Autoimmune and Chronic Inflammatory Disease Patients with COVID-19.
Autoimmune and Chronic Inflammatory Disease Patients with COVID-19.
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DOI：
10.1002/acr2.11221
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发表时间：
2021-03
影响因子：
3.4
通讯作者：
Klang E
中科院分区：
文献类型：
--
作者：
Ungaro RC;Agrawal M;Park S;Hirten R;Colombel JF;Twyman K;Gulko PS;Klang E
与没有自身免疫性和慢性炎症性疾病的住院患者相比，关于冠状病毒病2019(新冠肺炎)对住院患者的影响的数据有限。我们试图评估确诊为新冠肺炎的AICID患者与感染新冠肺炎的非AICID患者相比，是否有更高的不良结局风险，以及免疫抑制药物是否会影响这一风险。我们进行了一项多中心回顾性队列研究，患者在一个大型学术卫生系统中的五家医院就诊，聚合酶链式反应证实为新冠肺炎感染。我们评估了AICID和用于治疗AICID(生物制剂、非生物免疫抑制剂或全身性皮质类固醇)患者的免疫抑制药物类别对发展为需要机械通气(MV)和/或死亡的严重新冠肺炎的风险的影响。共有6,792名确诊为新冠肺炎的患者纳入研究，其中159人(2.3%)至少有一种AICID。在多变量分析中，AICID与严重新冠肺炎无显著关联(调整后的优势比[AOR]1.3，95%可信区间[CI]：0.9-1.8)。在AICID患者中，使用生物制剂或非生物免疫抑制剂不会增加严重新冠肺炎的风险。相反，全身应用皮质类固醇与严重新冠肺炎风险的增加显著相关(AOR6.8，95%CI：2.5-18.4)。除服用皮质类固醇的患者外，患有严重新冠肺炎的患者并没有增加风险。这些数据表明，在新冠肺炎大流行期间，艾滋病患者应该继续接受生物和非生物免疫抑制，但限制类固醇类药物的使用。
There are limited data on the impact of coronavirus disease 2019 (COVID‐19) on hospitalized patients with autoimmune and chronic inflammatory disease (AICID) compared with patients who do not have AICID. We sought to evaluate whether patients with AICID who have confirmed COVID‐19 presenting to the hospital are at higher risk of adverse outcomes compared with those patients without AICID who are infected with COVID‐19 and whether immunosuppressive medications impact this risk. We performed a multicenter retrospective cohort study with patients presenting to five hospitals in a large academic health system with polymerase chain reaction–confirmed COVID‐19 infection. We evaluated the impact of having an AICID and class of immunosuppressive medication being used to treat patients with AICID (biologics, nonbiologic immunosuppressives, or systemic corticosteroids) on the risk of developing severe COVID‐19 defined as requiring mechanical ventilation (MV) and/or death. A total of 6792 patients with confirmed COVID‐19 were included in the study, with 159 (2.3%) having at least one AICID. On multivariable analysis, AICIDs were not significantly associated with severe COVID‐19 (adjusted odds ratio [aOR] 1.3, 95% confidence interval [CI]: 0.9‐1.8). Among patients with AICID, use of biologics or nonbiologic immunosuppressives did not increase the risk of severe COVID‐19. In contrast, systemic corticosteroid use was significantly associated with an increased risk of severe COVID‐19 (aOR 6.8, 95% CI: 2.5‐18.4). Patients with AICID are not at increased risk of severe COVID‐19 with the exception of those on corticosteroids. These data suggest that patients with AICID should continue on biologic and nonbiologic immunosuppression but limit steroids during the COVID‐19 pandemic.
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