COVID-19 Hospitalizations, Intensive Care Unit Stays, Ventilation, and Death Among Patients With Immune-mediated Inflammatory Diseases Compared to Controls

Abstract

Objective To investigate COVID-19 hospitalization risk in patients with immune mediated inflammatory diseases (IMIDs) compared with matched non-IMID comparators from the general population. Methods We conducted a population-based, matched cohort study using health administrative data from January to July 2020 in Ontario, Canada. Cohorts for each of the following IMIDs were assembled: rheumatoid arthritis (RA), psoriasis, psoriatic arthritis (PsA), ankylosing spondylitis, systemic autoimmune rheumatic diseases (SARDs), multiple sclerosis (MS), iritis, inflammatory bowel disease, polymyalgia rheumatica and vasculitis. Each patient was matched with 5 non-IMID comparators based on socio-demographic factors. We compared the cumulative incidence of hospitalizations for COVID-19 and their outcomes between IMID and non-IMID patients. Results A total of 493,499 IMID patients (417 hospitalizations) and 2,466,946 non-IMID comparators (1,519 hospitalizations) were assessed. The odds of being hospitalized for COVID- 19 was significantly higher in patients with IMIDs compared with their matched non-IMID comparators (matched unadjusted Odds Ratio (OR) 1.37, adjusted OR 1.23). Significantly higher risk of hospitalizations was found in patients with iritis (OR 1.46), MS (OR 1.83), PsA (OR 2.20), RA (OR 1.42), SARDs (OR 1.47) and vasculitis (OR 2.07). COVID-19 hospitalizations were associated with older age, male sex, long-term care residence, multimorbidity, and lower income. The odds of complicated hospitalizations was 21% higher among all IMID versus matched non-IMID patients, but this association was attenuated after adjusting for demographic factors and comorbidities. Conclusion Patients with IMIDs were at higher risk of being hospitalized with COVID-19. This risk was explained in part by their comorbidities.

Factors associated with freqeuncy and severity of COVID-19 in patients with axial spondyloarthritis

“…Unlike our study, DM does not affect poor prognosis [21]. The hospitalization risk of COVID-19 in patients with immune-mediated inflammatory diseases (IMID) is higher than in the general population, but the hospitalization risk varies between IMIDs; iritis, multiple sclerosis, RA, and vasculitis have an increased risk but is not applicable for AS so we believe that each IMID should be assessed separately with a homogenous study group for the evaluation of COVID-19 outcomes [22]. In a prospective study with 103 COVID-19 patients who had a diagnosis with AS (54%) and RA (46%), hospitalized patients had a higher ratio of advanced age, HT, COPD, and GC use, but anti-cytokine therapy was associated with worse COVID-19 outcomes [23].…”

Absent or suboptimal response to booster dose of COVID-19 vaccine in patients with autoimmune systemic diseases

“…As a consequence, it may be crucial to early identify individuals with absent/suboptimal seroconversion who are at high risk to be infected and to develop severe COVID-19. The latter event is more frequently noticed in older ASD patients with disease-related complications such as interstitial lung involvement [ 6 , 8 ] and/or with major comorbidities [ 31 ].…”

Risk Factors of Severe COVID-19: A Review of Host, Viral and Environmental Factors

“…Both immune-mediated inflammatory diseases [ 311 ] (e.g., rheumatoid arthritis [ 201 ]) which are characterized by dysfunctional cytokine responses, and the use of immunosuppressant medications [ 13 , 280 ], have been associated with poor COVID-19 outcomes. Special attention has been given to glucocorticoids [ 319 , 321 , 401 , 402 ].…”