The Impact of Immunosuppression and Autoimmune Disease on Severe Outcomes in Patients Hospitalized with COVID-19

Abstract

Immunosuppression (IS) and autoimmune disease (AD) are prevalent in patients with severe coronavirus disease 2019 (COVID-19), but their impact on its clinical course is unknown. We investigated relationships between IS, AD, and outcomes in patients hospitalized with COVID-19. Data on consecutive admissions for COVID-19 were extracted retrospectively from medical records. Patients were assigned to one of four cohorts, according to whether or not they had an AD (AD and NAD) or were immunosuppressed (IS and NIS). The primary endpoint was development of severe acute respiratory distress syndrome (ARDS); secondary endpoints included death, and a composite of mechanical ventilation (MV) or death. A total of 789 patients were included: 569 (72.1%) male, 76 (9.6%) with an AD, and 63 (8.0%) with IS. Relative to the NIS-NAD cohort, patients in the IS-AD cohort had a significantly reduced risk of severe ARDS (adjusted hazard ratio [aHR] 0.42; 95% confidence interval [CI] 0.23-0.80; p = 0.008). No significant relationships between IS or AD status and either death or the composite of MV and death were identified, although a trend towards higher mortality was identified in the IS-NAD cohort (aHR vs NIS-NAD 1.71; 95% CI 0.94-3.12; p = 0.081). Patients in this cohort also had higher median serum levels of interleukin-6 compared with IS-AD patients (98.2 vs 21.6 pg/mL; p = 0.0328) and NIS-NAD patients (29.1 pg/mL; p = 0.0057). In conclusion, among patients hospitalized with COVID-19, those receiving immunosuppressive treatment for an AD may have a reduced risk of developing severe ARDS.

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

“…have not yet found such an association (35,36). We found 21% higher odds of complicated hospitalizations among patients with IMIDs when considering the entire study population regardless of whether they were admitted.…”

COVID-19: biologic and immunosuppressive therapy in gastroenterology and hepatology

“…It was found that fewer patients with IMIDs receiving cytokine blocker therapy (which do not deplete B cells) had SARS-CoV-2 IgG seroconversion than patients without such therapy and healthy individuals 53 , suggesting that cytokine inhibitors at least partially protect against severe SARS-CoV-2 infection. Conversely, another study ( n = 789 patients) examined the effects of immunosuppression on COVID-19 in patients with autoimmune and chronic inflammatory diseases 90 . Relative to the control cohort (without autoimmune diseases and immunosuppressive therapy), patients with immunosuppressive therapy in autoimmunity had a markedly reduced risk of severe acute respiratory distress syndrome.…”

COVID-19 infection among autoimmune rheumatic disease patients: Data from an observational study and literature review

“…Despite the initial concerns regarding susceptibility to SARS-CoV-2 infection among patients with AARD, a growing body of data -mostly observational in nature-is reassuring and detects similar or slightly elevated risk for serious/fetal COVID-19 compared to the general population [ [2] , [3] , [4] , [5] , [6] ]. Of interest the use of immunosuppressive therapy and adherence to treatment has been shown to be associated with lower frequency of COVID-19 related symptoms [ 5 ], lowering the risk for developing severe acute respiratory distress syndrome (ARDS) [ 7 ]. Small series and case reports of patients with AARD infected with SARS-CoV-2 revealed that the treatment with tumor necrosis factor a (TNFα) antagonists, anakinra or tocilizumab develop a mildest form of SARS-CoV-2 infection [ 8 ].…”