# Outcome of SARS-CoV-2 Infection in 121 Patients with Inborn Errors of Immunity: A Cross-Sectional Study.

- **DOI:** [10.1007/s10875-021-01066-8](https://doi.org/10.1007/s10875-021-01066-8)
- **Rating:** Sound (3.0 out of 5)
- **Verdict:** A useful Brazilian IEI case series broadens early COVID-19 evidence, but unadjusted severity analyses prevent independent risk-factor inference.
- **Framework version:** v5.9
- **Pipeline version:** v0.4
- **Evaluation date:** 2026-09-18
- **Evaluation page:** https://www.nabu.science/paper/10.1007%2Fs10875-021-01066-8

## Key claims

1. The outcome was mild in most patients, but the Case Fatality Ratio was higher than in the general population.
   - Support: Tentative
   - Type: Primary finding
   - Basis: the observed 5% rate lacks an ascertainment- and demography-adjusted general-population comparison
   - Location: Abstract, Conclusion
2. the type of IEI was not a determining factor for severity, except for complement deficiencies linked to milder COVID-19.
   - Support: Tentative
   - Type: Secondary
   - Basis: small heterogeneous IEI strata and unadjusted comparisons cannot establish absence of subtype effects
   - Location: Abstract, Conclusion
3. The severity of SARS-CoV-2 infection seems to be more related to older age, a higher number of comorbidities and type of comorbidities (bronchiectasis and cardiopathy).
   - Support: Tentative
   - Type: Secondary
   - Basis: cross-sectional bivariate analyses cannot identify independent severity predictors
   - Location: Abstract, Conclusion
4. We could not observe sex-related susceptibility, and there was a weak correlation between age and severity of infection.
   - Support: Supported
   - Type: Secondary
   - Basis: reported cohort analyses directly support the cautious, sample-specific wording
   - Location: Abstract, Results

## Strengths

- **Large early Brazilian IEI cohort** The 121-patient multicentre series extends the early evidence base beyond the European and UK cohorts discussed in the paper and includes a broad age range and multiple IEI groups.
  - Dimension: contribution
  - Location: Methods; Results, Fig. 1A; Discussion, paragraphs 1–3
- **Transparent cohort and outcome reporting** The paper reports infection-confirmation routes, acute severity counts, hospitalization, mortality, and detailed rare subgroups such as post-HSCT patients.
  - Dimension: methodological rigour
  - Location: Results, opening paragraph, Fig. 1B, Table 1, and mortality paragraphs
- **Substantive comparison with prior series** The Discussion compares age, sex, IEI composition, comorbidities, and fatality outcomes with the Meyts, Shields, Marcus, and Ho reports rather than treating the cohort in isolation.
  - Dimension: positioning
  - Location: Discussion, paragraphs 1–4 and CFR comparison paragraphs

## Limitations

- **Severity associations remain materially confounded** Age, comorbidity burden, bronchiectasis, immunoglobulin use, and immunosuppression are assessed through separate bivariate tests. The analysis cannot identify independent prognostic relationships or resolve confounding by indication.
  - Dimension: methodological rigour
  - Location: Methods, statistical analysis; Results, treatment and comorbidity analyses
- **Selected and heterogeneous case ascertainment** Testing was not systematic, asymptomatic cases were found mainly through contact or unrelated hospitalization, and 11 patients lacked laboratory confirmation. The resulting case mix may not represent all infected IEI patients.
  - Dimension: methodological rigour
  - Location: Methods, inclusion criteria; Results, opening and acute-infection paragraphs; Discussion, testing paragraph
- **Multiplicity and reporting inconsistencies** Numerous uncorrected bivariate tests include several borderline p-values, while the symptom section prints anosmia as n=380 among 99 symptomatic patients. A nominal sex variable is also analysed using Kendall's tau-b despite the stated methods framework.
  - Dimension: reporting
  - Location: Methods, statistical analysis; Results, sex, treatment, comorbidity, and symptom-severity paragraphs

## Reliability checks

Caveats (4 of 4 checks).

- **Internal coherence:** Noted. The principal cohort and outcome totals reconcile, but the paper contains a clear symptom-count typo, a statistical-method inconsistency, and extensive uncorrected bivariate testing. These issues warrant caution without making the central descriptive results unusable.
- **Research conduct:** Clean. Ethics approval and participant consent are declared in Methods, and the supplied text presents no specific conduct concern. The linked supplement was outside the supplied material and is treated as an assessability gap rather than a reliability defect.
- **Reference integrity:** Clean. 47 of 47 checkable references verified
  - 52 references in manuscript
  - 5 are books, websites or datasets — counted, but not index-checkable
  - References not verified automatically are resolved manually within 24 hours.

## Post-publication record

- **Status:** Clean
- **Summary:** No retraction or expression of concern found in Crossref (includes Retraction Watch).
- **Last checked:** 2026-10-17