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

Abstract

OBJECTIVES:

The 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.

METHODS:

In 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.

RESULTS:

The 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).

CONCLUSION:

In hospitalised patients with chronic inflammatory rheumatic diseases, having a CTD but not IA nor previous immunosuppressive therapies was associated with severe COVID-19.

• Authors: Jose L Pablos, María Galindo, Loreto Carmona, Ana Lledó, Miriam Retuerto, Ricardo Blanco, Miguel A Gonzalez-Gay, David Martinez-Lopez, Isabel Castrejón, José M Alvaro-Gracia, David Fernández Fernández, Antonio Mera-Varela, Sara Manrique-Arija, Natalia Mena Vázquez, Antonio Fernandez-Nebro, RIER Investigators Group, RIER investigators group
• Journal: Annals of the rheumatic diseases (Ann Rheum Dis) Vol. 79 Issue 12 Pg. 1544-1549 (12 2020) ISSN: 1468-2060 [Electronic] England
• PMID: 32796045 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: © Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.

Chemical References

• Antiviral Agents
• Drug Combinations
• Glucocorticoids
• Immunosuppressive Agents
• lopinavir-ritonavir drug combination
• Lopinavir
• remdesivir
• Adenosine Monophosphate
• Hydroxychloroquine
• Ritonavir
• Alanine

Topics

• Adenosine Monophosphate (analogs & derivatives, therapeutic use)
• Age Factors
• Aged
• Alanine (analogs & derivatives, therapeutic use)
• Antiviral Agents (therapeutic use)
• Arthritis, Psoriatic (complications, drug therapy, epidemiology)
• Arthritis, Rheumatoid (complications, drug therapy, epidemiology)
• Betacoronavirus
• COVID-19
• Cardiovascular Diseases (epidemiology)
• Case-Control Studies
• Cohort Studies
• Comorbidity
• Connective Tissue Diseases (complications, drug therapy, epidemiology)
• Coronavirus Infections (complications, drug therapy, epidemiology)
• Drug Combinations
• Female
• Glucocorticoids (therapeutic use)
• Hospitalization
• Humans
• Hydroxychloroquine (therapeutic use)
• Immunosuppressive Agents (therapeutic use)
• Logistic Models
• Lopinavir (therapeutic use)
• Lupus Erythematosus, Systemic (complications, drug therapy, epidemiology)
• Male
• Middle Aged
• Obesity (epidemiology)
• Pandemics
• Pneumonia, Viral (complications, drug therapy, epidemiology)
• Polymyalgia Rheumatica (complications, drug therapy, epidemiology)
• Prognosis
• Rheumatic Diseases (complications, drug therapy, epidemiology)
• Risk Factors
• Ritonavir (therapeutic use)
• SARS-CoV-2
• Severity of Illness Index
• Sex Factors
• Sjogren's Syndrome (complications, drug therapy, epidemiology)
• Spondylarthropathies (complications, drug therapy, epidemiology)
• COVID-19 Drug Treatment