Severity Outcomes among Adult Patients with Primary Immunodeficiency and COVID-19 Seen in Emergency Departments, United States, April 2020–August 2021
Abstract
1. Introduction
2. Materials and Methods
2.1. Data Source and Study Population
2.2. Statistical Analysis
3. Results
3.1. Descriptive Characteristics
3.2. COVID-19 Outcomes
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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ICD-10 Code a | Frequency, No. (%) | Label |
---|---|---|
D83.9 | 318 (31.2%) | Common variable immunodeficiency, unspecified |
D80.3 | 250 (24.5%) | Selective deficiency of immunoglobulin G (IgG) subclass |
D84.1 | 83 (8.1%) | Defects in the complement system |
D80.2 | 79 (7.7%) | Selective deficiency of immunoglobulin A (IgA) |
D80.0 | 32 (3.1%) | Hereditary hypogammaglobulinemia |
D80.4 | 32 (3.1%) | Selective deficiency of immunoglobulin M (IgM) |
D80.9 | 27 (2.6%) | Immunodeficiency with predominantly antibody defects, unspecified |
D82.4 | 25 (2.5%) | Hyperimmunoglobulin E (IgE) syndrome |
D80.8 | 24 (2.4%) | Other immunodeficiencies with predominantly antibody defects |
M04.1 | 24 (2.4%) | Periodic fever syndromes |
D82.1 | 20 (2.0%) | Di George’s syndrome |
D83.8 | <20 | Other common variable immunodeficiencies |
D80.6 | <20 | Antibody deficiency with near-normal immunoglobulins or with hyperimmunoglobulinemia |
D89.82 | <20 | Autoimmune lymphoproliferative syndrome (ALPS) |
D83.0 | <20 | Common variable immunodeficiency with predominant abnormalities of B-cell numbers and function |
M04.8 | <20 | Other autoinflammatory syndromes |
D83.1 | <20 | Common variable immunodeficiency with predominant immunoregulatory T-cell disorders |
D80.5 | <20 | Immunodeficiency with increased immunoglobulin M (IgM) |
D81.818 | <20 | Other biotin-dependent carboxylase deficiency |
D82.3 | <20 | Immunodeficiency following hereditary defective response to Epstein–Barr virus |
D82.9 | <20 | Immunodeficiency associated with major defect, unspecified |
D81.819 | <20 | Other biotin-dependent carboxylase deficiency, unspecified |
D82.0 | <20 | Wiskott–Aldrich syndrome |
D84.0 | <20 | Lymphocyte function antigen-1 (LFA-1) defect |
D82.8 | <20 | Immunodeficiency associated with other specified major defects |
D83.2 | <20 | Common variable immunodeficiency with autoantibodies to B or T cells |
D80.7 | 0 (0%) | Transient hypogammaglobulinemia of infancy |
D81.0 | 0 (0%) | Severe combined immunodeficiency (SCID) with reticular dysgenesis |
D81.1 | 0 (0%) | SCID with low T- and B-cell numbers |
D81.2 | 0 (0%) | SCID with low or normal B-cell number |
D81.3 | 0 (0%) | Adenosine deaminase (ADA) deficiency |
D81.4 | 0 (0%) | Nezelof’s syndrome |
D81.5 | 0 (0%) | Purine nucleoside phosphorylase (PNP) deficiency |
D81.6 | 0 (0%) | Major histocompatibility complex class I deficiency |
D81.7 | 0 (0%) | Major histocompatibility complex class II deficiency |
D81.810 | 0 (0%) | Biotinidase deficiency |
D81.89 | 0 (0%) | Other combined immunodeficiencies |
D81.9 | 0 (0%) | Combined immunodeficiency, unspecified |
D82.2 | 0 (0%) | Immunodeficiency with short-limbed stature |
D83 | 0 (0%) | Common variable immunodeficiency |
M04.2 | 0 (0%) | Cryopyrin-associated periodic syndromes |
Total | 1020 (100%) | Any primary immunodeficiency (Any PI) |
Characteristic | Primary Immunodeficiency | Non-Primary Immunodeficiency | |
---|---|---|---|
All, No. (row %) | 853 (100%) | 1,197,430 (100%) | |
Gender | Female | 548 (64.2%) | 627,785 (52.4%) |
Male | 305 (35.8%) | 569,645 (47.8%) | |
Age | 18–39 | 144 (16.9%) | 305,230 (25.5%) |
40–54 | 167 (19.6%) | 277,375 (23.2%) | |
55–64 | 187 (21.9%) | 215,113 (18.0%) | |
65–74 | 185 (21.7%) | 188,704 (15.8%) | |
75+ | 170 (19.9%) | 211,008 (17.6%) | |
Race/Ethnicity | Hispanic | 75 (8.8%) | 257,666 (21.5%) |
Non-Hispanic black | 79 (9.3%) | 242,556(20.3%) | |
Non-Hispanic white | 649 (76.1%) | 581,790 (48.6%) | |
Other | 38 (4.5%) | 88,541 (7.4%) | |
Unknown | <20 | 26,877 (2.2%) | |
Comorbidities | Neoplasm | 191 (22.4%) | 54,043 (4.5%) |
Chronic obstructive pulmonary disease | 305 (35.8%) | 116,591 (9.7%) | |
Chronic kidney disease | 190 (22.3%) | 142,879 (11.9%) | |
Obesity | 298 (32.9%) | 242,324 (20.2%) | |
Type 2 diabetes | 308 (36.1%) | 324,018(27.1%) | |
Cardiovascular disease | 388 (45.5%) | 281,763 (23.5%) |
Characteristic | Primary Immunodeficiency | Non-Primary Immunodeficiency | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
ED Visit | Hospitalization | ICU | IMV | Death | ED Visit | Hospitalization | ICU | IMV | Death | ||
No. (%) | No. (%) | No. (% a) | No. (% a) | No. (% a) | No. (%) | No. (%) | No. (% a) | No. (% a) | No. (% a) | ||
All, No. (row %) | 853 (100%) | 624 (73.2%) | 183 (29.3%) | 121 (19.4%) | 111 (17.8%) | 1,197,430 (100%) | 535,663 (44.7%) | 118,566 (22.1%) | 72,610 (13.6%) | 76,594 (14.3%) | |
Gender | Female | 548 (100%) | 389 (71.0%) | 112 (28.8%) | 67 (17.2%) | 59 (15.2%) | 627,785 (100%) | 254,989 (40.6%) | 49,509 (19.4%) | 29,139 (11.4%) | 32,227 (12.6%) |
Male | 305 (100%) | 235 (77.1%) | 71 (30.2%) | 54 (23.0%) | 52 (22.1%) | 569,645 (100%) | 280,674 (49.3%) | 69,057 (24.6%) | 43,471 (15.5%) | 44,367 (15.8%) | |
Age | 18–39 | 144 (100%) | 78 (54.2%) | 24 (30.8%) | <20 | <20 | 305,230 (100%) | 53,042 (17.4%) | 8667 (16.3%) | 4009 (7.6%) | 1311 (2.5%) |
40–54 | 167 (100%) | 110 (65.9%) | 30 (27.3%) | 22 (20.0%%) | <20 | 277,375 (100%) | 97,441 (35.1%) | 19,241 (19.7%) | 11,010 (11.3%) | 5693 (5.8%) | |
55–64 | 187 (100%) | 142 (75.9%) | 41 (28.9%) | 25 (17.6%) | 23 (16.2%) | 215,113 (100%) | 109,598 (51.0%) | 26,188 (23.9%) | 16,951 (15.5%) | 11,768 (10.7%) | |
65–74 | 185 (100%) | 149 (80.5%) | 45 (30.2%) | 36 (24.2%) | 32 (21.5%) | 188,704 (100%) | 119,010 (63.1%) | 31,541 (26.5%) | 21,305 (17.9%) | 20,034 (16.8%) | |
75+ | 170 (100%) | 145(85.3%) | 43 (29.7%) | 23 (15.9%) | 34 (23.4%) b | 211,008 (100%) | 156,572 (74.2%) | 32,929 (21.0%) | 19,335 (12.3%) | 37,788 (24.1%) | |
Race/Ethnicity | Hispanic | 75 (100%) | 47 (62.7%) | <20 | <20 | <20 | 257,666 (100%) | 99,548 (38.6%) | 22,727 (22.8%) | 14,673 (14.7%) | 13,236 (13.3%) |
Non-Hispanic black | 79 (100%) | 54 (68.4%) | <20 | <20 b | <20 b | 242,556 (100%) | 101,304 (41.8%) | 22,614 (22.3%) | 14,102 (13.98%) | 12,990 (12.8%) | |
Non-Hispanic white | 649 (100%) | 486 (74.9%) | 136 (28.0%) | 94 (19.3%) | 90 (18.5%) | 581,790 (100%) | 282,771 (48.6%) | 61,455 (21.7) | 35,415 (12.5%) | 42,080 (14.9%) | |
Other | 38 (100%) | 27 (71.1%) | <20 | <20 | <20 b | 88,541 (100%) | 40,350 (45.6%) | 9042 (22.4%) | 6538 (16.2%) | 6491 (16.1%) | |
Unknown | <20 (100%) | <20 (83.3%) | <20 b | <20 b | <20 b | 26,877 (100%) | 11,690 (43.5%) | 2728 (23.3%) | 1882 (16.1%) | 1797 (15.4%) | |
Comorbidities | Neoplasm | 191 (100%) | 153 (80.1%) b | 48 (31.4%) | 26 (17.0%) b | 38 (24.8%) b | 54,043 (100%) | 41,076 (76.0%) | 10,174 (24.8%) | 6213 (15.1%) | 8460 (20.6%) |
Chronic obstructive pulmonary disease | 305 (100%) | 246 (80.7%) b | 81 (32.9%) | 52 (21.1%) b | 55 (22.4%) b | 116,591 (100%) | 89,136 (76.5%) | 24,260 (27.2%) | 15,447 (17.3%) | 18,642 (20.9%) | |
Chronic kidney disease | 190 (100%) | 154 (81.1%) b | 61 (39.6%) | 40 (26.0%) | 46 (29.9%) b | 142,879 (100%) | 117,518 (82.3%) | 32,870 (28.0%) | 21,367 (18.2%) | 27,587 (23.5%) | |
Obesity | 298 (100%) | 238 (79.9%) | 85 (35.7%) | 62 (26.1%) | 49 (20.6%) | 242,324 (100%) | 173,657 (71.7%) | 46,109 (26.6%) | 30,208 (17.4%) | 24,594 (14.2%) | |
Type 2 diabetes | 308 (100%) | 243 (78.9%) | 88 (36.2%) | 62 (25.5%) | 58 (23.9%) | 324,018 (100%) | 223,072 (68.9%) | 60,451 (27.1%) | 38,428 (17.2%) | 38,830 (17.4%) | |
Cardiovascular disease | 388 (100%) | 320 (82.5%) | 111 (34.7%) | 74 (23.1%) | 80 (25.0%) b | 281,763 (100%) | 214,185 (76.0%) | 61,940 (28.9%) | 40,506 (18.9%) | 49,042 (22.9%) |
ICD-10 Code | Primary Immunodeficiency | Total | Hospitalized | ICU a | IMV a | Deaths a |
---|---|---|---|---|---|---|
D83.9 | Common variable immunodeficiency, unspecified | 318 | 216 (67.9%) | 71 (32.9%) | 52 (24.1%) | 44 (20.4%) |
D80.3 | Selective deficiency of immunoglobulin G (IgG) subclass | 250 | 188 (75.2%) | 48 (25.5%) | 37 (19.7%) | 34 (18.1%) |
D84.1 | Defects in the complement system | 83 | 55 (66.3%) | 23 (41.8%) | <20 | <20 |
D80.2 | Selective deficiency of immunoglobulin A (IgA) | 79 | 46 (58.2%) | <20 | <20 | <20 |
1 April 2020–31 August 2021 | |||
---|---|---|---|
COVID-19 Outcome | Non-Primary Immunodeficiency Patients (n = 1,197,430) | Primary Immunodeficiency Patients (n = 853) | Adjusted Odds Ratio a (95% CI) |
Hospitalization | 535,663 (44.7%) | 624 (73.2%) | 2.36 (1.87–2.98) |
ICU admission | 118,566 (9.9%) | 183 (21.5%) | 1.53 (1.19–1.96) |
Invasive mechanical ventilation | 72,610 (6.1%) | 121 (14.2%) | 1.41 (1.15–1.72) |
Death | 76,594 (6.4%) | 111 (13.0%) | 1.37 (1.08–1.74) |
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Drzymalla, E.; Moonesinghe, R.; Kolor, K.; Khoury, M.J.; Schieber, L.; Gundlapalli, A.V. Severity Outcomes among Adult Patients with Primary Immunodeficiency and COVID-19 Seen in Emergency Departments, United States, April 2020–August 2021. J. Clin. Med. 2023, 12, 3516. https://doi.org/10.3390/jcm12103516
Drzymalla E, Moonesinghe R, Kolor K, Khoury MJ, Schieber L, Gundlapalli AV. Severity Outcomes among Adult Patients with Primary Immunodeficiency and COVID-19 Seen in Emergency Departments, United States, April 2020–August 2021. Journal of Clinical Medicine. 2023; 12(10):3516. https://doi.org/10.3390/jcm12103516
Chicago/Turabian StyleDrzymalla, Emily, Ramal Moonesinghe, Katherine Kolor, Muin J. Khoury, Lyna Schieber, and Adi V. Gundlapalli. 2023. "Severity Outcomes among Adult Patients with Primary Immunodeficiency and COVID-19 Seen in Emergency Departments, United States, April 2020–August 2021" Journal of Clinical Medicine 12, no. 10: 3516. https://doi.org/10.3390/jcm12103516
APA StyleDrzymalla, E., Moonesinghe, R., Kolor, K., Khoury, M. J., Schieber, L., & Gundlapalli, A. V. (2023). Severity Outcomes among Adult Patients with Primary Immunodeficiency and COVID-19 Seen in Emergency Departments, United States, April 2020–August 2021. Journal of Clinical Medicine, 12(10), 3516. https://doi.org/10.3390/jcm12103516