Autoimmune Diseases and COVID-19 as Risk Factors for Poor Outcomes: Data on 13,940 Hospitalized Patients from the Spanish Nationwide SEMI-COVID-19 Registry

Abstract

(1) Objectives: To describe the clinical characteristics and clinical course of hospitalized patients with COVID-19 and autoimmune diseases (ADs) compared to the general population. (2) Methods: We used information available in the nationwide Spanish SEMI-COVID-19 Registry, which retrospectively compiles data from the first admission of adult patients with COVID-19. We selected all patients with ADs included in the registry and compared them to the remaining patients. The primary outcome was all-cause mortality during admission, readmission, and subsequent admissions, and secondary outcomes were a composite outcome including the need for intensive care unit (ICU) admission, invasive and non-invasive mechanical ventilation (MV), or death, as well as in-hospital complications. (3) Results: A total of 13,940 patients diagnosed with COVID-19 were included, of which 362 (2.6%) had an AD. Patients with ADs were older, more likely to be female, and had greater comorbidity. On the multivariate logistic regression analysis, which involved the inverse propensity score weighting method, AD as a whole was not associated with an increased risk of any of the outcome variables. Habitual treatment with corticosteroids (CSs), age, Barthel Index score, and comorbidity were associated with poor outcomes. Biological disease-modifying anti-rheumatic drugs (bDMARDs) were associated with a decrease in mortality in patients with AD. (4) Conclusions: The analysis of the SEMI-COVID-19 Registry shows that ADs do not lead to a different prognosis, measured by mortality, complications, or the composite outcome. Considered individually, it seems that some diseases entail a different prognosis than that of the general population. Immunosuppressive/immunoregulatory treatments (IST) prior to admission had variable effects.

Antibody development and disease severity of COVID-19 in non-immunised patients with rheumatic immune-mediated inflammatory diseases: data from a prospective cohort study

“…These studies include a Danish and Spanish national registry study that both observed similar COVID-19-related mortality rates for patients with rheumatic diseases and the general population. 3 4 This is in line with our own data, as we observed low absolute numbers of patients with rheumatic diseases that were admitted to the ICU or who died (n=3), although we were unable to estimate relative risks due to these low number and absence of controls who required ICU admission. In contrast, we observed that COVID-19-related hospitalisation rates were higher in patients compared with controls (7% vs 1%), especially in patients treated with B-cell targeting therapy (42%).…”

“…Registry studies that have assessed severe COVID-19 outcomes (eg, ICU admission or death) in a population that was hospitalised due to COVID-19 avoided using these (possibly) biased incidence rates, and may therefore provide more accurate risk estimates for severe COVID-19 manifestations. These studies include a Danish and Spanish national registry study that both observed similar COVID-19-related mortality rates for patients with rheumatic diseases and the general population 3 4. This is in line with our own data, as we observed low absolute numbers of patients with rheumatic diseases that were admitted to the ICU or who died (n=3), although we were unable to estimate relative risks due to these low number and absence of controls who required ICU admission.…”

“…Moreover, treatment with immunosuppressive drugs may hamper the maintenance of immunological memory against SARS-CoV-2, which might increase the susceptibility of patients with rheumatic diseases to (severe) COVID-19 reinfections as well. Although current data on disease severity of COVID-19 in patients with rheumatic diseases seem reassuring,3 4 definitive conclusions have not yet been drawn due to lack of studies that provide a high quality of evidence. So far, most data have been derived from cross-sectional cohort studies or retrospective registry studies that often suffer from considerable methodological disadvantages, such as selection bias 5.…”

Hospital readmissions and post-discharge all-cause mortality in COVID-19 recovered patients; A systematic review and meta-analysis

“…In the manual search of gray literature and preprints, 18 potentially related papers were included. After reviewing the titles and abstracts of the articles, 157 peer-reviewed papers or preprinted manuscripts were reviewed and a total of 91 articles were entered into the present meta-analysis [ 8 , [14] , [15] , [16] , [17] , [18] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] , [34] , [35] , [36] , [37] , [38] , [39] , [40] , [41] , [42] , [43] , [44] , [45] , [46] , [47] , [48] , [49] , [50] , [51] , [52] , [53] , [54] , [55] , [56] , [57] , [58] , [59] , [60] , [61] , [62] , [63] , [64] , [65] , [66] , [67] , [68] , [69] , [70] , [71] , [72] , [73] , [74] , [75] , [76] , [77] , [78] , [79] ,…”

Clinical characteristics of COVID-19 patients with underlying rheumatic diseases in Japan: data from a multicenter observational study using the COVID-19 Global Rheumatology Alliance physician-reported registry

“…Previous reports suggested association of biologic DMARDs with severe COVID-19 outcome [ 11 , 12 , 36 , 38 – 40 ],; however, the relationship of biologic DMARDs or JAK inhibitor usage with COVID-19 outcomes is not clear currently. A report from the first 600 cases from the C19-GRA physician-reported registry suggested that the use of tumour necrosis factor (TNF) inhibitors may reduce the probability of hospitalisation [ 11 ].…”