Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry.
Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry.
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DOI：
10.1136/annrheumdis-2020-219498
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发表时间：
2021-07
影响因子：
27.4
通讯作者：
COVID-19 Global Rheumatology Alliance
中科院分区：
文献类型：
--
作者：
Strangfeld A;Schäfer M;Gianfrancesco MA;Lawson-Tovey S;Liew JW;Ljung L;Mateus EF;Richez C;Santos MJ;Schmajuk G;Scirè CA;Sirotich E;Sparks JA;Sufka P;Thomas T;Trupin L;Wallace ZS;Al-Adely S;Bachiller-Corral J;Bhana S;Cacoub P;Carmona L;Costello R;Costello W;Gossec L;Grainger R;Hachulla E;Hasseli R;Hausmann JS;Hyrich KL;Izadi Z;Jacobsohn L;Katz P;Kearsley-Fleet L;Robinson PC;Yazdany J;Machado PM;COVID-19 Global Rheumatology Alliance
确定与风湿性疾病患者COVID-19相关死亡相关的因素。医生报告的风湿性疾病和确诊或推定COVID-19成人登记（2020年3月24日至7月1日）。主要结局为COVID-19相关死亡。年龄、性别、吸烟状况、合并症、风湿性疾病诊断、疾病活动和药物作为协变量纳入多变量logistic回归模型。根据风湿性疾病类别进一步分层分析。在3729例患者（平均年龄57岁，68%为女性）中，390例（10.5%）死亡。与COVID-19相关死亡相关的独立因素是年龄（66-75岁：OR 3.00，95% CI 2.13 ~ 4.22; >75岁：6.18，4.47 ~ 8.53;均vs ≤65岁），男性（1.46，1.11 ~ 1.91），高血压合并心血管疾病（1.89，1.31 - 2.73）、慢性肺病（1.68，1.26 - 2.25）和泼尼松龙等效剂量>10 mg/天（1.69，1.18 - 2.41; vs无糖皮质激素摄入）。中度/高度疾病活动性（相对于缓解/低疾病活动性）与较高的死亡几率相关（1.87，1.27至2.77）。美罗华（4.04，2.32至7.03），柳氮磺胺吡啶（3.60，1.66至7.78），免疫抑制剂（硫唑嘌呤、环磷酰胺、环孢素、麦考酚酯或他克莫司：2.22，1.43至3.46），且未接受任何缓解疾病的抗风湿药物（DMARD）（2.11，1.48至3.01）与更高的死亡几率，与甲氨蝶呤单药治疗相比。其他合成/生物DMARD与COVID-19相关死亡无关。在风湿性疾病患者中，COVID-19相关死亡与已知的一般因素（年龄较大、男性和特定合并症）和疾病特异性因素（疾病活动和特定药物）相关。与中度/高度疾病活动性的相关性突出了使用DMARD充分控制疾病的重要性，最好不增加糖皮质激素剂量。使用利妥昔单抗、柳氮磺胺吡啶和一些免疫抑制剂时可能需要谨慎。
To determine factors associated with COVID-19-related death in people with rheumatic diseases. Physician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category. Of 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66–75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death. Among people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants.
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