁蛋白和D-二聚体升高提示患者预后不良。.