Characteristics associated with poor COVID-19 outcomes in individuals with systemic lupus erythematosus: data from the COVID-19 Global Rheumatology Alliance
Characteristics associated with poor COVID-19 outcomes in individuals with systemic lupus erythematosus: data from the COVID-19 Global Rheumatology Alliance
复制标题
DOI：
10.1136/annrheumdis-2021-221636
复制
发表时间：
2022-02-15
影响因子：
27.4
通讯作者：
Yazdany, Jinoos
中科院分区：
文献类型：
--
作者：
Ugarte-Gil, Manuel Francisco;Alarcon, Graciela S.;Yazdany, Jinoos
目的在系统性红斑狼疮（SLE）和COVID-19患者的全球登记中确定与更严重结局相关的特征。方法纳入2020年3月至2021年6月在COVID-19全球风湿病联盟登记处报告的SLE和COVID-19患者。顺序结局定义为：(1)未住院，(2)住院时无氧供氧，(3)住院时无通气或氧供氧，(4)死亡。构建多变量有序logistic回归模型，评估COVID-19严重程度与人口统计学特征、合并症、药物和疾病活动度之间的关系。结果共纳入1606例SLE患者。在多变量模型中，年龄较大（OR 1.03, 95% CI 1.02 - 1.04），男性（1.50,1.01 - 2.23），强的松剂量（1-5 mg/天1.86,1.20 - 2.66,6-9 mg/天2.47,1.24 - 4.86,>= 10 mg/天1.95,1.27 - 2.99），未接受当前治疗（1.80,1.17 - 2.75），合共病（如肾脏疾病3.51,2.42 - 5.09，心血管疾病/高血压1.69,1.25 - 2.29），中度或高度SLE疾病活动性(vs缓解；（分别为1.61（1.02 ~ 2.54）和3.94(2.11 ~ 7.34)）与更严重的结局相关。在年龄调整和性别调整模型中，与羟氯喹相比，霉酚酸盐、利妥昔单抗和环磷酰胺的预后更差；甲氨蝶呤和贝利单抗组的结果更有利。结论：SLE患者中更严重的COVID-19结局主要由人口统计学因素、合并症和未治疗或活动性SLE驱动。使用糖皮质激素的患者也经历了更严重的后果。
Aim To determine characteristics associated with more severe outcomes in a global registry of people with systemic lupus erythematosus (SLE) and COVID-19. Methods People with SLE and COVID-19 reported in the COVID-19 Global Rheumatology Alliance registry from March 2020 to June 2021 were included. The ordinal outcome was defined as: (1) not hospitalised, (2) hospitalised with no oxygenation, (3) hospitalised with any ventilation or oxygenation and (4) death. A multivariable ordinal logistic regression model was constructed to assess the relationship between COVID-19 severity and demographic characteristics, comorbidities, medications and disease activity. Results A total of 1606 people with SLE were included. In the multivariable model, older age (OR 1.03, 95% CI 1.02 to 1.04), male sex (1.50, 1.01 to 2.23), prednisone dose (1-5 mg/day 1.86, 1.20 to 2.66, 6-9 mg/day 2.47, 1.24 to 4.86 and >= 10 mg/day 1.95, 1.27 to 2.99), no current treatment (1.80, 1.17 to 2.75), comorbidities (eg, kidney disease 3.51, 2.42 to 5.09, cardiovascular disease/hypertension 1.69, 1.25 to 2.29) and moderate or high SLE disease activity (vs remission; 1.61, 1.02 to 2.54 and 3.94, 2.11 to 7.34, respectively) were associated with more severe outcomes. In age-adjusted and sex-adjusted models, mycophenolate, rituximab and cyclophosphamide were associated with worse outcomes compared with hydroxychloroquine; outcomes were more favourable with methotrexate and belimumab. Conclusions More severe COVID-19 outcomes in individuals with SLE are largely driven by demographic factors, comorbidities and untreated or active SLE. Patients using glucocorticoids also experienced more severe outcomes.