{ "abstract": "Rationale: The 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. Methods: We 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. Results: A 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). Conclusion: In 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.", "abstract_shown": true, "affiliations": [ "Division of Pulmonary, Allergy and Critical Care Medicine, Stanford University School of Medicine, Stanford, California, United States of America", "Division of Pulmonary, Allergy and Critical Care Medicine, Oregon Health & Sciences University, Portland, Oregon, United States of America", "Department of Medicine, Stanford University School of Medicine, Stanford, California, United States of America", "Department of Medicine, University of California San Francisco, San Francisco, California, United States of America", "Department of Anesthesiology, Stanford University, Stanford, California, United States of America", "Department of Emergency Medicine, Stanford University, Stanford, California, United States of America", "Division of Hospital Medicine, Stanford University, Stanford, California, United States of America" ], "article_type": "Research Article", "arxiv": null, "author_total": 14, "authors": [ { "affs": [ 0 ], "name": "Shreya Battu" }, { "affs": [ 1 ], "name": "Andrew R. Moore" }, { "affs": [ 2 ], "name": "Katie Lebold" }, { "affs": [ 3 ], "name": "Ana Pacheco-Navarro" }, { "affs": [ 4 ], "name": "Shaun Pienkos" }, { "affs": [ 5 ], "name": "Christian O’Donnell" }, { "affs": [ 6 ], "name": "Pablo Sanchez" }, { "name": "Caitlin Parmer-Chow" }, { "name": "Jonasel Roque" }, { "name": "Tara Ramaswamy" }, { "name": "Jennifer G. Wilson" }, { "name": "Joseph E. Levitt" }, { "name": "William Collins" }, { "name": "Angela J. Rogers" } ], "bibtex": "https://research.draconitic.com/paper/eyacpsct0mj05.bib", "cited_by": 0, "doi": "10.1371/journal.pone.0357181", "fulltext_url": null, "id": "eyacpsct0mj05", "issns": [ "1932-6203" ], "landing_url": "https://doi.org/10.1371/journal.pone.0357181", "language": null, "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "journal", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2725|COVID-19 Clinical Research Studies" ], [ "plos", "/Biology and life sciences/Immunology/Vaccination and immunization" ], [ "plos", "/Biology and life sciences/Microbiology/Medical microbiology/Microbial pathogens/Viral pathogens/Coronaviruses/SARS coronavirus/SARS CoV 2" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/RNA viruses/Coronaviruses/SARS coronavirus/SARS CoV 2" ], [ "plos", "/Biology and life sciences/Organisms/Viruses/Viral pathogens/Coronaviruses/SARS coronavirus/SARS CoV 2" ], [ "plos", "/Computer and information sciences/Information technology/Health information technology/Electronic medical records" ], [ "plos", "/Medicine and health sciences/Epidemiology/Pandemics" ], [ "plos", "/Medicine and health sciences/Health care/Health care facilities/Hospitals/Intensive care units" ], [ "plos", "/Medicine and health sciences/Health care/Health information technology/Electronic medical records" ], [ "plos", "/Medicine and health sciences/Immunology/Vaccination and immunization" ], [ "plos", "/Medicine and health sciences/Medical conditions/Infectious diseases/Infectious disease control/Vaccines/Booster doses" ], [ "plos", "/Medicine and health sciences/Medical conditions/Infectious diseases/Respiratory infections" ], [ "plos", "/Medicine and health sciences/Medical conditions/Infectious diseases/Viral diseases/COVID 19" ], [ "plos", "/Medicine and health sciences/Medical conditions/Respiratory disorders/Respiratory infections" ], [ "plos", "/Medicine and health sciences/Pathology and laboratory medicine/Pathogens/Microbial pathogens/Viral pathogens/Coronaviruses/SARS coronavirus/SARS CoV 2" ], [ "plos", "/Medicine and health sciences/Public and occupational health/Preventive medicine/Vaccination and immunization" ], [ "plos", "/Medicine and health sciences/Pulmonology/Respiratory disorders/Respiratory infections" ] ], "openalex": "W7212046293", "pdf_url": "https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0357181&type=printable", "pmcid": null, "pmid": null, "published": "2026-09-09", "publisher": "Public Library of Science", "ris": "https://research.draconitic.com/paper/eyacpsct0mj05.ris", "sources": [ { "first_seen": "2026-10-30T12:17:56Z", "native_id": "10.1371/journal.pone.0357181", "source": "plos", "url": "https://doi.org/10.1371/journal.pone.0357181" } ], "subjects": [ { "field": "biology", "origin": "plos:immunology", "subfield": "immunology" }, { "field": "medicine", "origin": "plos:epidemiology", "subfield": "epidemiology-public-health" }, { "field": "medicine", "origin": "plos:infectious diseases", "subfield": "infectious-disease" } ], "title": "Outcomes of immunocompromised and non-immunocompromised patients in the ICU diverge late in the pandemic", "title_text": "Outcomes of immunocompromised and non-immunocompromised patients in the ICU diverge late in the pandemic", "type": "peer-reviewed", "updated_at": "2026-10-30T12:17:56Z", "url": "https://research.draconitic.com/paper/eyacpsct0mj05", "venue": "PLOS One", "versions": [] }