COVID‐19 Outcomes in Patients With Systemic Autoimmune Rheumatic Diseases Compared to the General Population: A US Multicenter, Comparative Cohort Study

Abstract

Objective. Patients with systemic autoimmune rheumatic diseases (ARDs) continue to be concerned about risks of severe coronavirus disease 2019 outcomes. This study was undertaken to evaluate the risks of severe outcomes in COVID-19 patients with systemic ARDs compared to COVID-19 patients without systemic ARDs.Methods. Using a large multicenter electronic health record network, we conducted a comparative cohort study of patients with systemic ARDs diagnosed as having COVID-19 (identified by diagnostic code or positive molecular test result) compared to patients with COVID-19 who did not have systemic ARDs, matched for age, sex, race/ethnicity, and body mass index (primary matched model) and additionally matched for comorbidities and health care utilization (extended matched model). Thirty-day outcomes were assessed, including hospitalization, intensive care unit (ICU) admission, mechanical ventilation, acute renal failure requiring renal replacement therapy, ischemic stroke, venous thromboembolism, and death.Results. We initially identified 2,379 COVID-19 patients with systemic ARDs (mean age 58 years; 79% female) and 142,750 comparators (mean age 47 years; 54% female). In the primary matched model (2,379 patients with systemic ARDs and 2,379 matched comparators with COVID-19 without systemic ARDs), patients with systemic ARDs had a significantly higher risk of hospitalization (relative risk [RR] 1.14 [95% confidence interval (95% CI) 1.03-1.26]), ICU admission (RR 1.32 [95% CI 1.03-1.68]), acute renal failure (RR 1.81 [95% CI 1.07-3.07]), and venous thromboembolism (RR 1.74 [95% CI 1.23-2.45]) versus comparators but did not have a significantly higher risk of mechanical ventilation or death. In the extended model, all risks were largely attenuated, except for the risk of venous thromboembolism (RR 1.60 [95% CI 1.14-2.25]). Conclusion.Our findings indicate that COVID-19 patients with systemic ARDs may be at a higher risk of hospitalization, ICU admission, acute renal failure, and venous thromboembolism when compared to COVID-19 patients without systemic ARDs. These risks may be largely mediated by comorbidities, except for the risk of venous thromboembolism.

American College of Rheumatology Guidance for COVID‐19 Vaccination in Patients With Rheumatic and Musculoskeletal Diseases: Version 1

“…Among these individuals, the risk for incident viral infections (e.g., herpes zoster) was rated as being higher than for the general population (20)(21)(22). There was also agreement that AIIRD patients are likely to be at increased risk for hospitalized SARS-CoV-2 infection (23)(24)(25)(26)(27) and that age, race/ethnicity (especially for underrepresented minorities), and sex were important risk factors that needed to be considered (28)(29)(30)(31) in evaluating risk at the individual patient level. Multimorbidity was felt to likewise play an important role in the risk for developing COVID-19.…”

Point of view on the vaccination against COVID-19 in patients with autoimmune inflammatory rheumatic diseases

“…17 A large cohort study conducted in the USA reported a higher rate of venous thromboembolism in patients with AIIRD within 30 days follow-up of COVID-19 infection compared with the matched population without AIIRD. 18 A large US electronic health records based study investigated temporal trends in COVID-19 outcomes in patients with rheumatic diseases over the course of the pandemic. 19 The risks of severe COVID-19 outcomes, including risks of hospitalisation, respiratory failure, mechanical ventilation, renal failure and death after COVID-19 diagnosis, have improved over time in patients with rheumatic but remain substantial.…”

The intersection of COVID-19 and autoimmunity: What is our current understanding?

“…These data are derived largely from numerous small case-controlled investigations. In general, patients with IMIDs such as rheumatic diseases [49], IBD [50], and multiple sclerosis [42] appear to be more vulnerable to severe outcomes (ie, hospitalization, ICU status, and death), but after adjusting for comorbid conditions that are overrepresented in patients with autoimmune disease, such as cardiovascular disease, this risk is greatly diminished in most [49], but not all investigations. Preliminary data, primarily derived from case reports and small case studies have also associated SARS-CoV-2 infection with disease flares in patients with pre-existing IMIDs, but conclusions of causation should be avoided [51].…”