{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T18:07:23Z","timestamp":1788977243986,"version":"build-2803163510"},"reference-count":23,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u20138\/2021), Delta (9\/2021-12\/2021), and Omicron (1\/2022\u20137\/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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>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\u2009=\u20090.008). Immunocompromise was associated with worse outcomes in the entire cohort after adjustment (HR 1.68, 95% CI 1.2\u20132.3, p\u2009&lt;\u20090.001). 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\u20135.0, p\u2009&lt;\u20090.001). 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\u20132.1, p\u2009=\u20090.15) or Delta periods (32% vs. 28% HR 1.0, 95% CI 0.4\u20132.5, p\u2009=\u20090.92). Notably, survival was significantly improved during the Omicron period compared to earlier strain periods in immunocompetent patients (HR 0.6, 95% CI 0.4\u20130.9, p\u2009=\u20090.02) but not for immunocompromised patients (HR 1.4, 95% CI 0.80\u20132.44, p\u2009=\u20090.24).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0357181","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T17:25:36Z","timestamp":1788974736000},"page":"e0357181","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Outcomes of immunocompromised and non-immunocompromised patients in the ICU diverge late in the pandemic"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-7515-7545","authenticated-orcid":true,"given":"Shreya","family":"Battu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew 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G.","family":"Wilson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph E.","family":"Levitt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0974-2599","authenticated-orcid":true,"given":"William","family":"Collins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela J.","family":"Rogers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"issue":"10","key":"pone.0357181.ref001","doi-asserted-by":"crossref","first-page":"2121","DOI":"10.1093\/cid\/ciz638","article-title":"Outcomes of immunocompromised adults hospitalized with laboratory-confirmed influenza in the United States, 2011-2015","volume":"70","author":"JP Collins","year":"2020","journal-title":"Clin Infect 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