High levels of immunosuppression are related to unfavourable outcomes in hospitalised patients with rheumatic diseases and COVID-19: first results of ReumaCoV Brasil registry.
High levels of immunosuppression are related to unfavourable outcomes in hospitalised patients with rheumatic diseases and COVID-19: first results of ReumaCoV Brasil registry.
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DOI：
10.1136/rmdopen-2020-001461
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发表时间：
2021-01
期刊：
影响因子：
6.2
通讯作者：
Reis APMG
中科院分区：
文献类型：
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作者：
Marques CDL;Kakehasi AM;Pinheiro MM;Mota LMH;Albuquerque CP;Silva CR;Santos GPJ;Reis-Neto ET;Matos P;Devide G;Dantas A;Giorgi RD;Marinho AO;Valadares LDA;Melo AKG;Ribeiro FM;Ferreira GA;Santos FPS;Ribeiro SLE;Andrade NPB;Yazbek MA;Souza VA;Paiva ES;Azevedo VF;Freitas ABSB;Provenza JR;Toledo RA;Fontenelle S;Carneiro S;Xavier R;Pileggi GCS;Reis APMG
评估与不利结果相关的危险因素：免疫介导的风湿病（IMRD）和COVID-19患者的急诊护理、住院、入住重症监护病房（ICU）、机械通气和死亡。对观察性多中心前瞻性队列研究（ReumaCoV Brasil register）前8周的分析。根据卫生部的标准，IMRD和COVID-19患者被归类为符合研究条件的患者。334名参与者被招募，其中大多数是女性，平均年龄为45岁；系统性红斑狼疮（32.9%）是最常见的IMRD。160例患者需要紧急护理，其中33.0%住院，15.0%住进ICU， 10.5%接受了机械通气；死亡28例（8.4%）。在急诊护理的多变量调整模型中，糖尿病（患病率比，PR 1.38; 95% CI 1.11 ~ 1.73; p=0.004）、肾脏疾病（PR 1.36; 95% CI 1.05 ~ 1.77; p=0.020）、口服糖皮质激素（GC） （PR 1.49; 95% CI 1.21 ~ 1.85; p<0.001）和甲基强的松龙脉冲治疗（PR 1.38; 95% CI 1.14 ~ 1.67; p=0.001）仍然具有显著性；对于住院患者，年龄在50岁至50岁之间（PR为1.89；95% CI为1.26至2.85;p=0.002），未使用肿瘤坏死因子抑制剂（TNFi） （PR为2.51；95% CI为1.16至5.45;p=0.004）和甲基强的松龙脉冲治疗（PR为2.50；95% CI为1.59至3.92;p<0.001）；对于ICU患者，口服GC （PR 2.24; 95% CI 1.36 ~ 3.71; p<0.001）和甲基强的松龙脉冲治疗（PR 1.65; 95% CI 1.00 ~ 2.68; p<0.043）；与死亡相关的两个变量是甲基强的松龙或环磷酰胺脉冲治疗（PR 2.86; 95% CI 1.59 ~ 5.14; p<0.018）。年龄0 ~ 50岁、GC和环磷酰胺免疫抑制与COVID-19的不良结局相关。TNFi治疗可能具有保护作用，可能导致COVID-19炎症过程。
To evaluate risk factors associated with unfavourable outcomes: emergency care, hospitalisation, admission to intensive care unit (ICU), mechanical ventilation and death in patients with immune-mediated rheumatic disease (IMRD) and COVID-19. Analysis of the first 8 weeks of observational multicentre prospective cohort study (ReumaCoV Brasil register). Patients with IMRD and COVID-19 according to the Ministry of Health criteria were classified as eligible for the study. 334 participants were enrolled, a majority of them women, with a median age of 45 years; systemic lupus erythematosus (32.9%) was the most frequent IMRD. Emergency care was required in 160 patients, 33.0% were hospitalised, 15.0% were admitted to the ICU and 10.5% underwent mechanical ventilation; 28 patients (8.4%) died. In the multivariate adjustment model for emergency care, diabetes (prevalence ratio, PR 1.38; 95% CI 1.11 to 1.73; p=0.004), kidney disease (PR 1.36; 95% CI 1.05 to 1.77; p=0.020), oral glucocorticoids (GC) (PR 1.49; 95% CI 1.21 to 1.85; p<0.001) and pulse therapy with methylprednisolone (PR 1.38; 95% CI 1.14 to 1.67; p=0.001) remained significant; for hospitalisation, age >50 years (PR 1.89; 95% CI 1.26 to 2.85; p=0.002), no use of tumour necrosis factor inhibitor (TNFi) (PR 2.51;95% CI 1.16 to 5.45; p=0.004) and methylprednisolone pulse therapy (PR 2.50; 95% CI 1.59 to 3.92; p<0.001); for ICU admission, oral GC (PR 2.24; 95% CI 1.36 to 3.71; p<0.001) and pulse therapy with methylprednisolone (PR 1.65; 95% CI 1.00 to 2.68; p<0.043); the two variables associated with death were pulse therapy with methylprednisolone or cyclophosphamide (PR 2.86; 95% CI 1.59 to 5.14; p<0.018). Age >50 years and immunosuppression with GC and cyclophosphamide were associated with unfavourable outcomes of COVID-19. Treatment with TNFi may have been protective, perhaps leading to the COVID-19 inflammatory process.