Risk Factors for Severe Outcomes in Patients With Systemic Vasculitis and COVID-19: A Binational, Registry-Based Cohort Study.
Risk Factors for Severe Outcomes in Patients With Systemic Vasculitis and COVID-19: A Binational, Registry-Based Cohort Study.
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DOI：
10.1002/art.41728
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发表时间：
2021-09
期刊：
影响因子：
--
通讯作者：
UK and Ireland Vasculitis Rare Disease Group (UKIVAS)
中科院分区：
文献类型：
--
作者：
Rutherford MA;Scott J;Karabayas M;Antonelou M;Gopaluni S;Gray D;Barrett J;Brix SR;Dhaun N;McAdoo SP;Smith RM;Geddes CC;Jayne D;Luqmani R;Salama AD;Little MA;Basu N;UK and Ireland Vasculitis Rare Disease Group (UKIVAS)
新冠肺炎是一种新的传染性疾病，具有广泛的临床严重性。系统性脉管炎患者严重感染的风险增加，并可能面临新冠肺炎后严重预后的风险。我们开展了这项研究，以确定这些患者严重新冠肺炎预后的危险因素，包括免疫抑制治疗的影响。通过参与英国和爱尔兰国家脉管炎登记中心的参与，建立了一个多中心队列。临床特点和结果进行了描述。Logistic回归用于评估潜在危险因素与严重新冠肺炎结局之间的关系，严重预后被定义为需要高级氧疗、需要有创机械通气或死亡。队列包括65名发生新冠肺炎的系统性脉管炎患者(中位年龄70岁，女性占49%)，其中25名患者(38%)经历了严重的结局。大多数患者(55/65[85%])患有抗中性粒细胞胞浆抗体相关性小血管炎(AAV)。几乎所有患者都需要住院(59/65[91%])，7名患者(11%)住进重症监护室，18名患者(28%)死亡。背景糖皮质激素治疗与严重预后相关(调整后的优势比[OR]3.7[95%可信区间1.1~14.9]；P=0.047)，合并呼吸道疾病(调整后的OR 7.5[95%可信区间1.9~38.2]；P=0.006)。血管炎、疾病活动性和非糖皮质激素免疫抑制治疗与严重预后无关。在系统性脉管炎患者中，出现症状时使用糖皮质激素和并发呼吸道疾病与新冠肺炎的严重预后相关。这些数据可以为临床决策提供信息，与这一脆弱患者组发生严重新冠肺炎的风险有关。
COVID‐19 is a novel infectious disease with a broad spectrum of clinical severity. Patients with systemic vasculitis have an increased risk of serious infections and may be at risk of severe outcomes following COVID‐19. We undertook this study to establish the risk factors for severe COVID‐19 outcomes in these patients, including the impact of immunosuppressive therapies. A multicenter cohort was developed through the participation of centers affiliated with national UK and Ireland vasculitis registries. Clinical characteristics and outcomes are described. Logistic regression was used to evaluate associations between potential risk factors and a severe COVID‐19 outcome, defined as a requirement for advanced oxygen therapy, a requirement for invasive ventilation, or death. The cohort included 65 patients with systemic vasculitis who developed COVID‐19 (median age 70 years, 49% women), of whom 25 patients (38%) experienced a severe outcome. Most patients (55 of 65 [85%]) had antineutrophil cytoplasmic antibody–associated vasculitis (AAV). Almost all patients required hospitalization (59 of 65 [91%]), 7 patients (11%) were admitted to intensive care, and 18 patients (28%) died. Background glucocorticoid therapy was associated with severe outcomes (adjusted odds ratio [OR] 3.7 [95% confidence interval 1.1–14.9]; P = 0.047), as was comorbid respiratory disease (adjusted OR 7.5 [95% confidence interval 1.9–38.2]; P = 0.006). Vasculitis disease activity and nonglucocorticoid immunosuppressive therapy were not associated with severe outcomes. In patients with systemic vasculitis, glucocorticoid use at presentation and comorbid respiratory disease were associated with severe outcomes in COVID‐19. These data can inform clinical decision‐making relating to the risk of severe COVID‐19 in this vulnerable patient group.
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