Predictors of hospitalization for COVID-19 in patients with autoimmune rheumatic diseases: results from a community cohort follow-up

Abstract

Objective The identification of risk factors for COVID-19 adverse course in autoimmune rheumatic diseases (ARDs) is of the utmost importance when approaching patient management; however, data are scarce in relation to the Latin American population. The objective of this study was to determine predictors of hospitalization for COVID-19 patients from an ARD community cohort. Methods A real setting longitudinal study (March to November 2020) in an ARD community cohort was carried out. Potential predictors of hospitalization for COVID-19 examined included (1) sociodemographic variables (age, gender, education, tobacco use, socioeconomic status, and co-inhabitants), (2) comorbidities, (3) time to COVID-19 diagnosis, and (4) ARD’s features: clinical (disease type, disease duration, activity), treatment [corticosteroids use/doses, use of synthetic DMARDs (cDMARDs, tsDMARDs, and bDMARDs)], treatment schedule and non-adherence, and the Multidimensional Health Assessment Questionnaire (MDHAQ). Univariable and multivariable regression analysis were conducted; OR and 95% CI (p < 0.05) were determined. Results One thousand and one hundred forty-eight patients with ARDs were included; 154 had COVID-19; of these 139 (90.3%) were women, aged 52.5 (13.7) years; 33.1% had hypertension and 61.0% an affected organ by ARD. Infection was detected 8.4 (10.1) days after symptoms started; there were 33 hospitalized patients (rate 21.4%). Predictors of hospitalization by multivariable analysis were age (OR: 1.06; CI: 1.01–1.10; p: 0.01), comorbidities: hypertension (OR: 3.95; 95% CI: 1.40–10.95, p: 0.01) and neoplasm (OR: 9.0; 95% CI: 1.6–52.3; p: 0.01), number of organs involved by ARD (OR: 2.26; 95% CI: 1.16–4.41; p: 0.02), and infection diagnosis delay (OR: 1.36; 95% CI: 1.03–1.80; p: 0.01). Conclusions In our ARD patients with COVID-19, older age, comorbidities (neoplasm and hypertension), and a delay in COVID-19 diagnosis were predictors of hospitalization. The only ARD-associated predictor feature was the number of organs involved. Key Points • Patients with ARD and COVID-19 have an adverse course in comparison to the general population. • Previous predictors of COVID-19 hospitalization, including known risk factors (such as older age and comorbidities) and systemic manifestations, should be taken into account in the management of these patients. • Delayed diagnosis of COVID-19 impacts negatively on prognosis. • Availability of diagnostic tests is of utmost importance.

Delays in COVID-19 Diagnosis and Hospitalization and Outcomes — New York City, New York, USA, October 2020–November 2021

“…Early COVID-19 testing and diagnosis can ensure timely treatment with appropriate therapies including mAb, antivirals, and steroids, which can improve prognosis ( 9, 10 ). While we do not have treatment data, our findings are consistent with previous studies that support early diagnosis and hospitalization of COVID-19 patients to prevent severe outcomes ( 1, 11 ).…”

Impact of Distinct Therapies on Antibody Response to SARS‐CoV‐2 Vaccine in Systemic Lupus Erythematosus

“…The impact of COVID‐19 in patients with autoimmune rheumatic diseases (ARDs) during the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) pandemic remains a major concern, especially in systemic lupus erythematosus (SLE). Data are still controversial, with some studies showing that the number of organs involved, disease activity, and ARD itself are associated with COVID‐19 poor outcome (1–3). In contrast, other studies have not confirmed this worse prognosis and have even suggested a lower risk of developing severe COVID‐19 in these patients (4,5).…”

Global Perspective on the Impact of the COVID‐19 Pandemic on Rheumatology and Health Equity

“…Informal work is much more common in populations with lower socioeconomic status, and social support for these groups was insufficient (60). Since this population had limited in-person and virtual health care access, their diagnosis was usually delayed, portending poorer outcomes (61). Moreover, social media networks were not helpful vehicles for educational outreach in these populations (62), creating barriers to disseminating COVID-19-related information and other information during the pandemic.…”