ORCID

Abstract

Background: Adults classified as immunosuppressed have beendisproportionately affected by the COVID-19 pandemic. Compared to theimmunocompetent, certain patients are at increased risk of suboptimal vaccineresponse and adverse health outcomes if infected. However, there has beeninsufficient work to pinpoint where these risks concentrate within theimmunosuppressed spectrum; surveillance efforts typically treat theimmunosuppressed as a single entity, leading to wide confidence intervals. Aclinically meaningful and computerised medical record (CMR) compatiblemethod to subdivide immunosuppressed COVID-19 data is urgently needed.Methods: We conducted a rapid scoping review into COVID-19 mortality acrossUK immunosuppressed categories to assess if differential mortality risk was aviable means of subdivision. We converted the risk hierarchy that surfaced into apilot digital phenotype—a valueset and series of ontological rules ready to extractimmunosuppressed patients from CMR data and stratify outcomes of interest inCOVID-19 surveillance dataflows.Results: The rapid scoping review returned COVID-19 mortality data for allimmunosuppressed subgroups assessed and revealed significant heterogeneityacross the spectrum. There was a clear distinction between heightened COVID19 mortality in haematological malignancy and transplant patients and mortalitythat approached the immunocompetent baseline amongst cancer therapyrecipients, autoimmune patients, and those with HIV. This process,complemented by expert clinical input, informed the curation of the five-partdigital phenotype now ready for testing in real-world data; its ontological ruleswill enable mutually exclusive, hierarchical extraction with nuanced time andtreatment conditions. Unique categorisations have been introduced, including‘Bone Marrow Compromised’ and those dedicated to differentiatingprescriptions related and unrelated to cancer. Codification was supported byexisting reference sets of medical codes; absent or redundant codes had to beresolved manually.Discussion: Although this work is in its earliest phases, the development processwe report has been highly informative. Systematic review, clinical consensusbuilding, and implementation studies will test the validity of our results andaddress criticisms of the rapid scoping exercise they are predicated on.Conclusion: Comprehensive testing for COVID-19 has differentiated mortalityrisks across the immunosuppressed spectrum. This risk hierarchy has beencodified into a digital phenotype for differentiated COVID-19 surveillance; thismarks a step towards the needs-based management of these patients that isurgently required.

Publication Date

2024-12-04

Publication Title

Frontiers in Immunology

Volume

15

Keywords

CMR, digital health, disease surveillance, immunosuppressed, surveillance, vaccine

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10.3389/fimmu.2024.1491565" data-hide-no-mentions="true">

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