Journal Article

Clinical outcomes of hospitalised patients with COVID-19 and chronic inflammatory and autoimmune rheumatic diseases: a multicentric matched cohort study

Puig-Kröger, Amaya, Castrejón, Isabel, Martín-López, María, Gonzalez-Gay, Miguel A, Salas, Luis, Retuerto, Miriam, Aguirre, Rodrigo, Seijas-López, Álvaro, Blanco, Ricardo, Fernández Fernández, David, Pablos, Jose L, Carreira, Patricia, Fernandez-Nebro, Antonio, Galindo, María, Gonzalez, Antonio, Manrique-Arija, Sara, Blanco, Francisco J, Martinez-Lopez, David, Mena Vázquez, Natalia, Alvaro-Gracia, José M, Carmona, Loreto, Lledó, Ana, Mera-Varela, Antonio

2020

Overview

ObjectivesThe impact of inflammatory rheumatic diseases on COVID-19 severity is poorly known. Here, we compare the outcomes of a cohort of patients with rheumatic diseases with a matched control cohort to identify potential risk factors for severe illness.MethodsIn this comparative cohort study, we identified hospital PCR+COVID-19 rheumatic patients with chronic inflammatory arthritis (IA) or connective tissue diseases (CTDs). Non-rheumatic controls were randomly sampled 1:1 and matched by age, sex and PCR date. The main outcome was severe COVID-19, defined as death, invasive ventilation, intensive care unit admission or serious complications. We assessed the association between the outcome and the potential prognostic variables, adjusted by COVID-19 treatment, using logistic regression.ResultsThe cohorts were composed of 456 rheumatic and non-rheumatic patients, in equal numbers. Mean age was 63 (IQR 53–78) years and male sex 41% in both cohorts. Rheumatic diseases were IA (60%) and CTD (40%). Most patients (74%) had been hospitalised, and the risk of severe COVID-19 was 31.6% in the rheumatic and 28.1% in the non-rheumatic cohort. Ageing, male sex and previous comorbidity (obesity, diabetes, hypertension, cardiovascular or lung disease) increased the risk in the rheumatic cohort by bivariate analysis. In logistic regression analysis, independent factors associated with severe COVID-19 were increased age (OR 4.83; 95% CI 2.78 to 8.36), male sex (1.93; CI 1.21 to 3.07) and having a CTD (OR 1.82; CI 1.00 to 3.30).ConclusionIn hospitalised patients with chronic inflammatory rheumatic diseases, having a CTD but not IA nor previous immunosuppressive therapies was associated with severe COVID-19.

• Publisher: BMJ Publishing Group Ltd and European League Against Rheumatism,Elsevier Limited,BMJ Publishing Group
• Subject: Adenosine Monophosphate - analogs & derivatives / Adenosine Monophosphate - therapeutic use / Age / Age Factors / Aged / Aging / Alanine - analogs & derivatives / Alanine - therapeutic use / ankylosing / Antiviral Agents - therapeutic use / Arthritis / Arthritis, Psoriatic - complications / Arthritis, Psoriatic - drug therapy / Arthritis, Psoriatic - epidemiology / Arthritis, Rheumatoid - complications / Arthritis, Rheumatoid - drug therapy / Arthritis, Rheumatoid - epidemiology / autoimmune diseases / Betacoronavirus / Cardiovascular disease / Cardiovascular Diseases - epidemiology / Case-Control Studies / Clinical outcomes / Cohort analysis / Cohort Studies / Comorbidity / Connective tissue / Connective tissue diseases / Connective Tissue Diseases - complications / Connective Tissue Diseases - drug therapy / Connective Tissue Diseases - epidemiology / Connective tissues / Coronavirus Infections - complications / Coronavirus Infections - drug therapy / Coronavirus Infections - epidemiology / Coronaviruses / COVID-19 / COVID-19 Drug Treatment / Diabetes / Diabetes mellitus / Drug Combinations / Epidemiology / Female / Glucocorticoids - therapeutic use / Hospitalization / Hospitals / Humans / Hydroxychloroquine - therapeutic use / Hypertension / Immunosuppressive agents / Immunosuppressive Agents - therapeutic use / Infections / Intubation / Investigations / Logistic Models / Lopinavir - therapeutic use / Lung diseases / Lupus Erythematosus, Systemic - complications / Lupus Erythematosus, Systemic - drug therapy / Lupus Erythematosus, Systemic - epidemiology / Male / Medical prognosis / Medical records / Middle Aged / Obesity / Obesity - epidemiology / Pandemics / Patients / Pneumonia, Viral - complications / Pneumonia, Viral - drug therapy / Pneumonia, Viral - epidemiology / Polymyalgia Rheumatica - complications / Polymyalgia Rheumatica - drug therapy / Polymyalgia Rheumatica - epidemiology / Prognosis / psoriatic / Rheumatic diseases / Rheumatic Diseases - complications / Rheumatic Diseases - drug therapy / Rheumatic Diseases - epidemiology / rheumatoid / Rheumatology / Risk Factors / Ritonavir - therapeutic use / SARS-CoV-2 / Severe acute respiratory syndrome coronavirus 2 / Severity of Illness Index / Sex / Sex Factors / Sjogren's Syndrome - complications / Sjogren's Syndrome - drug therapy / Sjogren's Syndrome - epidemiology / Spondylarthropathies - complications / Spondylarthropathies - drug therapy / Spondylarthropathies - epidemiology / spondylitis / Tumor necrosis factor-TNF / Variables / Ventilators