Systemic autoimmune rheumatic disease (SARD) patients with coronavirus disease 2019 (COVID-19) had higher risk of hospitalization, intensive care unit (ICU) admission, acute renal failure requiring renal replacement therapy, and venous thromboembolism (VTE) than comparators, but did not have higher risk of mechanical ventilation or death, according to a study published in Arthritis & Rheumatology. Additionally,the study found that these risks may be largely mediated by comorbidities, except for risk of VTE.
“This is the first national multicenter cohort study examining COVID-19 outcomes in SARD patients. The data source is representative of academic and community healthcare settings across the US, and the results are therefore likely generalizable,” wrote Kristin M D’Silva, MD, Massachusetts General Hospital & Harvard Medical School, Boston, Massachusetts and colleagues.
Using a large multi-center electronic health record network, the researchers conducted a comparative cohort study of patients with SARD diagnosed with COVID-19 versus non-SARD comparators with COVID-19, matched by age, sex, race/ethnicity, and body mass index (primary model) and comorbidities and health care utilization (extended model). Thirty-day outcomes were assessed, including hospitalization, ICU admission, mechanical ventilation, acute renal failure requiring renal replacement therapy, ischemic stroke, VTE, death and a composite outcome of ICU admission, mechanical ventilation, or death.
A total of 2,379 SARD patients with COVID-19 (mean age, 58 years; 79% female) and 142,750 non-SARD patients with COVID-19 (mean age, 47 years; 54% female) were identified. In the SARD cohort, the most common rheumatic diseases were rheumatoid arthritis (50%), systemic lupus erythematosus (22%), Sjögren’s syndrome (13%), mixed or undifferentiated connective tissue disease (8%), systemic vasculitis (7%), and psoriatic arthritis (8%). Further, 55% of SARD patients were on glucocorticoids, 41% were on conventional synthetic disease-modifying antirheumatic drugs (DMARDs), and 16% were on biologic/targeted synthetic DMARDs.
In the primary exposure score (ES)-matched analysis of 2,379 SARD patients and 2,379 matched non-SARD comparators, SARD patients were found to have significantly higher risks of hospitalization (relative risk [RR], 1.14; 95% confidence interval [CI], 1.03-1.26), ICU admission (RR, 1.32; 95% CI, 1.03-1.68), acute renal failure requiring renal replacement therapy (RR, 1.81; 95% CI, 1.07-3.07), and VTE (RR, 1.74; 95% CI, 1.23-2.45) compared with non-SARD comparators. However, there were no significantly higher risks of mechanical ventilation, death, or a composite outcome of ICU admission, mechanical ventilation, or death in the SARD cohort compared with the non-SARD cohort.
In the extended ES-matched analysis, the previously observed higher risks of hospitalization, ICU admission, and acute renal failure requiring renal replacement therapy were attenuated and no longer significantly higher in the SARD cohort when compared to the comparator cohort, except for the risk of VTE (RR, 1.60; 95% CI, 1.14-2.25).
Within the SARDs cohort, there were significantly higher risks of the composite outcome among patients on glucocorticoids compared with non-users in the primary ES-matched (RR, 1.74; 95% CI, 1.28- 2.38) and extended ES-matched (RR, 1.50; 95% CI, 1.07-2.10) analyses, while conventional synthetic DMARDs and biologic/targeted synthetic DMARDs were not associated with higher risks of composite outcome.
“We observed a significantly higher risk of VTE in SARD patients versus matched comparators in our primary and extended models … Patients living with SARDs at baseline may be at higher risk of VTE due to a chronic inflammatory state and/or antiphospholipid syndrome,” the authors noted. “SARD patients with COVID-19 should be closely monitored for thrombotic complications.”