ArticlePloS one2026
Outcomes of immunocompromised and non-immunocompromised patients in the ICU diverge late in the pandemic.
Article in PloS one, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
rationaleThe impact of immunocompromising conditions on outcomes in critically ill patients with COVID-19 remains poorly characterized. We hypothesized that disparities in COVID-19 outcomes in immunocompromised patients may differ by viral strain and time course of the pandemic.
methodsWe retrospectively reviewed SARS-CoV-2 RT-PCR positive patients admitted to intensive care (ICU) at Stanford from March 2020 to July 2022 using electronic medical records. Immunocompromised status included solid organ transplant; hematologic malignancy/transplant; solid cancer with metastases and recent chemotherapy; HIV/AIDS; and connective tissue disease on immunosuppression. SARS-CoV-2 strain periods were classified as pre-Delta (3/2020-8/2021), Delta (9/2021-12/2021), and Omicron (1/2022-7/2022). We assessed 90-day survival differences between immunocompromised and non-immunocompromised patients by strain using Cox-proportional hazards, adjusted for age, sex, and APACHE II score.
resultsA total of 791 patients were included, 450 from the pre-Delta period, 114 from the Delta period, and 227 from the Omicron period. We compared 633 non-immunocompromised patients with 158 immunocompromised patients (77 during the pre-Delta, 22 Delta, and 59 Omicron periods). Patients admitted during the Omicron period were more likely to be immunocompromised (26%) compared to pre-Delta (17%) or Delta periods (19%; p = 0.008). Immunocompromise was associated with worse outcomes in the entire cohort after adjustment (HR 1.68, 95% CI 1.2-2.3, p < 0.001). However, when stratified by strain period, immunocompromised status was only significantly associated with higher 90-day mortality in patients from the Omicron period (42% vs 17%, HR 2.9, CI% 1.7-5.0, p < 0.001). Differences in mortality between immunocompromised and immunocompetent patients were not statistically different in either the pre-Delta (34% vs. 23%, HR 1.4, 95% CI 0.9-2.1, p = 0.15) or Delta periods (32% vs. 28% HR 1.0, 95% CI 0.4-2.5, p = 0.92). Notably, survival was significantly improved during the Omicron period compared to earlier strain periods in immunocompetent patients (HR 0.6, 95% CI 0.4-0.9, p = 0.02) but not for immunocompromised patients (HR 1.4, 95% CI 0.80-2.44, p = 0.24).
conclusionIn this retrospective cohort analysis of patients admitted to the ICU due to SARS-CoV-2 infection, we found that lower survival among immunocompromised patients was due to higher mortality during the Omicron period, with similar mortality between immunocompetent and immunocompromised patients during other periods.
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