免疫系统受损的患者在住院新冠肺炎（COVID-19）时死亡风险比免疫系统正常的患者更高，但既往研究结果不一致。本研究旨在确定免疫系统受损患者是否存在更高的住院死亡风险，以及这种风险在疫情中如何变化。我们招募符合ISARIC WHO UK前瞻性队列研究的社区获得性COVID-19症状患者，年龄≥19岁。我们将免疫系统受损定义为住院前免疫抑制剂药物使用、癌症治疗、器官移植、HIV或先天性免疫缺陷。我们使用逻辑回归比较两组死亡风险，并调整年龄、性别、贫困、种族、接种和共同疾病。我们使用贝叶斯逻辑回归探索时间内的死亡率。在2020年1月17日至2022年2月28日期间，我们招募了156,552名符合条件的患者，其中23,142名（14%）免疫系统受损。总共，29%（n = 6,499）免疫系统受损和21%（n = 28,608）免疫系统正常的患者在医院死亡。免疫系统受损患者住院死亡率升高（调整后OR1.44，95％CI [1.39、1.50]，p <0.001）。并非所有的免疫系统损伤状态风险相同，例如进行癌症治疗的患者不太可能将其护理提升到重症监护室（调整后OR 0.77，95％CI [0.7，0.85]，p <0.001）或机械通气（调整后OR 0.65，95 ％CI [0.56，0.76]，p <0.001）。然而，癌症患者死亡率更高（调整后OR 2.0，95％CI [1.87、2.15]，p <0.001）。分析结果已调整年龄、性别、社会经济贫困、共同疾病和接种状态。随着疫情的发展，在医院死亡率减少方面，免疫系统受损的患者比免疫系统正常的患者减少得更慢。随着年龄增长，这一趋势尤其明显：“50-69岁免疫系统受损男性减少住院死亡概率的可能性为88％，女性为83％；对于年龄大于80岁的免疫系统受损男性，住院死亡减少概率为99％，女性为98％。”此研究的局限性在于缺乏详细的住院前药物数据，包括类固醇剂量，意味着我们可能错误地将某些免疫系统受损患者归类为免疫系统正常。免疫系统受损的患者仍然面临着因COVID-19而导致的死亡风险较高。针对这一患者群体应持续推荐采取定向措施，如额外的疫苗接种、单克隆抗体以及非药物预防干预。ISRCTN 66726260。版权所有：© 2023 Turtle等。本文是根据创作共同授权许可下的开放获取文章。这意味着，只要保留原作者和出处，无论在什么媒介上，都可以自由地使用、分发和重制本文。

Immunocompromised patients may be at higher risk of mortality if hospitalised with Coronavirus Disease 2019 (COVID-19) compared with immunocompetent patients. However, previous studies have been contradictory. We aimed to determine whether immunocompromised patients were at greater risk of in-hospital death and how this risk changed over the pandemic.We included patients > = 19 years with symptomatic community-acquired COVID-19 recruited to the ISARIC WHO Clinical Characterisation Protocol UK prospective cohort study. We defined immunocompromise as immunosuppressant medication preadmission, cancer treatment, organ transplant, HIV, or congenital immunodeficiency. We used logistic regression to compare the risk of death in both groups, adjusting for age, sex, deprivation, ethnicity, vaccination, and comorbidities. We used Bayesian logistic regression to explore mortality over time. Between 17 January 2020 and 28 February 2022, we recruited 156,552 eligible patients, of whom 21,954 (14%) were immunocompromised. In total, 29% (n = 6,499) of immunocompromised and 21% (n = 28,608) of immunocompetent patients died in hospital. The odds of in-hospital mortality were elevated for immunocompromised patients (adjusted OR 1.44, 95% CI [1.39, 1.50], p < 0.001). Not all immunocompromising conditions had the same risk, for example, patients on active cancer treatment were less likely to have their care escalated to intensive care (adjusted OR 0.77, 95% CI [0.7, 0.85], p < 0.001) or ventilation (adjusted OR 0.65, 95% CI [0.56, 0.76], p < 0.001). However, cancer patients were more likely to die (adjusted OR 2.0, 95% CI [1.87, 2.15], p < 0.001). Analyses were adjusted for age, sex, socioeconomic deprivation, comorbidities, and vaccination status. As the pandemic progressed, in-hospital mortality reduced more slowly for immunocompromised patients than for immunocompetent patients. This was particularly evident with increasing age: the probability of the reduction in hospital mortality being less for immunocompromised patients aged 50 to 69 years was 88% for men and 83% for women, and for those >80 years was 99% for men and 98% for women. The study is limited by a lack of detailed drug data prior to admission, including steroid doses, meaning that we may have incorrectly categorised some immunocompromised patients as immunocompetent.Immunocompromised patients remain at elevated risk of death from COVID-19. Targeted measures such as additional vaccine doses, monoclonal antibodies, and nonpharmaceutical preventive interventions should be continually encouraged for this patient group.ISRCTN 66726260.Copyright: © 2023 Turtle et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.