University of Leicester
Browse
Nosocomial COVID final.pdf (2.06 MB)

A Systematic Review and Meta-Analysis of Inpatient Mortality Associated With Nosocomial and Community COVID-19 Exposes the Vulnerability of Immunosuppressed Adults

Download (2.06 MB)
journal contribution
posted on 2024-06-20, 09:31 authored by Mark J Ponsford, Tom JC Ward, Simon M Stoneham, Clare M Dallimore, Davina Sham, Khalid Osman, Simon M Barry, Stephen Jolles, Ian R Humphreys, Daniel Farewell

Background

Little is known about the mortality of hospital-acquired (nosocomial) COVID-19 infection globally. We investigated the risk of mortality and critical care admission in hospitalised adults with nosocomial COVID-19, relative to adults requiring hospitalisation due to community-acquired infection.


Methods

We systematically reviewed the peer-reviewed and pre-print literature from 1/1/2020 to 9/2/2021 without language restriction for studies reporting outcomes of nosocomial and community-acquired COVID-19. We performed a random effects meta-analysis (MA) to estimate the 1) relative risk of death and 2) critical care admission, stratifying studies by patient cohort characteristics and nosocomial case definition.


Results

21 studies were included in the primary MA, describing 8,251 admissions across 8 countries during the first wave, comprising 1513 probable or definite nosocomial COVID-19, and 6738 community-acquired cases. Across all studies, the risk of mortality was 1.3 times greater in patients with nosocomial infection, compared to community-acquired (95% CI: 1.005 to 1.683). Rates of critical care admission were similar between groups (Relative Risk, RR=0.74, 95% CI: 0.50 to 1.08). Immunosuppressed patients diagnosed with nosocomial COVID-19 were twice as likely to die in hospital as those admitted with community-acquired infection (RR=2.14, 95% CI: 1.76 to 2.61).


Conclusions

Adults who acquire SARS-CoV-2 whilst already hospitalised are at greater risk of mortality compared to patients admitted following community-acquired infection; this finding is largely driven by a substantially increased risk of death in individuals with malignancy or who had undergone transplantation. These findings inform public health and infection control policy and argue for individualised clinical interventions to combat the threat of nosocomial COVID-19, particularly for immunosuppressed groups.Systematic Review RegistrationPROSPERO CRD42021249023

Funding

UK Coronavirus Immunology Consortium (UK-CIC)

Wellcome Trust

History

Citation

Ponsford MJ, Ward TJC, Stoneham SM, Dallimore CM, Sham D, Osman K, Barry SM, Jolles S, Humphreys IR and Farewell D (2021) A Systematic Review and Meta-Analysis of Inpatient Mortality Associated With Nosocomial and Community COVID-19 Exposes the Vulnerability of Immunosuppressed Adults. Front. Immunol. 12:744696. doi: 10.3389/fimmu.2021.744696

Author affiliation

College of Life Sciences/Respiratory Sciences

Version

  • VoR (Version of Record)

Published in

FRONTIERS IN IMMUNOLOGY

Volume

12

Pagination

(17)

Publisher

FRONTIERS MEDIA SA

issn

1664-3224

eissn

1664-3224

Acceptance date

2021-09-13

Copyright date

2021

Available date

2024-06-20

Spatial coverage

Switzerland

Language

English

Deposited by

Dr Tom Ward

Deposit date

2024-03-27

Data Access Statement

The original contributions presented in the study are included in the article/Supplementary Material. Further inquiries can be directed to the corresponding author.

Rights Retention Statement

  • No

Usage metrics

    University of Leicester Publications

    Categories

    No categories selected

    Licence

    Exports

    RefWorks
    BibTeX
    Ref. manager
    Endnote
    DataCite
    NLM
    DC