Clinical outcomes of hospitalised patients with COVID-19 and chronic inflammatory and autoimmune rheumatic diseases: a multicentric matched cohort study
Clinical outcomes of hospitalised patients with COVID-19 and chronic inflammatory and autoimmune rheumatic diseases: a multicentric matched cohort study
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DOI：
10.1136/annrheumdis-2020-218296
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发表时间：
2020-12-01
影响因子：
27.4
通讯作者：
Fernandez-Nebro, Antonio
中科院分区：
文献类型：
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作者：
Pablos, Jose L.;Galindo, Maria;Fernandez-Nebro, Antonio
目的炎症性风湿性疾病对COVID-19严重程度的影响知之甚少。在这里，我们比较了风湿性疾病患者队列与匹配对照队列的结果，以确定严重疾病的潜在风险因素。方法在这项比较队列研究中，我们确定了医院PCR+COVID-19风湿性患者的慢性炎症性关节炎（IA）或结缔组织病（CTD）。非风湿性对照组按1：1随机抽样，并按年龄、性别和PCR日期匹配。主要结局是严重的COVID-19，定义为死亡、有创通气、重症监护室入院或严重并发症。我们使用logistic回归评估了结果与潜在预后变量之间的关联，并根据COVID-19治疗进行了调整。结果队列由456名风湿性和非风湿性患者组成，人数相等。两个队列的平均年龄为63（IQR 53-78）岁，男性占41%。风湿性疾病以IA（60%）和CTD（40%）为主。大多数患者（74%）已住院，风湿性队列中重度COVID-19的风险为31.6%，非风湿性队列中为28.1%。通过双变量分析，年龄、男性和既往合并症（肥胖、糖尿病、高血压、心血管或肺部疾病）增加了风湿性队列的风险。在logistic回归分析中，与严重COVID-19相关的独立因素是年龄增加（OR 4.83; 95% CI 2.78 - 8.36），男性（1.93; CI 1.21至3.07），并具有CTD（OR 1.82;结论在慢性炎症性风湿病住院患者中，患有CTD但未患有IA或既往免疫抑制治疗与重度COVID-19相关。
Objectives The impact of inflammatory rheumatic diseases on COVID-19 severity is poorly known. Here, we compare the outcomes of a cohort of patients with rheumatic diseases with a matched control cohort to identify potential risk factors for severe illness.Methods In this comparative cohort study, we identified hospital PCR+COVID-19 rheumatic patients with chronic inflammatory arthritis (IA) or connective tissue diseases (CTDs). Non-rheumatic controls were randomly sampled 1:1 and matched by age, sex and PCR date. The main outcome was severe COVID-19, defined as death, invasive ventilation, intensive care unit admission or serious complications. We assessed the association between the outcome and the potential prognostic variables, adjusted by COVID-19 treatment, using logistic regression.Results The cohorts were composed of 456 rheumatic and non-rheumatic patients, in equal numbers. Mean age was 63 (IQR 53-78) years and male sex 41% in both cohorts. Rheumatic diseases were IA (60%) and CTD (40%). Most patients (74%) had been hospitalised, and the risk of severe COVID-19 was 31.6% in the rheumatic and 28.1% in the non-rheumatic cohort. Ageing, male sex and previous comorbidity (obesity, diabetes, hypertension, cardiovascular or lung disease) increased the risk in the rheumatic cohort by bivariate analysis. In logistic regression analysis, independent factors associated with severe COVID-19 were increased age (OR 4.83; 95% CI 2.78 to 8.36), male sex (1.93; CI 1.21 to 3.07) and having a CTD (OR 1.82; CI 1.00 to 3.30).Conclusion In hospitalised patients with chronic inflammatory rheumatic diseases, having a CTD but not IA nor previous immunosuppressive therapies was associated with severe COVID-19.