COVID-19 Outcomes in Patients With Systemic Autoimmune Rheumatic Diseases Compared to the General Population: A US Multicenter, Comparative Cohort Study.
COVID-19 Outcomes in Patients With Systemic Autoimmune Rheumatic Diseases Compared to the General Population: A US Multicenter, Comparative Cohort Study.
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DOI：
10.1002/art.41619
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发表时间：
2021-06
期刊：
影响因子：
--
通讯作者：
Choi HK
中科院分区：
文献类型：
--
作者：
D'Silva KM;Jorge A;Cohen A;McCormick N;Zhang Y;Wallace ZS;Choi HK
患有系统性自身免疫性风湿病(SARD)的患者继续担心严重新冠肺炎结局的风险。利用大型多中心电子健康档案网络，我们对新冠肺炎(以诊断代码或阳性分子测试识别)与非SARD对照新冠肺炎的SARD患者进行了一项比较队列研究，按年龄、性别、种族/民族、体重指数(初级模型)、合并症和医疗利用情况(扩展模型)进行匹配。评估了30天的结果，包括住院、重症监护病房(ICU)入院、机械通气、需要肾脏替代治疗(ARF)的急性肾衰竭、缺血性中风、静脉血栓栓塞症(VTE)和死亡。我们最初确定了2,379名患有新冠肺炎的SARD患者(平均年龄58岁，79%为女性)和142,750名对照组(平均年龄47岁，女性54%)。在初次匹配模型中(2,379名SAD患者和2,379名与新冠肺炎匹配的非SAD对照患者)，SAD患者住院(RR 1.14，95%CI：1.03~1.26)、ICU住院(RR 1.32，95%CI：1.03~1.68)、急性肾功能衰竭(RR 1.81，95%CI：1.07~3.07)和静脉血栓形成(RR 1.74，95%CI：1.23~2.45)的风险显著高于对照患者，但没有显著高于机械通气或死亡的风险。在扩展模型中，除VTE风险(RR 1.60，95%CI：1.14至2.25)外，所有风险均已基本减弱。与匹配的对照患者相比，患有新冠肺炎的SARD患者住院、ICU入院、ARF和静脉血栓栓塞症的风险可能更高。除了静脉血栓栓塞症的风险外，这些风险在很大程度上可能是由合并症所介导的。
Patients living with systemic autoimmune rheumatic diseases (SARDs) continue to be concerned about risks of severe COVID-19 outcomes. Using a large multi-center electronic health record network, we conducted a comparative cohort study of patients with SARDs diagnosed with COVID-19 (identified by diagnostic code or positive molecular test) versus non-SARD comparators with COVID-19, matched by age, sex, race/ethnicity, and body mass index (primary model) and comorbidities and health care utilization (extended model). Thirty-day outcomes were assessed, including hospitalization, intensive care unit (ICU) admission, mechanical ventilation, acute renal failure requiring renal replacement therapy (ARF), ischemic stroke, venous thromboembolism (VTE), and death. We initially identified 2,379 SARD patients with COVID-19 (mean age 58 years, 79% female) and 142,750 comparators (mean age 47 years, 54% female). In the primary matched model (2,379 SARD patients and 2,379 matched non-SARD comparators with COVID-19), SARD patients had significantly higher risks of hospitalization (RR 1.14, 95% CI: 1.03 to 1.26), ICU admission (RR 1.32, 95% CI: 1.03 to 1.68), ARF (RR 1.81, 95% CI: 1.07 to 3.07), and VTE (RR 1.74, 95% CI: 1.23 to 2.45) versus comparators but did not have significantly higher risks of mechanical ventilation or death. In the extended model, all risks were largely attenuated except risk of VTE (RR 1.60, 95% CI: 1.14 to 2.25). SARD patients with COVID-19 may be at higher risk of hospitalization, ICU admission, ARF, and VTE versus matched comparators. These risks may be largely mediated by comorbidities, except for risk of VTE.
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