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Salto-Alejandre S, Jiménez-Jorge S, Sabé N, Ramos-Martínez A, Linares L, Valerio M, Martín-Dávila P, Fernández-Ruiz M, Fariñas MC, Blanes-Juliá M, Vidal E, Palacios-Baena ZR, Hernández-Gallego R, Carratalá J, Calderón-Parra J, Ángeles Marcos M, Muñoz P, Fortún-Abete J, Aguado JM, Arnaiz-Revillas F, Blanes-Hernández R, de la Torre-Cisneros J, López-Cortés LE, García de Vinuesa-Calvo E, Rosso CM, Pachón J, Sánchez-Céspedes J, Cordero E. Risk factors for unfavorable outcome and impact of early post-transplant infection in solid organ recipients with COVID-19: A prospective multicenter cohort study. PLoS One 2021; 16:e0250796. [PMID: 33914803 PMCID: PMC8084252 DOI: 10.1371/journal.pone.0250796] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 04/13/2021] [Indexed: 12/15/2022] Open
Abstract
The aim was to analyze the characteristics and predictors of unfavorable outcomes in solid organ transplant recipients (SOTRs) with COVID-19. We conducted a prospective observational cohort study of 210 consecutive SOTRs hospitalized with COVID-19 in 12 Spanish centers from 21 February to 6 May 2020. Data pertaining to demographics, chronic underlying diseases, transplantation features, clinical, therapeutics, and complications were collected. The primary endpoint was a composite of intensive care unit (ICU) admission and/or death. Logistic regression analyses were performed to identify the factors associated with these unfavorable outcomes. Males accounted for 148 (70.5%) patients, the median age was 63 years, and 189 (90.0%) patients had pneumonia. Common symptoms were fever, cough, gastrointestinal disturbances, and dyspnea. The most used antiviral or host-targeted therapies included hydroxychloroquine 193/200 (96.5%), lopinavir/ritonavir 91/200 (45.5%), and tocilizumab 49/200 (24.5%). Thirty-seven (17.6%) patients required ICU admission, 12 (5.7%) suffered graft dysfunction, and 45 (21.4%) died. A shorter interval between transplantation and COVID-19 diagnosis had a negative impact on clinical prognosis. Four baseline features were identified as independent predictors of intensive care need or death: advanced age, high respiratory rate, lymphopenia, and elevated level of lactate dehydrogenase. In summary, this study presents comprehensive information on characteristics and complications of COVID-19 in hospitalized SOTRs and provides indicators available upon hospital admission for the identification of SOTRs at risk of critical disease or death, underlining the need for stringent preventative measures in the early post-transplant period.
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Affiliation(s)
- Sonsoles Salto-Alejandre
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - Silvia Jiménez-Jorge
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - Nuria Sabé
- Service of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Antonio Ramos-Martínez
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Puerta de Hierro University Hospital, Madrid, Spain
| | - Laura Linares
- Service of Infectious Diseases, Clinic University Hospital, Barcelona, Spain
| | - Maricela Valerio
- Service of Clinical Microbiology and Infectious Diseases, Sanitary Research Institute, Gregorio Marañón University Hospital, Madrid, Spain
| | - Pilar Martín-Dávila
- Service of Infectious Diseases, Ramón y Cajal University Hospital, Madrid, Spain
| | - Mario Fernández-Ruiz
- Unit of Infectious Diseases, 12 de Octubre University Hospital, 12 de Octubre Hospital Research Institute (i+12), Madrid, Spain
| | - María Carmen Fariñas
- Service of Infectious Diseases, Marqués de Valdecilla University Hospital, Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | | | - Elisa Vidal
- Service of Infectious Diseases, Reina Sofía University Hospital, Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
| | - Zaira R. Palacios-Baena
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen Macarena University Hospital, Seville, Spain
| | - Román Hernández-Gallego
- Unit of Kidney Transplant, Service of Nefrology, Badajoz University Hospital, Extremadura, Spain
| | - Jordi Carratalá
- Service of Infectious Diseases, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Hospitalet de Llobregat, Barcelona, Spain
| | - Jorge Calderón-Parra
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Puerta de Hierro University Hospital, Madrid, Spain
| | | | - Patricia Muñoz
- Service of Clinical Microbiology and Infectious Diseases, Sanitary Research Institute, Gregorio Marañón University Hospital, Madrid, Spain
- CIBERES (CB06/06/0058), Department of Medicine, Faculty of Medicine, Complutense University, Madrid, Spain
| | - Jesús Fortún-Abete
- Service of Infectious Diseases, Ramón y Cajal University Hospital, Madrid, Spain
| | - José María Aguado
- Unit of Infectious Diseases, 12 de Octubre University Hospital, 12 de Octubre Hospital Research Institute (i+12), Madrid, Spain
| | - Francisco Arnaiz-Revillas
- Service of Infectious Diseases, Marqués de Valdecilla University Hospital, Marqués de Valdecilla-IDIVAL, University of Cantabria, Santander, Spain
| | | | - Julián de la Torre-Cisneros
- Service of Infectious Diseases, Reina Sofía University Hospital, Maimónides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
| | - Luis E. López-Cortés
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen Macarena University Hospital, Seville, Spain
| | | | - Clara M. Rosso
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
- Unit of Clinical Investigation and Clinical Trials, Virgen del Rocío University Hospital, Seville, Spain
| | - Jerónimo Pachón
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
- Department of Medicine, University of Seville, Seville, Spain
| | - Javier Sánchez-Céspedes
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
| | - Elisa Cordero
- Unit of Infectious Diseases, Microbiology, and Preventive Medicine, Virgen del Rocío University Hospital, Seville, Spain
- Institute of Biomedicine of Seville (IBiS), Virgen del Rocío University Hospital/CSIC/University of Seville, Seville, Spain
- Department of Medicine, University of Seville, Seville, Spain
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