Assessing the Vulnerability of Splenectomized Patients to Severe COVID-19 Outcomes: A Systematic Review and Meta-Analysis

TL;DR

This study finds that people without a spleen are at higher risk for severe outcomes from COVID-19, especially hospitalization.

Contribution

The study is the first to systematically review and meta-analyze the risk of severe COVID-19 outcomes in splenectomized/asplenic individuals.

Findings

Splenectomy/asplenia is significantly associated with increased risk of severe COVID-19 outcomes (OR = 1.92).

Hospitalization due to COVID-19 is significantly higher in splenectomized/asplenic individuals (OR = 2.06).

The association between splenectomy/asplenia and death from COVID-19 is not statistically significant.

Abstract

Background: Splenectomized/asplenic individuals are at a heightened risk for severe infections due to compromised immune function. However, the impact of splenectomy/asplenia on COVID-19 outcomes remains underexplored. This study aims to systematically review and meta-analyze the association between splenectomy/asplenia and severe COVID-19 outcomes. Methods: Following the PRISMA guidelines, databases including Scopus, MEDLINE/PubMed, and Web of Knowledge were searched for relevant articles published between January 2020 and June 2024. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated for severe COVID-19 outcomes, with a random-effects model being used to account for heterogeneity. Out of 749 identified studies, 4 met the inclusion criteria. Results: The meta-analysis revealed a significant association between splenectomy/asplenia and overall severe COVID-19 outcomes (OR = 1.92; 95% CI = 1.06–3.47). Specifically, splenectomy/asplenia was significantly associated with increased COVID-19-related hospitalization (OR = 2.06; 95% CI = 1.21–3.49), while the association with COVID-19-related death was not statistically significant (OR = 1.52; 95% CI = 0.78–2.99). COVID-19 vaccination is strongly recommended for these patients. Conclusions: Splenectomy/asplenia significantly increases the risk of severe COVID-19 outcomes, particularly hospitalization. The findings underscore the need for vigilant clinical management and targeted interventions for this vulnerable population. Further research is warranted to fully understand the risks and to develop effective guidelines for the protection of splenectomized individuals against COVID-19.

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