COVID Risks in Systemic Autoimmune Patients Save

There have been conflicting reports of whether rheumatic patients have greater risks once they are infected with COVID-19. This claims cohort analysis suggests a mixed picture. 

Drawing from a large multi‐center electronic health record network, this comparative cohort study of systemic autoimmune rheumatic diseases (SARDs) patients diagnosed with COVID‐19 were compared with COVID-19 infected persons without SARD. They analyzed 30 day outcomes, including hospitalization, ICU admission, mechanical ventilation, acute renal failure requiring renal replacement therapy (ARF), ischemic stroke, venous thromboembolism (VTE), and death.

Overall, the cohorts each included 2,379 COVID patients with SARD (mean age 58 years, 79% female) and 2,379 matched non‐SARD comparators with COVID‐19)., SARD patients had significantly higher risks of:

• Hospitalization (RR 1.14, 95% CI: 1.03 to 1.26),
• ICU admission (RR 1.32, 95% CI: 1.03 to 1.68),
• ARF (RR 1.81, 95% CI: 1.07 to 3.07), and
• VTE (RR 1.74, 95% CI: 1.23 to 2.45)

But SARDs with COVID-19 did not have significantly higher risks of mechanical ventilation or death.

In the extended model, where they corrected for comorbidities, all of these increased risks disappeared with the exception of higher risk of VTE (RR 1.60, 95% CI: 1.14 to 2.25).

Hence, like others infected with COVID-19, comorbidities in SARD patients may drive up the COVID-19 risks.  Other studies have suggested that the most at risk SARD patients are those with evidence of increased disease activity.  Lastly, the increased risk of VTE seen in many SARD patients, appears to be amplified in the setting of COVID-19 infection.