Systemic autoimmune rheumatic disease linked to higher end-organ failure risk in COVID-19
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Patients with systemic autoimmune rheumatic diseases who contract COVID-19 may have a higher risk for end-organ failure than those without such diseases, according to a speaker at ACR Convergence 2020.
“Patients with rheumatic diseases and their providers continue to have concerns regarding the potentially increased risk for poor COVID-19 outcomes due to underlying immunosuppression, a chronic inflammatory state, comorbidities and racial, ethnic and socioeconomic disparities,” Kristin D'Silva, MD, a rheumatology fellow at Massachusetts General Hospital, told attendees at the virtual meeting. “Early center-specific studies from Wuhan, China, and Boston, Massachusetts, reported up to three-fold higher odds of mechanical ventilation in patients with rheumatic disease versus comparators.”
“The Global Rheumatology Alliance reported no higher odds of hospitalization in patients on conventional, biologic or targeted synthetic DMARDs, which is reassuring,” she added. “However, they did note 2-fold higher odds of hospitalization in patients on prednisone-equivalent doses at or above 10 mg daily.”
To examine whether patients with systemic autoimmune rheumatic diseases demonstrate more severe COVID-19 complications, D’Silva and colleagues conducted a matched cohort study using the TriNETX Research Network. According to the researchers, this network includes real-time electronic health record data from more than 52 million patients across 35 health care organizations. COVID-19 infections were identified ICD-10 codes, or positive testing based on polymerase chain reaction, focusing on the period between Jan. 20 and June 1.
Systemic autoimmune rheumatic disease was defined as rheumatoid arthritis, systemic lupus erythematosus, Sjogren’s syndrome, systemic sclerosis, idiopathic inflammatory myositis, mixed or undifferentiated connective tissue disease, systemic vasculitis, psoriatic arthritis, or ankylosing spondylitis, and identified through two ICD-10 codes greater than 2 months apart.
For the comparison cohort, D’Silva and colleagues matched one individual without systemic autoimmune rheumatic disease based on age, sex and race or ethnicity. In all, the researchers included 716 patients with COVID-10 and systemic autoimmune rheumatic diseases, and 716 matched comparators, in their analysis.
The distribution of rheumatic disease was 45% with RA, 18% with SLE, 10% with Sjogren’s syndrome, 3% with SSc, 3% with idiopathic inflammatory myositis, 5% with mixed or undifferentiated connective tissue disease, 9% with systemic vasculitis, with 6% PsA and 3% with AS. Among these patients, 40% were using prednisone, 20% were receiving hydroxychloroquine and 12% were on TNF inhibitors.
D’Silva and colleagues assessed baseline characteristics during the 1 year prior to COVID-19 infection, and then outcomes between 2 weeks and 3 months following COVID-19 infection. They then calculated the risk difference and risk ratio for the association between systemic autoimmune rheumatic disease with each outcome.
According to the researchers, patients with systemic autoimmune rheumatic disease demonstrated higher rates of comorbidities — including hypertension, asthma, chronic kidney disease, and heart failure — compared with those without. These patients also had a higher risk for hospitalization (RR = 1.23), intensive care unit admission (RR = 1.75), mechanical ventilation (RR = 1.77), acute kidney injury (RR = 1.83) and congestive heart failure (RR = 3.06), versus the comparators (all P < .05). Mortality was numerically higher among patients with systemic autoimmune rheumatic disease compared with those without, but this finding was not statistically significant.
“Overall, there was an improvement in mechanical ventilation risk over time,” D’Silva said. “Patients with rheumatic disease appear to be at higher risk of some severe COVID-19 outcomes, including hospitalization, intensive care unit admission and renal failure, and this is likely mediated largely by comorbidities. Rheumatic disease may contribute to the risk for venous thromboembolism even beyond the mediating effects of comorbidities. Therefore, patients with rheumatic disease should be monitored closely for venous thromboembolism during COVID-19 infection.”
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D’Silva K. Abstract 0430. Presented at: ACR Convergence 2020; November 5-9, 2020 (virtual meeting).
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