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Autoimmunity & Severe COVID-19: Omicron Meta-Analysis

A systematic review and meta-analysis was recently published on the risk of severe COVID-19 in immunocompromised people. The study analyzed SARS-CoV-2 Omicron strain infections between January 2022 and March 2024 and is the first large-scale assessment of outcomes in this population.

The review included people of all ages with at least one of the following conditions:

autoimmunity, transplant, liver disease, malignancy, chronic or end-stage renal disease, HIV, or unspecified immunocompromising/immunosuppressive (IC/IS) conditions.

Outcomes measured were death, hospitalization, and intensive care unit (ICU) admission.

Severe COVID-19 Risk for Immunocompromised Patients

Those with IC/IS conditions, including autoimmune disease, are more likely to be impacted by COVID-19, even with milder Omicron strains. This group may experience persistent symptoms and faces a higher risk of severe outcomes compared to those without IC/IS conditions. Of 21,937 records screened, 66 studies were included.

Across these 66 studies, outcomes were reported at different frequencies: death in 65% (43 studies), hospitalization in 33% (22), ICU admission in 24% (16), and combined outcomes in 29% (19). These figures reflect how often outcomes were assessed, not the proportion of patients who experienced them.

Thirteen studies specifically assessed autoimmune disease, with more than 2.5 million participants across them.

COVID-19 Outcomes by Comorbidity

  • Renal disease: People with advanced kidney disease were most often reported as being at higher risk of death from COVID-19.
  • Autoimmune disease: Too few studies focused on autoimmune disease to calculate reliable risks for hospitalization or ICU admission.
  • Cancer: People with cancer were at least twice as likely to die, need hospitalization, or require ICU care.
  • Transplant: Transplant patients were at least six times more likely to face severe outcomes.
  • IC/IS unspecified group: People in the “immunocompromised/immunosuppressed (unspecified)” group had the highest risk of ICU admission.

COVID-19 Outcomes & Autoimmune Disease

For people with autoimmune disease, the analysis did not show a clear increase in risk of death or combined severe outcomes from COVID-19. However, the researchers note this may simply be because there were too few autoimmune-focused studies to draw firm conclusions. There also weren’t enough studies to properly measure the risks of hospitalization or ICU admission in this group.

Interestingly, some studies did find that people were more likely to develop a new autoimmune disease after a COVID-19 infection, pointing to what the authors describe as “a potential positive feedback loop between autoimmunity and COVID-19.”

Citation

Chapman, A., et al. (2025). Risk of Severe Outcomes From COVID-19 in Immunocompromised People During the Omicron Era: A Systematic Review and Meta-Analysis. Clinical therapeutics, 47(9), 770–787. https://doi.org/10.1016/j.clinthera.2025.07.006