The Association between Noninfectious Uveitis and Coronavirus Disease 2019 Outcomes: An Analysis of United States Claims-Based Data.
The Association between Noninfectious Uveitis and Coronavirus Disease 2019 Outcomes: An Analysis of United States Claims-Based Data.
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DOI：
10.1016/j.ophtha.2021.10.007
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发表时间：
2022-03
期刊：
影响因子：
13.7
通讯作者：
Acharya NR
中科院分区：
文献类型：
--
作者：
Miller DC;Sun Y;Chen EM;Arnold BF;Acharya NR
以确定非传染性葡萄膜炎(NIU)是否与2019年冠状病毒病(新冠肺炎)感染、住院和死亡的更高风险相关。一项从2020年1月20日到2020年12月31日的回溯性队列研究，使用的是基于国家索赔的数据库。在2020年1月20日之前连续投保医疗和药房保险满3年的投保人。在研究开始后3年内确诊为NIU的患者被纳入NIU队列。那些在风险期间有感染性葡萄膜炎代码或新诊断为NIU的人被排除在外。使用COX比例风险模型来确定每个结果测量的所有协变量的未调整风险比(HR)和调整后风险比(HR)。调整后的模型考虑了风险期间患者的人口统计学、健康状况和免疫抑制药物的使用情况。新冠肺炎感染率、新冠肺炎相关住院率和新冠肺炎相关住院死亡率符合国际疾病分类第10版修订代码。本研究包括5例 -806- -227患者，其中29例 -869(0.5%)被诊断为NIU.在未调整的分析中，患有非淋菌性尿道炎的患者有更高的新冠肺炎感染率(5.7%比4.5%，P<；0.001)、与新冠肺炎相关的住院率(1.2%比0.6%，P<；0.001)和新冠肺炎相关死亡(0.3%比0.1%，P<；0.001)。然而，在调整后的模型中，NIU与新冠肺炎感染的风险(HR，1.05；95%可信区间[CI]，1.00~1.10；P=0.04)、住院(HR，0.98；95%CI，0.88~1.09；P=0.67)或死亡(HR，0.90，95%CI，0.72~1.13，P=0.37)无关。全身性皮质类固醇的使用与新冠肺炎感染、住院和死亡的风险显著相关。患有NIU的患者明显更有可能感染新冠肺炎并经历严重的疾病后果。然而，这种关联是由于NIU患者的人口统计学、合并症和药物治疗，而不是单独的NIU。使用全身皮质类固醇的患者感染新冠肺炎的可能性显著增加，住院和住院死亡的风险也更大。有必要进行额外的调查，以确定皮质类固醇暴露对新冠肺炎相关结局的影响。
To identify if noninfectious uveitis (NIU) is associated with a greater risk of Coronavirus Disease 2019 (COVID-19) infection, hospitalization, and death. A retrospective cohort study from January 20, 2020 to December 31, 2020, using a national claims-based database. Enrollees who had continuous enrollment with both medical and pharmacy coverage for 3 years before January 20, 2020. Patients with an NIU diagnosis within 3 years of the start of the study were included in the NIU cohort. Those with infectious uveitis codes or new NIU diagnoses during the risk period were excluded. Cox proportional hazard models were used to identify unadjusted hazard ratios (HRs) and adjusted HRs for all covariates for each outcome measure. Adjusted models accounted for patient demographics, health status, and immunosuppressive medication use during the risk period. Rates of COVID-19 infection, COVID-19-related hospitalization, and COVID-19-related in-hospital death identified with International Classification of Disease 10th revision codes. This study included 5 806 227 patients, of whom 29 869 (0.5%) had a diagnosis of NIU. On unadjusted analysis, patients with NIU had a higher rate of COVID-19 infection (5.7% vs. 4.5%, P < 0.001), COVID-19-related hospitalization (1.2% vs. 0.6%, P < 0.001), and COVID-19-related death (0.3% vs. 0.1%, P < 0.001). However, in adjusted models, NIU was not associated with a greater risk of COVID-19 infection (HR, 1.05; 95% confidence interval [CI], 1.00–1.10; P = 0.04), hospitalization (HR, 0.98; 95% CI, 0.88–1.09; P = 0.67), or death (HR, 0.90, 95% CI, 0.72–1.13, P = 0.37). Use of systemic corticosteroids was significantly associated with a higher risk of COVID-19 infection, hospitalization, and death. Patients with NIU were significantly more likely to be infected with COVID-19 and experience severe disease outcomes. However, this association was due to the demographics, comorbidities, and medications of patients with NIU, rather than NIU alone. Patients using systemic corticosteroids were significantly more likely to be infected with COVID-19 and were at greater risk of hospitalization and in-hospital death. Additional investigation is necessary to identify the impact of corticosteroid exposure on COVID-19-related outcomes.
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