Risk factors for hospital admissions related to COVID-19 in patients with autoimmune inflammatory rheumatic diseases

  1. Dalifer D Freites Nuñez
  2. Leticia Leon
  3. Arkaitz Mucientes
  4. Luis Rodriguez-Rodriguez
  5. Judit Font Urgelles
  6. Alfredo Madrid García
  7. Jose I Colomer
  8. Juan A Jover
  9. Benjamín Fernandez-Gutierrez
  10. Lydia Abasolo

Reviewed by

Read the full article

Listed in

Log in to save this article

Abstract

To describe patients with autoimmune inflammatory rheumatic diseases (AIRD) who had COVID-19 disease; to compare patients who required hospital admission with those who did not and assess risk factors for hospital admission related to COVID-19.

Methods

An observational longitudinal study was conducted during the pandemic peak of severe acute respiratory syndrome coronavirus 2 (1 March 2020 to 24 April). All patients attended at the rheumatology outpatient clinic of a tertiary hospital in Madrid, Spain with a medical diagnosis of AIRD and with symptomatic COVID-19 were included. The main outcome was hospital admission related to COVID-19. The covariates were sociodemographic, clinical and treatments. We ran a multivariable logistic regression model to assess risk factors for the hospital admission.

Results

The study population included 123 patients with AIRD and COVID-19. Of these, 54 patients required hospital admission related to COVID-19. The mean age on admission was 69.7 (15.7) years, and the median time from onset of symptoms to hospital admission was 5 (3–10) days. The median length of stay was 9 (6–14) days. A total of 12 patients died (22%) during admission. Compared with outpatients, the factors independently associated with hospital admission were older age (OR: 1.08; p=0.00) and autoimmune systemic condition (vs chronic inflammatory arthritis) (OR: 3.55; p=0.01). No statistically significant findings for exposure to disease-modifying antirheumatic drugs were found in the final model.

Conclusion

Our results suggest that age and having a systemic autoimmune condition increased the risk of hospital admission, whereas disease-modifying antirheumatic drugs were not associated with hospital admission.

Article activity feed

  1. Version published to 10.1136/annrheumdis-2020-217984
  2. ScreenIT

    SciScore for 10.1101/2020.05.14.20101584: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIACUC: The study was conducted in accordance with the Declaration of Helsinki and Good Clinical Practices and was approved by the Hospital Clínico San Carlos institutional ethics committee (approval number 20/268-E-BS).
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The results of our study should be interpreted considering limitations. First, we have to take into account the observational nature of the study and that our patients were treated at a single center. This, associated with the fact that data was recorded during routine consultations, that it is an environment with heavy workload, makes easier the possibility of incomplete and not recoverable information. Another limitation is the difficulty to identify patients. Of the patients who did not require admission, a third contacted the rheumatology service to report the disease, and the other cases were detected through the discharge parts by COVID-19 of their primary care physician. For sure, elderly or housewives who have not contacted us are missing, and may have patient selection biases between those admitted and not admitted, however this has been solved adjusting for confounders in multivariate analysis. PCR test should be required for main outcome definition. However, in all admissions during this period, almost 20% of them did not have PCR performed due to a lack of available tests or extreme health care overload. Nevertheless, all cases included were carefully reviewed being clinically compatible and managed as COVID-19. Finally, we have not been able to study if ethnic differences have a role in the severity COVID-19, but doctors believe that there are a large number of infected people from some groups that for economic or cultural reasons tend to share a home with more p...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.05.14.20101584v1 on medRxiv