Background
Autoimmune blistering disorders (AIBD) are rare, potentially life-threatening conditions often requiring immunosuppression. Throughout the SARS-CoV-2 pandemic, infection risk and mortality in AIBD patients is unknown.
Objective
We report outcomes of SARS-CoV-2 infections in AIBD patients and determined if patients on rituximab have increased risk of SARS-CoV-2 infection.
Methods
We examined clinical outcomes in ten AIBD patients who developed SARS-CoV-2 infections at an American hospital. We performed a retrospective analysis of 132 AIBD patients enrolled in a clinical trial.
Results
Patients with severe SARS-CoV-2 (n = 4) or death (n = 2) trended older. These patients had higher mortality than the national average (20% vs 1.6%). Our cohort included 52 patients with a history of rituximab treatment, 35 of whom were immunosuppressed by rituximab during the pandemic, and 45 patients never treated with rituximab. We found no difference between rates of SARS-CoV-2 positivity in AIBD patients immunosuppressed by rituximab compared to those not on rituximab (9.1% vs 12.1%).
Limitations
Testing for SARS-CoV-2 was performed on demand rather than surveillance. Overall transmission varied over time and outcomes depended on accepted treatments. The small sample size of our cohort limits the generalizability of our results.
Conclusion
This study suggests that rituximab may not increase the risk of SARS-CoV-2 test positivity in AIBD patients. However, these results should be interpreted with caution due to our relatively small sample size.
BACKGROUND:
Women of color with breast cancer are less likely to undergo post-mastectomy reconstruction compared with White women, but it is unclear whether their perioperative outcomes are worse. The goal of this study was to investigate differences in preoperative comorbidities and postoperative complications by race/ethnicity among women with breast cancer undergoing postmastectomy reconstruction.
STUDY DESIGN:
Data were collected from the National Inpatient Sample database of the Healthcare Cost and Utilization Project from 2012 to 2016. Patient demographics, types of reconstruction, comorbid conditions, Charlson-Deyo Combined Comorbidity (CDCC) scores, length of stay (LOS), and perioperative complications were abstracted. Multivariate linear and logistic regression were performed to model LOS and likelihood of postoperative complications, respectively.
RESULTS:
Compared with White women (n = 19,730), Black women (n = 3,201) underwent autologous reconstruction more frequently (40.7% vs 28.3%), had more perioperative comorbidities (eg diabetes: 12.9% vs 5.8%), higher CDCC scores (% CDCC ≥ 4: 5.5% vs 2.7%), and longer LOS (median 3 vs 2 days, all p < 0.001). Being Black (vs White: +0.13 adjusted days, 95% CI 0.06 to 0.19) was also associated with longer LOS and an increased likelihood of surgical complications (vs White: odds ratio 1.24, 95% CI 1.09 to 1.42, both p < 0.01), but this association did not persist when outcomes were limited to microsurgical complications.
CONCLUSION:
Disparities in postmastectomy breast reconstruction between Black and White women extend beyond access to care and include perioperative factors and outcomes. These findings suggest an important opportunity to mitigate inequities in reconstruction through perioperative health optimization and improved access to and co-management with primary care.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.