Journal Article Ppublish
PubMed: 38627873 DOI: 10.3348/kjr.2023.0992
Clinical and Imaging Characteristics of SARS-CoV-2 Breakthrough Infection in Hospitalized Immunocompromised Patients.
Korean J Radiol 25(5):481-492
Authors: Jong Eun Lee, Jinwoo Kim, Minhee Hwang, Yun-Hyeon Kim, Myung Jin Chung, Won Gi Jeong, Yeon Joo Jeong
Affiliations
- Department of Radiology, Chonnam National University Hospital, Gwangju, Republic of Korea.
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
- Department of Radiology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, Republic of Korea.
- Department of Radiology and Biomedical Engineering, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea.
- Department of Radiology and Center for Imaging Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- Department of Radiology, Chonnam National University Hwasun Hospital and Chonnam National University Medical School, Hwasun, Republic of Korea.
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan, Republic of Korea.
Abstract
OBJECTIVE
To evaluate the clinical and imaging characteristics of SARS-CoV-2 breakthrough infection in hospitalized immunocompromised patients in comparison with immunocompetent patients.
MATERIALS AND METHODS
This retrospective study analyzed consecutive adult patients hospitalized for COVID-19 who received at least one dose of the SARS-CoV-2 vaccine at two academic medical centers between June 2021 and December 2022. Immunocompromised patients (with active solid organ cancer, active hematologic cancer, active immune-mediated inflammatory disease, status post solid organ transplantation, or acquired immune deficiency syndrome) were compared with immunocompetent patients. Multivariable logistic regression analysis was performed to evaluate the effect of immune status on severe clinical outcomes (in-hospital death, mechanical ventilation, or intensive care unit admission), severe radiologic pneumonia (≥ 25% of lung involvement), and typical CT pneumonia.
RESULTS
Of 2218 patients (mean age, 69.5 ± 16.1 years), 274 (12.4%), and 1944 (87.6%) were immunocompromised an immunocompetent, respectively. Patients with active solid organ cancer and patients status post solid organ transplantation had significantly higher risks for severe clinical outcomes (adjusted odds ratio = 1.58 [95% confidence interval {CI}, 1.01-2.47], = 0.042; and 3.12 [95% CI, 1.47-6.60], = 0.003, respectively). Patient status post solid organ transplantation and patients with active hematologic cancer were associated with increased risks for severe pneumonia based on chest radiographs (2.96 [95% CI, 1.54-5.67], = 0.001; and 2.87 [95% CI, 1.50-5.49], = 0.001, respectively) and for typical CT pneumonia (9.03 [95% CI, 2.49-32.66], < 0.001; and 4.18 [95% CI, 1.70-10.25], = 0.002, respectively).
CONCLUSION
Immunocompromised patients with COVID-19 breakthrough infection showed an increased risk of severe clinical outcome, severe pneumonia based on chest radiographs, and typical CT pneumonia. In particular, patients status post solid organ transplantation was specifically found to be associated with a higher risk of all three outcomes than hospitalized immunocompetent patients.
MeSH
Organ Transplantation, Risk, Pneumonia, Hematologic Neoplasms, Radiology, Immunocompromised Host, Sars Virus, Sars-Cov-2, Covid-19 Vaccines, Breakthrough Infections