Outcomes of immunocompromised and non-immunocompromised patients in the ICU diverge late in the pandemic
Shreya Battu, Andrew R. Moore, Katie Lebold, Ana Pacheco-Navarro, Shaun Pienkos, Christian O’Donnell, Pablo Sanchez, Caitlin Parmer-Chow, Jonasel Roque, Tara Ramaswamy, Jennifer G. Wilson, Joseph E. Levitt, William Collins, Angela J. Rogers
Abstract
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.
Introduction
The COVID-19 pandemic left an indelible mark on the global landscape, claiming millions of lives worldwide. In the pre-COVID era, common respiratory viruses, such as influenza and respiratory syncytial virus (RSV), were associated with more severe outcomes in immunocompromised patients.
Materials and methods
We performed a retrospective review of sequential patients with acute SARS-CoV-2 infection who required ICU admission in the Stanford Health Care System from March 2020 to July 2022. Stanford Health Care includes both an academic tertiary care center ICU and an ICU at a community affiliate hospital.
Results
Of the 791 adult patients with COVID-19 admitted to the ICU between March 2020 and July 2022, 450 were during the pre-Delta, 114 during Delta, and 227 during the Omicron period. This cohort included 158 (20%) immunocompromised patients and 633 (80%) non-immunocompromised patients (Fig 1).
Discussion
In this large single health-care system cohort, immunocompromised patients who were admitted to the ICU with SARS-CoV-2 infection experienced higher mortality than immunocompetent patients.
Conclusion
In this study, we found that immunocompromised patients admitted to the ICU with positive SARS-CoV-2 test experienced higher mortality than immunocompetent patients. This difference in outcomes differed by viral strain period and was largely driven by improved survival in immunocompetent patients in the Omicron period.
Citation: Battu S, Moore AR, Lebold K, Pacheco-Navarro A, Pienkos S, O’Donnell C, et al. (2026) Outcomes of immunocompromised and non-immunocompromised patients in the ICU diverge late in the pandemic. PLoS One 21(9): e0357181. https://doi.org/10.1371/journal.pone.0357181
Editor: Rishi Jaiswal, University of Arkansas for Medical Sciences, UNITED STATES OF AMERICA
Received: April 27, 2026; Accepted: August 13, 2026; Published: September 9, 2026
Copyright: © 2026 Battu 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.
Data Availability: All relevant data are within the paper and its Supporting Information files.
Funding: The author(s) received no specific funding for this work.
Competing interests: The authors have declared that no competing interests exist.
