Increased risk of hospitalization, intensive care and death due to COVID‐19 in patients with adrenal insufficiency: A Swedish nationwide study

Abstract

BackgroundPatients with adrenal insufficiency (AI) have excess morbidity and mortality related to infectious disorders. Whether patients with AI have increased morbidity and mortality from COVID‐19 is unknown.MethodsIn this linked Swedish national register‐based cohort study, patients with primary and secondary AI diagnosis were identified and followed from 1 January 2020 to 28 February 2021. They were compared with a control cohort from the general population matched 10:1 for age and sex. The following COVID‐19 outcomes were studied: incidence of COVID‐19 infection, rates of hospitalization, intensive care admission and death. Hazard ratios (HR) with 95% confidence intervals (95% CI) adjusted for socioeconomic factors and comorbidities were estimated using Cox regression analysis.ResultsWe identified 5430 patients with AI and 54,300 matched controls: There were 47.6% women, mean age was 57.1 (standard deviation 18.1) years, and the frequency of COVID‐19 infection was similar, but the frequency of hospitalization (2.1% vs. 0.8%), intensive care (0.3% vs. 0.1%) and death (0.8% vs. 0.2%) for COVID‐19 was higher in AI patients than matched controls. After adjustment for socioeconomic factors and comorbidities, the HR (95% CI) was increased for hospitalization (1.96, 1.59–2.43), intensive care admission (2.76, 1.49–5.09) and death (2.29, 1.60–3.28).ConclusionPatients with AI have a similar incidence of COVID‐19 infection to a matched control population, but a more than twofold increased risk of developing a severe infection or a fatal outcome. They should therefore be prioritized for vaccination, antiviral therapy and other appropriate treatment to mitigate hospitalization and death.

Only as strong as the weakest link: Adrenal insufficiency in the COVID‐19 storm

“…In this issue of the Journal of Internal Medicine, Bergthorsdottir et al have analysed the COVID-19related outcomes in patients with adrenal insufficiency (AI) in Sweden [1]. Through a nationwide project that involved the entire Swedish population in the development of a unified healthcare database, they designed a matched-control study of mortality and morbidity associated with SARS-CoV-2 infection that yielded concerning results.…”