COVID-19 death is higher in hospital for immunocompromised patients

People with weakened immune systems remain more likely to die if hospitalised with COVID-19 than patients with normal immune systems, a new UK study has confirmed.

Using data from the world’s largest study of hospitalised patients with the disease, a team of researchers from the University of Liverpool, University of Edinburgh, Imperial College London and the University of Birmingham aimed to determine whether immunocompromised patients were at greater risk of in-hospital death, and how this risk changed over the pandemic.

The team’s analysis published in PLOS Medicine showed that immunocompromised patients overall had a 44% higher risk of death in hospital than patients with normal immune systems. This difference remained even accounting for other important factors such as age, sex and the presence of other chronic medical conditions.

we need to continue to urgently look at protective treatments and measures to care for those for those at most threat
Professor Alex Richter
Professor Alex Richter, co-author of the study and Director of the Clinical Immunology Service at the University of Birmingham said:

“This adds to a growing body of evidence that shows that the pandemic is far from over for millions around the world. With more than 500,000 people in the UK alone at increased risk from COVID-19 and with this new evidence about the risk of hospital deaths, we need to continue to urgently look at protective treatments and measures to care for those for those at most threat from an infection.”

Despite the benefits of vaccination, immunocompromised patients still lag behind the general patient population in the improvements in outcomes after hospitalisation. The authors urge policy makers to be aware of the increased risk of death in this patient group and say targeted interventions such as antiviral treatments, antibodies, and non-pharmaceutical interventions should continue to be used in this patient group.

Still a substantial risk


Previous studies have compared in-hospital mortality among immunocompromised patients with other COVID-19 patient groups with conflicting results. Some studies reported increased mortality, whereas others found no difference from other patient groups.

The study analysed data from more than 150,000 adult UK patients who were recruited to the ISARIC WHO Clinical Characterisation Protocol UK prospective cohort study between January 2020 and February 2022.

Over the course of the pandemic, although the risk of death for all patients decreased, the researchers found that risk decreased much more for immunocompetent patients and the gap widened for immunocompromised patients.

First author Dr Lance Turtle, a Reader in Infectious Diseases at the University of Liverpool, said:

“There is a general assumption that COVID is no longer a big problem. However, what we have shown here is that for patients who have a weakened immune system, perhaps because of cancer treatment, or other medical treatments, this is not true. COVID still poses a substantial risk to this group of patients, compared with patients with a normal immune system. This difference can still be seen even after the threshold of illness for admission to hospital is reached.”