Protracted Course of SARS-CoV-2 Pneumonia in Severely Immunocompromised Patients

Abstract Purpose: There have been few studies comparing the clinical manifestations of SARS-CoV-2 pneumonia in individuals with and without severely immunocompromised conditions. Methods: We reviewed adult patients with SARS-CoV-2 infection who had radiologic evidence of pneumonia at a tertiary hospital in Seoul, South Korea from February 2020 to April 2022. Severely immunocompromised status was defined as solid organ transplantation (SOT) or hematologic malignancy. The time to pneumonia development was defined as the time from symptom onset to the time when radiologic evidence of pneumonia was obtained. Viral clearance was defined as a Ct value >30. COVID-19-related death was defined as 90-day death following imaging-confirmed pneumonia without any other plausible cause of death. Results: A total of 467 patients with SARS-CoV-2 pneumonia were analyzed. Of these, 86 (25%) were severely immunocompromised, with 29 (34%) SOT and 57 (66%) hematologic malignancy, and 381 (75%) were not severely immunocompromised. The median (interquartile range [IQR]) time to pneumonia development was significantly longer in the severely immunocompromised patients (10 [7-15] days) than the comparator (6 [3-8] days), p < 0.001), as was the median (IQR) time to viral clearance (19 [13-25] days versus 11 [9-15] days, p < 0.001). Severely immunocompromised status (adjusted odds ratio, 5.70; 95% confidence interval, 2.09-15.56; p < 0.001) was independently associated with COVID-19-related death. Conclusion: Patients who receive SOT or have hematologic malignancies are likely to experience a more protracted course of SARS-CoV-2 pneumonia and a worse outcome than those without these conditions.