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Clinical outcomes of hospitalised patients with COVID-19 and chronic inflammatory and autoimmune rheumatic diseases: a multicentric matched cohort study.
Ann Rheum Dis. 2020 12; 79(12):1544-1549.AR

Abstract

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.

Authors+Show Affiliations

Servicio de Reumatología, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain jlpablos@h12o.es. Universidad Complutense de Madrid, Madrid, Spain.Servicio de Reumatología, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain.Instituto de Salud Musculoesquelética (INMUSC), Madrid, Spain.Servicio de Reumatología, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain.Servicio de Reumatología, Instituto de Investigación Hospital 12 de Octubre, Madrid, Spain.Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla (IDIVAL), Santander, Spain.Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla (IDIVAL), Santander, Spain.Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla (IDIVAL), Santander, Spain.Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.Servicio de Reumatología, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.Servicio de Reumatología, Hospital Clínico Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain.Servicio de Reumatología, Hospital Clínico Universitario de Santiago, Instituto de Investigación Sanitaria de Santiago (IDIS), Santiago de Compostela, Spain.UGC de Reumatología, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.UGC de Reumatología, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.UGC de Reumatología, Hospital Regional Universitario de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, Spain.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

32796045

Citation

Pablos, Jose L., et al. "Clinical Outcomes of Hospitalised Patients With COVID-19 and Chronic Inflammatory and Autoimmune Rheumatic Diseases: a Multicentric Matched Cohort Study." Annals of the Rheumatic Diseases, vol. 79, no. 12, 2020, pp. 1544-1549.
Pablos JL, Galindo M, Carmona L, et al. Clinical outcomes of hospitalised patients with COVID-19 and chronic inflammatory and autoimmune rheumatic diseases: a multicentric matched cohort study. Ann Rheum Dis. 2020;79(12):1544-1549.
Pablos, J. L., Galindo, M., Carmona, L., Lledó, A., Retuerto, M., Blanco, R., Gonzalez-Gay, M. A., Martinez-Lopez, D., Castrejón, I., Alvaro-Gracia, J. M., Fernández Fernández, D., Mera-Varela, A., Manrique-Arija, S., Mena Vázquez, N., & Fernandez-Nebro, A. (2020). Clinical outcomes of hospitalised patients with COVID-19 and chronic inflammatory and autoimmune rheumatic diseases: a multicentric matched cohort study. Annals of the Rheumatic Diseases, 79(12), 1544-1549. https://doi.org/10.1136/annrheumdis-2020-218296
Pablos JL, et al. Clinical Outcomes of Hospitalised Patients With COVID-19 and Chronic Inflammatory and Autoimmune Rheumatic Diseases: a Multicentric Matched Cohort Study. Ann Rheum Dis. 2020;79(12):1544-1549. PubMed PMID: 32796045.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical outcomes of hospitalised patients with COVID-19 and chronic inflammatory and autoimmune rheumatic diseases: a multicentric matched cohort study. AU - Pablos,Jose L, AU - Galindo,María, AU - Carmona,Loreto, AU - Lledó,Ana, AU - Retuerto,Miriam, AU - Blanco,Ricardo, AU - Gonzalez-Gay,Miguel A, AU - Martinez-Lopez,David, AU - Castrejón,Isabel, AU - Alvaro-Gracia,José M, AU - Fernández Fernández,David, AU - Mera-Varela,Antonio, AU - Manrique-Arija,Sara, AU - Mena Vázquez,Natalia, AU - Fernandez-Nebro,Antonio, AU - ,, AU - ,, Y1 - 2020/08/12/ PY - 2020/06/12/received PY - 2020/07/31/revised PY - 2020/07/31/accepted PY - 2020/8/17/pubmed PY - 2020/11/27/medline PY - 2020/8/16/entrez KW - ankylosing KW - arthritis KW - autoimmune diseases KW - epidemiology KW - psoriatic KW - rheumatoid KW - spondylitis SP - 1544 EP - 1549 JF - Annals of the rheumatic diseases JO - Ann Rheum Dis VL - 79 IS - 12 N2 - 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. SN - 1468-2060 UR - https://www.unboundmedicine.com/medline/citation/32796045/Clinical_outcomes_of_hospitalised_patients_with_COVID_19_and_chronic_inflammatory_and_autoimmune_rheumatic_diseases:_a_multicentric_matched_cohort_study_ DB - PRIME DP - Unbound Medicine ER -