Temporal trends in severe COVID-19 outcomes in patients with rheumatic disease: a cohort study

Abstract

Background As the COVID-19 pandemic continues worldwide, severe COVID-19 outcomes remain a major concern for patients with rheumatic and musculoskeletal diseases. We aimed to investigate temporal trends in COVID-19 outcomes in patients with rheumatic and musculoskeletal diseases over the course of the pandemic. Methods Using a large, multicentre, electronic health record network (TriNetX), we did a comparative cohort study of patients with rheumatic and musculoskeletal diseases who were diagnosed with COVID-19 (by International Classification of Diseases, Tenth Revision code or positive PCR test) during the first 90 days of the pandemic (early cohort) compared with the second 90 days of the pandemic (late cohort), matched (1:1) for demographics, comorbidities, laboratory results, glucocorticoid use, and previous hospitalisations using an exposure score method. Outcomes were assessed within 30 days of COVID-19 diagnosis, including hospitalisation, intensive care unit admission, invasive mechanical ventilation, renal failure, and death. We did a subgroup analysis among patients with rheumatic and musculoskeletal diseases who were hospitalised with COVID-19. Findings We identified 8540 patients with rheumatic and musculoskeletal diseases who were diagnosed with COVID-19 during the 6-month study period, including 2811 in the early cohort and 5729 in the late cohort. In the exposure score matched analysis, the risk of hospitalisation was lower in the late cohort than in the early cohort (874 [32·4%] of 2701 patients vs 1227 [45·4%] of 2701 patients; relative risk [RR] 0·71, 95% CI 0·67–0·76). The risks of intensive care unit admission (214 [7·9%] vs 385 [14·3%]; RR 0·56, 95% CI 0·47–0·65), mechanical ventilation (96 [3·6%] vs 247 [9·1%]; 0·39, 0·31–0·49), acute kidney injury (372 [13·8%] vs 560 [20·7%]; 0·66, 0·59–0·75), renal replacement therapy (17 [0·6%] vs 32 [1·2%]; 0·53, 0·30–0·96), and death (122 [4·5%] vs 252 [9·3%]; 0·48, 0·39–0·60) were lower in the late cohort compared with the early cohort. Among the hospitalised subgroup, the risk of the composite outcome of intensive care unit admission, mechanical ventilation, and death was lower in the late cohort than in the early cohort (334 [30·7%] of 1089 patients vs 450 [41·3%] of 1089 patients; RR 0·74, 95% CI 0·67–0·83). Interpretation The risks of severe COVID-19 outcomes have improved over time in patients with rheumatic and musculoskeletal disease but remain substantial. These findings might reflect ascertainment of milder cases in the later cohort and improvements in treatment and supportive care. Funding None.

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

“…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. 19 Overall, the interpretation of the presented studies should be cautious in view of a potentially significant selection bias, as compared with the general population, immunosuppressed patients with AIIRD may be evaluated more closely, sent earlier to hospital, and admitted earlier into intensive care units, or been more frequently reported.…”

COVID-19 and the clinical course of rheumatic manifestations

“…Overall, the risks of severe COVID-19 in patients with rheumatic diseases have gradually reduced over time [ 79 ]. Rheumatic diseases have multiple comorbidities that may predispose to severe disease and worse outcomes [ 80 ].…”

Between COVID-19 severity and its prevention – what should rheumatologists be aware of?

“…What seems very interesting is that the outcomes of COVID-19 treatments in RMD patients have changed over time. In the study of Jorge et al [ 7 ] two cohorts of rheumatic patients infected with SARS-CoV-2 were compared. The early cohort (infections in the spring of 2020) had higher risk of hospitalization, mechanical ventilation, intensive care unit admission and fatal outcome compared to the late cohort (infections during summer months).…”