Coronavirus disease 2019 (COVID-19) in autoimmune and inflammatory conditions: clinical characteristics of poor outcomes
Coronavirus disease 2019 (COVID-19) in autoimmune and inflammatory conditions: clinical characteristics of poor outcomes
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DOI：
10.1007/s00296-020-04676-4
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发表时间：
2020-08-13
影响因子：
4
通讯作者：
alvaro-Gracia, Jose
中科院分区：
文献类型：
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作者：
Montero, Fernando;Martinez-Barrio, Julia;alvaro-Gracia, Jose
目的描述马德里一家学术风湿病中心风湿病和肌肉骨骼疾病(RMD)患者的临床特征以及接受免疫抑制治疗的冠状病毒病2019(新冠肺炎)患者的临床特征，并确定与需要住院的严重感染相关的基线变量。方法应用聚合酶链式反应对SARS-CoV-2阳性病例进行鉴定，并建立临床RMDS数据库。当其他RMDS患者因阳性感染而联系诊所时，他们被发现。数据提取包括诊断、人口统计学、免疫抑制治疗、合并症和实验室测试。对有或没有住院的患者进行比较。采用多变量Logistic回归分析基线变量与住院需求之间的关系。结果截至2020年4月24日，共有62名新冠肺炎患者和潜在的RMD患者被确诊。中位年龄为60.9岁，其中42%为男性。42名患者需要住院；这些患者更多的是男性，年龄较大，并患有合并症。除了在住院患者中更常见的糖皮质激素外，在风湿病诊断和免疫抑制治疗的基线使用方面，组间没有统计学意义的差异。共死亡10例(16%)患者。在多因素分析中，男性(OR8.63；p=0.018)、既往肺部疾病史(OR27.47；p=0.042)和糖皮质激素使用(>；5 mg/d)(OR9.95；p=0.019)与住院显著相关。结论RMD的具体诊断和接触DMARDS与住院几率增加无关。男性、既往肺部疾病和接触糖皮质激素与RMDS患者住院几率较高相关。
Objective To describe clinical characteristics of patients with rheumatic and musculoskeletal diseases (RMDs) and immunosuppressive therapies with Coronavirus disease 2019 (COVID-19) at an academic rheumatology center in Madrid and to identify baseline variables associated with a severe infection requiring hospitalization. Methods We identified SARS-CoV-2 positive cases by polymerase chain reaction performed at our center within an updated RMDs database in our clinic. Additional RMDs patients were identified when they contacted the clinic because of a positive infection. Data extraction included diagnosis, demographics, immunosuppressive treatment, comorbidities, and laboratory tests. Comparisons between patients with or without hospitalization were performed. Multivariate logistic regression was used to analyze associations between baseline variables and need for hospitalization. Results A total of 62 patients with COVID-19 and underlying RMDs were identified by April 24, 2020. Median age was 60.9 years, and 42% men. Forty-two patients required hospitalization; these were more frequently men, older and with comorbidities. There were no statistically significant between-group differences for rheumatologic diagnosis and for baseline use of immunosuppressive therapy except for glucocorticoids that were more frequent in hospitalized patients. Total deaths were 10 (16%) patients. In multivariate analysis, male sex (odds ratio [OR], 8.63;p = 0.018), previous lung disease (OR, 27.47;p = 0.042), and glucocorticoids use (> 5 mg/day) (OR, 9.95;p = 0.019) were significantly associated to hospitalization. Conclusion Neither specific RMD diagnoses or exposures to DMARDs were associated with increased odds of hospitalization. Being male, previous lung disease and exposure to glucocorticoids were associated with higher odds of hospitalization in RMDs patients.