scholarly journals Relation of severe COVID-19 in Scotland to transmission-related factors and risk conditions eligible for shielding support: REACT-SCOT case-control study

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Paul M. McKeigue ◽  
David A. McAllister ◽  
David Caldwell ◽  
Ciara Gribben ◽  
Jen Bishop ◽  
...  
Keyword(s):  
General Population ◽  
Rate Ratio ◽  
Conditional Logistic Regression ◽  
Population Attributable Risk ◽  
Case Control ◽  
Care Practice ◽  
Solid Organ ◽  
Related Factors ◽  
Recent Exposure ◽  
The Impact

Abstract Background Clinically vulnerable individuals have been advised to shield themselves during the COVID-19 epidemic. The objectives of this study were to investigate (1) the rate ratio of severe COVID-19 associated with eligibility for the shielding programme in Scotland across the first and second waves of the epidemic and (2) the relation of severe COVID-19 to transmission-related factors in those in shielding and the general population. Methods In a matched case-control design, all 178,578 diagnosed cases of COVID-19 in Scotland from 1 March 2020 to 18 February 2021 were matched for age, sex and primary care practice to 1,744,283 controls from the general population. This dataset (REACT-SCOT) was linked to the list of 212,702 individuals identified as eligible for shielding. Severe COVID-19 was defined as cases that entered critical care or were fatal. Rate ratios were estimated by conditional logistic regression. Results With those without risk conditions as reference category, the univariate rate ratio for severe COVID-19 was 3.21 (95% CI 3.01 to 3.41) in those with moderate risk conditions and 6.3 (95% CI 5.8 to 6.8) in those eligible for shielding. The highest rate was in solid organ transplant recipients: rate ratio 13.4 (95% CI 9.6 to 18.8). Risk of severe COVID-19 increased with the number of adults but decreased with the number of school-age children in the household. Severe COVID-19 was strongly associated with recent exposure to hospital (defined as 5 to 14 days before presentation date): rate ratio 12.3 (95% CI 11.5 to 13.2) overall. The population attributable risk fraction for recent exposure to hospital peaked at 50% in May 2020 and again at 65% in December 2020. Conclusions The effectiveness of shielding vulnerable individuals was limited by the inability to control transmission in hospital and from other adults in the household. Mitigating the impact of the epidemic requires control of nosocomial transmission.

scholarly journals Relation of severe COVID-19 in Scotland to transmission-related factors and risk conditions eligible for shielding support: REACT-SCOT case-control study

2021 ◽  
Author(s):  
Paul M McKeigue ◽  
David McAllister ◽  
David Caldwell ◽  
Ciara Gribben ◽  
Jen Bishop ◽  
...  
Keyword(s):  
General Population ◽  
Rate Ratio ◽  
Case Control Study ◽  
Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Related Factors ◽  
Recent Exposure ◽  
Solid Organ Transplant Recipients ◽  
Control Study

* Objectives - To investigate:(1) the risk of severe COVID-19 in those eligible for shielding, and (2) the relation of severe COVID-19 to transmission-related factors in those in shielding and the general population. * Design - Matched case-control study (REACT-SCOT). * Setting - Population of Scotland from 1 March 2020 to 28 January 2021. * Participants - All 160307 diagnosed cases of COVID-19 and 1564782 controls matched for age, sex and primary care practice, linked with all 204913 individuals identified as eligible for shielding by Public Health Scotland. * Main outcome measure - Severe COVID-19, defined as cases that entered critical care or were fatal. * Results - With those without risk conditions as reference category, the univariate rate ratio for severe COVID-19 was 5.3 (95% CI 5.0 to 5.7, p=4 x 10−527) in those with moderate risk conditions and 7.6 (95% CI 7.1 to 8.3, p=1 x 10−527) in those eligible for shielding. The highest rate was in solid organ transplant recipients: rate ratio 13.6 (95% CI 9.6 to 19.2, p=8 x 10−50). In both the shielded and the general population, the risk of severe COVID-19 increased with the number of adults but decreased with the number of school-age children in the household. Severe COVID-19 was strongly associated with recent exposure to hospital (defined as 5 to 14 days before presentation date): rate ratio 12.6 (95% CI 11.7 to 13.6, p=2 x 10−989) overall. In a case-crossover analysis with less recent exposure only (15 to 24 days before first testing positive) as reference category, the rate ratio associated with recent exposure only was 6.3 (95% CI 3.6 to 11.1, p=2 x 10−10). Among those eligible for shielding, the population attributable risk fraction (PARF) of severe cases for recent exposure to hospital was 36%. In the general population the PARF for recent exposure to hospital peaked at 46% in May 2020 and again at 64% in December 2020. * Conclusions - The effectiveness of shielding vulnerable individuals was limited by the inability to control transmission in hospital and from other adults in the household. For solid organ transplant recipients, in whom the efficacy of vaccines is uncertain, these results support a policy of offering vaccination to household contacts. Mitigating the impact of the epidemic requires control of nosocomial transmission.

scholarly journals Efficacy of COVID-19 vaccination in individuals designated as clinically extremely vulnerable in Scotland

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 663
Author(s):  
Paul M McKeigue ◽  
David A McAllister ◽  
Jen Bishop ◽  
Sharon Hutchinson ◽  
Chris Robertson ◽  
...  
Keyword(s):  
General Population ◽  
Rate Ratio ◽  
Fatal Outcome ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Care Practice ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Organ Transplant Recipients ◽  
Solid Organ Transplant Recipients

Background: Although COVID-19 vaccines have been shown to have high efficacy in the general population, it has not been established whether this applies to vulnerable groups. The objective of this study was to estimate the efficacy of vaccination in reducing the risk of severe COVID-19 among those designated as clinically extremely vulnerable in Scotland. Methods: In a matched case-control design (REACT-SCOT), all 111295 cases of COVID-19 in Scotland diagnosed from 1 December 2020 to 16 March 2021 were matched for age, sex and primary care practice to 1093449 controls from the general population. This was linked to national data on vaccinations and those designated as clinically extremely vulnerable and thus eligible for shielding support. Severe COVID-19 was defined as cases with entry to critical care or fatal outcome. Rate ratios associated with vaccination within risk groups were estimated by conditional logistic regression. Results: The rate ratio for severe COVID-19 associated with vaccination at least 14 days before was 0.29 (95% CI 0.22 to 0.37) in those eligible for shielding, compared with 0.29 (95% CI 0.25 to 0.34) in those ineligible for shielding. The rate ratio for hospitalized or fatal COVID-19 was 0.39 (95% CI 0.33 to 0.46) in those eligible and 0.37 (95% CI 0.33 to 0.41) in those not eligible for shielding. Examined by specific shielding conditions, the rate ratio for hospitalized or fatal COVID-19 ranged from 0.33 (95% CI 0.21 to 0.51) in those with specific cancers to 0.74 (95% CI 0.36 to 1.51) in solid organ transplant recipients, and 0.53 (95% CI 0.33 to 0.84) in others on immunosuppressants (excluding solid organ transplant recipients). Conclusions: These results are reassuring with respect to efficacy in clinically vulnerable individuals including immunocompromised individuals, but studies in larger populations are needed to estimate efficacy in solid organ transplant recipients.

scholarly journals Relation of severe COVID-19 to polypharmacy and prescribing of psychotropic drugs: the REACT-SCOT case-control study

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Paul M. McKeigue ◽  
◽  
Sharon Kennedy ◽  
Amanda Weir ◽  
Jen Bishop ◽  
...  
Keyword(s):  
Primary Care ◽  
Rate Ratio ◽  
Case Control Study ◽  
Fatal Outcome ◽  
Case Control ◽  
Care Practice ◽  
Drug Classes ◽  
Increased Risk ◽  
Co Morbidity ◽  
Control Study

Abstract Background The objective of this study was to investigate the relation of severe COVID-19 to prior drug prescribing. Methods Severe cases were defined by entry to critical care or fatal outcome. For this matched case-control study (REACT-SCOT), all 4251 cases of severe COVID-19 in Scotland since the start of the epidemic were matched for age, sex and primary care practice to 36,738 controls from the population register. Records were linked to hospital discharges since June 2015 and dispensed prescriptions issued in primary care during the last 240 days. Results Severe COVID-19 was strongly associated with the number of non-cardiovascular drug classes dispensed. This association was strongest in those not resident in a care home, in whom the rate ratio (95% CI) associated with dispensing of 12 or more drug classes versus none was 10.8 (8.8, 13.3), and in those without any of the conditions designated as conferring increased risk of COVID-19. Of 17 drug classes postulated at the start of the epidemic to be “medications compromising COVID”, all were associated with increased risk of severe COVID-19 and these associations were present in those without any of the designated risk conditions. The fraction of cases in the population attributable to exposure to these drug classes was 38%. The largest effect was for antipsychotic agents: rate ratio 4.18 (3.42, 5.11). Other drug classes with large effects included proton pump inhibitors (rate ratio 2.20 (1.72, 2.83) for = 2 defined daily doses/day), opioids (3.66 (2.68, 5.01) for = 50 mg morphine equivalent/day) and gabapentinoids. These associations persisted after adjusting for covariates and were stronger with recent than with non-recent exposure. Conclusions Severe COVID-19 is associated with polypharmacy and with drugs that cause sedation, respiratory depression, or dyskinesia; have anticholinergic effects; or affect the gastrointestinal system. These associations are not easily explained by co-morbidity. Measures to reduce the burden of mortality and morbidity from COVID-19 should include reinforcing existing guidance on reducing overprescribing of these drug classes and limiting inappropriate polypharmacy. Registration ENCEPP number https://EUPAS35558

scholarly journals Ecological and behavioural risk factors of scrub typhus in central Vietnam: a case-control study

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Hanh Thi Duc Tran ◽  
Jan Hattendorf ◽  
Hung Manh Do ◽  
Thanh Tien Hoang ◽  
Hang Thi Hai Hoang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Case Control Study ◽  
Scrub Typhus ◽  
Conditional Logistic Regression ◽  
Febrile Illness ◽  
Case Control ◽  
Enzyme Linked Immunosorbent Assay ◽  
Protective Equipment ◽  
Related Factors ◽  
Control Study

Abstract Background The risk factors for scrub typhus in Vietnam remain unknown. Scrub typhus caused by Orientia tsutsugamushi often presents as an undifferentiated febrile illness and remains under appreciated due to the limited availability of diagnostic tests. This tropical rickettsial illness is increasingly recognized as an important cause of non-malaria acute undifferentiated fever in Asia. This study aimed to investigate behavioural and ecological related risk factors of scrub typhus to prevent this potentially life-threatening disease in Vietnam. Methods We conducted a clinical hospital-based active surveillance study, and a retrospective residence-enrolment date-age-matched case–control study in Khanh Hoa province, Vietnam, from August 2018 to March 2020. Clinical examinations, polymerase chain reaction and enzyme-linked immunosorbent assay IgM tests were applied to define cases and controls. All enrolled participants filled out a questionnaire including demographic socio-economic status, personal behaviors/protective equipment, habitat connections, land use, and possible exposure to the vector. Multivariable conditional logistic regression was used to define the scrub typhus associated risk factors. Results We identified 44 confirmed cases and matched them with 152 controls. Among cases and controls, the largest age group was the 41–50 years old and males accounted for 61.4% and 42.8%, respectively. There were similarities in demographic characteristics between the two groups, with the exception of occupation. Several factors were significantly associated with acquisition of scrub typhus, including sitting/laying directly on household floor [adjusted OR (aOR) = 4.9, 95% CI: 1.6–15.1, P = 0.006], household with poor sanitation/conditions (aOR = 7.9, 95% CI: 1.9–32.9, P = 0.005), workplace environment with risk (aOR = 3.0, 95% CI: 1.2–7.6, P = 0.020), always observing mice around home (aOR = 3.7, 95% CI: 1.4–9.9, P = 0.008), and use of personal protective equipment in the field (aOR = 0.4, 95% CI: 0.1–1.1, P = 0.076). Conclusions Ecological and household hygiene-related factors were more associated with scrub typhus infection, than individual-level exposure activities in the hyper-endemic area. These findings support local education and allow people to protect themselves from scrub typhus, especially in areas with limitations in diagnostic capacity. Graphical abstract

scholarly journals Periodontitis Impact in Interleukin-6 Serum Levels in Solid Organ Transplanted Patients: A Systematic Review and Meta-Analysis

Diagnostics ◽  
2020 ◽  
Vol 10 (4) ◽  
pp. 184 ◽  
Author(s):  
Vanessa Machado ◽  
João Botelho ◽  
Joana Lopes ◽  
Mariana Patrão ◽  
Ricardo Alves ◽  
...  
Keyword(s):  
Systematic Review ◽  
Serum Levels ◽  
Case Control ◽  
Risk Of Bias ◽  
Solid Organ ◽  
Systemic Complications ◽  
Moderate Quality ◽  
Meta Analyses ◽  
The Impact ◽  
Quality Evidence

This systematic review aimed to investigate the influence of periodontitis on post-transplant IL-6 serum levels of solid organ transplanted patients as compared to healthy subjects. Four databases (PubMed, Scholar, EMBASE, and CENTRAL) were searched up to February 2020 (PROSPERO CRD42018107817). Case-control and cohort studies on the association of IL-6 serum levels with a periodontal status of patients after solid organ transplantation were included. The risk of bias of observational studies was assessed through the Newcastle-Ottawa Scale (NOS). Random effects meta-analyses were thoroughly conducted. GRADE assessment provided quality evidence. Four case-control studies fulfilled the inclusion criteria (274 transplant recipients and 146 healthy controls), all of low risk of bias. Meta-analyses revealed significantly higher IL-6 levels in transplanted patients than healthy individuals with low-quality evidence (Mean Difference (MD): 2.55 (95% confidence interval (CI): 2.07, 3.03)). Transplanted patients with periodontitis have higher serum IL-6 levels than transplanted patients without periodontitis with moderate quality evidence (MD: 2.20 (95% CI: 1.00, 3.39)). We found low-quality evidence of higher IL-6 levels than healthy patients in patients with heart and kidney transplant. In these transplanted patients, there was moderate quality evidence that periodontitis is associated with higher IL-6 serum levels. Future research should consider the impact of such a difference in organ failure and systemic complications.

scholarly journals 1386. Reduction in Expected Survival Associated with Nontuberculous Mycobacterial Pulmonary Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S503-S504
Author(s):  
Ahmad Mourad ◽  
Arthur W Baker ◽  
Jason E Stout
Keyword(s):  
General Population ◽  
Pulmonary Disease ◽  
Pulmonary Infection ◽  
Positive Culture ◽  
The United States ◽  
Case Definition ◽  
Chronic Obstructive ◽  
Solid Organ ◽  
Expected Mortality ◽  
The Impact

Abstract Background Nontuberculous mycobacteria (NTM) are emerging agents of pulmonary disease, estimated to affect >80,000 people in the United States. While the spectrum of pulmonary NTM severity is broad, some published series report 5-year mortality of up to 40%. Methods We conducted a retrospective cohort study to examine mortality of patients with positive respiratory cultures for NTM in the Duke Health System from January 1, 1996 to June 30, 2015, compared with the expected mortality in the US population among a cohort with the same demographic composition. We included patients with ≥2 positive NTM respiratory cultures, or 1 positive culture plus an associated ICD diagnosis. Patients with disseminated NTM, HIV, cystic fibrosis, and solid-organ or hematopoietic cell transplants were excluded, as were isolates of Mycobacterium gordonae. Five specific comorbidities (cancer, chronic obstructive pulmonary disease, stroke, chronic renal failure, myocardial infarction) were assessed with ICD codes. Survival was measured from the date of first positive NTM culture and censored as of 6/30/2015. Results We identified 653 patients who met the case definition. 451 (69%) were female; 548 (84%) were Caucasian, and the median age was 69 years (IQR 59–76). 544 (83.3%) patients had only Mycobacterium avium complex (MAC) isolates in cultures; 39 (6%) had only M. abscessus; 33 (5%) had both MAC and M. abscessus; 37 (5.7%) had other NTM isolates. Most patients (n = 410, 62.8%) had none of the evaluated comorbidities prior to NTM diagnosis. Median follow-up time was 1252 days (IQR 449–2688). Median survival in our cohort among persons with and without comorbidities was 1973 days (95% CI 1487–2995) and 3952 days (95% CI 3496–5186), respectively. Median expected survival in the demographically-matched population cohort was significantly longer at 5479 days (P<.0001). Mortality at 5 years was 47.9% (39.7–55.0) and 27.2% (95% CI 22.1–32.0) among NTM patients with and without comorbidities, respectively, vs. expected mortality of 5.7% in the general population. Conclusion NTM pulmonary infection in our cohort was associated with significantly lower survival than expected in the general population. The impact of NTM infection itself vs. other comorbidities on survival requires further study. Disclosures All authors: No reported disclosures.

scholarly journals Association between glycemic control and risk of venous thromboembolism in diabetic patients: a nested case–control study

2022 ◽  
Vol 21 (1) ◽  
Author(s):  
Sarah H. R. Charlier ◽  
Christian Meier ◽  
Susan S. Jick ◽  
Christoph R. Meier ◽  
Claudia Becker
Keyword(s):  
Venous Thromboembolism ◽  
Glycemic Control ◽  
Conditional Logistic Regression ◽  
Case Control ◽  
Diabetic Patients ◽  
Control Analysis ◽  
Using Data ◽  
Nested Case Control ◽  
The Impact ◽  
Hba1c Levels

Abstract Background Previous studies suggested an elevated risk of venous thromboembolism (VTE) among patients with type 2 diabetes mellitus (T2DM), with a possible sex difference. The impact of glycemic control on the risk of VTE is unclear. Our objective was to analyze the association between glycemic control and the risk of unprovoked (idiopathic) VTE in men and women with T2DM. Methods We conducted a nested case–control analysis (1:4 matching) within a cohort of patients with incident T2DM between 1995 and 2019 using data from the CPRD GOLD. We excluded patients with known risk factors for VTE prior to onset of DM. Cases were T2DM patients with an unprovoked treated VTE. The exposure of interest was glycemic control measured as HbA1c levels. We conducted conditional logistic regression analyses adjusted for several confounders. Results We identified 2′653 VTE cases and 10′612 controls (53.1% females). We found no association between the HbA1c level and the risk of VTE in our analyses. However, when the most recent HbA1c value was recorded within 90 days before the index date, women with HbA1c levels > 7.0% had a 36–55% increased relative risk of VTE when compared to women with HbA1c > 6.5–7.0%. Conclusions Our study raises the possibility that female T2DM patients with HbA1c levels > 7% may have a slightly higher risk for unprovoked VTE compared to women with HbA1c levels > 6.5–7.0%. This increase may not be causal and may reflect differences in life style or other characteristics. We observed no effect of glycemic control on the risk of VTE in men.

scholarly journals A case-control and cohort study to determine the relationship between ethnic background and severe COVID-19

2020 ◽  
Author(s):  
Rosita Zakeri ◽  
Rebecca Bendayan ◽  
Mark Ashworth ◽  
Daniel M Bean ◽  
Hiten Dodhia ◽  
...  
Keyword(s):  
Cohort Study ◽  
Hospital Mortality ◽  
Hospital Admission ◽  
Conditional Logistic Regression ◽  
Severe Disease ◽  
Case Control ◽  
Ethnic Background ◽  
Asian Ethnicity ◽  
The Impact ◽  
The Relationship

Background. People of minority ethnic background may be disproportionately affected by severe COVID-19 for reasons that are unclear. We sought to examine the relationship between ethnic background and (1) hospital admission for severe COVID-19; (2) in-hospital mortality. Methods. We conducted a case-control study of 872 inner city adult residents admitted to hospital with confirmed COVID-19 (cases) and 3,488 matched controls randomly sampled from a primary healthcare database comprising 344,083 people resident in the same region. To examine in-hospital mortality, we conducted a cohort study of 1827 adults consecutively admitted with COVID-19. Data collected included hospital admission for COVID-19, demographics, comorbidities, in-hospital mortality. The primary exposure variable was self-defined ethnicity. Results. The 872 cases comprised 48.1% Black, 33.7% White, 12.6% Mixed/Other and 5.6% Asian patients. In conditional logistic regression analyses, Black and Mixed/Other ethnicity were associated with higher admission risk than white (OR 3.12 [95% CI 2.63-3.71] and 2.97 [2.30- 3.85] respectively). Adjustment for comorbidities and deprivation modestly attenuated the association (OR 2.28 [1.87-2.79] for Black, 2.66 [2.01-3.52] for Mixed/Other). Asian ethnicity was not associated with higher admission risk (OR 1.20 [0.86-1.66]). In the cohort study of 1827 patients, 455 (28.9%) died over a median (IQR) of 8 (4-16) days. Age and male sex, but not Black (adjusted HR 0.84 [0.63-1.11]) or Mixed/Other ethnicity (adjusted HR 0.69 [0.43-1.10]), were associated with in-hospital mortality. Asian ethnicity was associated with higher in-hospital mortality (adjusted HR 1.54 [0.98-2.41]). Conclusions. Black and Mixed ethnicity are independently associated with greater admission risk with COVID-19 and may be risk factors for development of severe disease. Comorbidities and socioeconomic factors only partly account for this and additional ethnicity-related factors may play a large role. The impact of COVID-19 may be different in Asians.

scholarly journals Parenthood in Survivors of Hodgkin Lymphoma: An EORTC-GELA General Population Case-Control Study

2012 ◽  
Vol 30 (31) ◽  
pp. 3854-3863 ◽  
Author(s):  
Marleen A.E. van der Kaaij ◽  
Natacha Heutte ◽  
Paul Meijnders ◽  
Edwige Abeilard-Lemoisson ◽  
Michele Spina ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
General Population ◽  
Hodgkin Lymphoma ◽  
Logistic Regression Analysis ◽  
Conditional Logistic Regression ◽  
Post Treatment ◽  
Factors Influencing ◽  
The Impact ◽  
Population Controls

Purpose We investigated the impact of Hodgkin lymphoma (HL) on parenthood, including factors influencing parenthood probability, by comparing long-term HL survivors with matched general population controls. Patients and Methods A Life Situation Questionnaire was sent to 3,604 survivors treated from 1964 to 2004 in successive clinical trials. Responders were matched with controls (1:3 or 4) for sex, country, education, and year of birth (10-year groups). Controls were given an artificial date of start of treatment equal to that of their matched case. The main end point was presence of biologic children after treatment, which was evaluated by using conditional logistic regression analysis. Logistic regression analysis was used to analyze factors influencing spontaneous post-treatment parenthood. Results In all, 1,654 French and Dutch survivors were matched with 6,414 controls. Median follow-up was 14 years (range, 5 to 44 years). After treatment, the odds ratio (OR) for having children was 0.77 (95% CI, 0.68 to 0.87; P < .001) for survivors compared with controls. Of 898 survivors who were childless before treatment, 46.7% achieved post-treatment parenthood compared with 49.3% of 3,196 childless controls (OR, 0.87; P = .08). Among 756 survivors with children before treatment, 12.4% became parents after HL treatment compared with 22.2% of 3,218 controls with children before treatment (OR, 0.49; P < .001). Treatment with alkylating agents, second-line therapy, and age older than 35 years at treatment appeared to reduce the chances of spontaneous post-treatment parenthood. Conclusion Survivors of HL had slightly but significantly fewer children after treatment than matched general population controls. The difference concerned only survivors who had children before treatment and appears to have more personal than biologic reasons. The chance of successful post-treatment parenthood was 76%.

scholarly journals Covid-19 in Liver Transplant Recipients: An Italian Case-Control Double-Centre Study.

2021 ◽  
Author(s):  
Maria Guarino ◽  
Valentina Cossiga ◽  
Ilaria Loperto ◽  
Ilaria Esposito ◽  
Rosanna Ortolani ◽  
...  
Keyword(s):  
General Population ◽  
Liver Transplant ◽  
Univariate Analysis ◽  
Case Fatality ◽  
Case Control ◽  
Multivariable Logistic Regression Analysis ◽  
Campania Region ◽  
Centre Study ◽  
Italian Case ◽  
The Impact

Abstract Background and Aims: Liver transplant (LT) recipients are vulnerable to SARS-CoV-2-infection (COVID-19), due to immunosuppression and comorbidities. This study aimed to evaluate the impact of COVID-19 on LT recipients compared to general population in the Campania region.Methods: In this case-control double-centre study, we enrolled all consecutive adult LT recipients with confirmed SARS-CoV-2-infection. Data were collected at diagnosis of COVID-19 and during follow-up and compared with the regional population. Results: Thirty LT recipients (3.28%) developed SARS-CoV-2-infection (76.6% male, median age 62.6 years). Sixteen (53.3%) were symptomatic. Common symptoms were fever, cough, fatigue, and anosmia. Twenty-five (83.4%) were outpatients, 5 (16.6%) required hospitalization (6.6% admitted to Intensive Care Unit, 6.6% developed Acute Respiratory Distress Syndrome and 6.6% died). Immunosuppressors were in 3 (10%) patients. Incidence rate of COVID-19 was similar between LT patients and general population (3.28% vs 4.37%, p=0.1) with higher rate of symptoms in LT patients (46.67% vs 15.87%, p<0.00). At univariate analysis, hospitalization and case fatality rates were higher in LT patients compared to general population (16.67% vs 4.54%, p=0.001; and 6.67% vs 1.76%, p=0.04, respectively). At multivariable logistic regression analysis, LT patients with COVID-19 were more frequently symptomatic (OR 5.44 [95%CI 2.44-12.17], p<0.00), whereas hospitalization and death for COVID-19 were not significatively associated with LT condition (p=0.72 and p=0.46, respectively) and were comparable with general population.Conclusions: LT is not a risk factor for acquiring COVID-19. Nonetheless, LT patients are more frequently symptomatic, although comparable to the general population for hospitalization rate and mortality.

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