The association between severe or dead COVID-19 and autoimmune diseases: A systematic review and meta-analysis ✩ Dear Editor, Recently, Chen Tao (Doctor) and colleagues published a retrospective study, and delineated the clinical characteristics of patients with coronavirus disease 2019 (COVID-19) who died 1. They found that chronic hypertension and other cardiovascular comorbidities were more frequent among deceased patients than recovered patients 1. And there was no difference in the prevalence of the autoimmune disease between the two group patients 1. We appreciate this discovery, however, the conclusion of their study drew from a retrospective study, and the number of patients is only 113. Higher levels of evidence are needed to evaluate the association between severe or death COVID-19 and autoimmune disease. Therefore, we conducted the present systematic review and metaanalysis. Studies published up to 8 May 2020 were searched through PubMed, Embase.com, Web of Science and Cochrane Library. The published language was not restricted. Keywords included "COVID-19", "coronavirus disease-19", "new coronavirus", "2019-nCoV", "novel corona virus", "novel coronavirus", "nCoV-2019", "2019 novel coronavirus", "coronavirus disease 2019", "SARS-CoV-2", "severe acute respiratory syndrome coronavirus 2", "autoimmune disease", "clinical characteristic", "clinical feature", "risk factor", and "comorbidities". In addition, we searched the reference lists of eligible studies and relevant reviews to find potentially eligible studies (See search strategy of PubMed in Appendix Table 1). Study inclusion criteria: (1) patient was diagnosed as COVID-19 by the laboratory test; (2) provided data of autoimmune disease with severe or non-severe patients or between death and survivors. Study exclusion criteria: (1) studies did not provide the prevalence of autoimmune disease; (2) studies without comparisons (severe versus non-severe patients, death versus survival); (3) studies sample size is less than 10 patients; (4) abstracts, news, comments, editorials and review articles. According to the published studies 2 , the severity of disease was defined mainly on the basis of the symptoms present at diagnosis (e.g. patients with pulse oxygen saturation (SpO 2) less than 90%, or need of intensive care unit (ICU) care, or with acute respiratory distress syndrome). Study selection and data extraction were independently conducted by two reviewers. Disagreements were resolved by consensus or by a third investigator. We extracted the following data: first author, year of publication, country of the corresponding author, publication language, recruitment time frame, age and sex of ✩ Key message: Autoimmune disease was slightly associated with increased risk of severity and mortality of COVID-19 disease. tology alliance [published online ahead of print, 2020 May 6]. Rheumatology (Oxford). 2020 keaa191.