Clinical outcomes of hospitalised patients with COVID-19 and chronic inflammatory and autoimmune rheumatic diseases: a multicentric matched cohort study
This article has been Reviewed by the following groups
Listed in
- Evaluated articles (ScreenIT)
Abstract
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.
Article activity feed
-
-
SciScore for 10.1101/2020.06.18.20133645: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: All data were anonymised, and the study was approved by the Ethics Committee of Hospital 12 de Octubre Hospital in April 3th, with ref N° CEIm: 20/160. Randomization not detected. Blinding The control cohort was assembled from the Microbiology databases of the participating centres matched on a 1:1 basis with the rheumatic cohort on the date of COVID-19 diagnosis (“index date”), sex, and age, and blinded to outcome or other variables. Power Analysis not detected. Sex as a biological variable Factors studied in relation to the outcome were those common to all COVID patients, such as age (with a cut-off at 60 years), male sex, cardiovascular disease, obesity, … SciScore for 10.1101/2020.06.18.20133645: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: All data were anonymised, and the study was approved by the Ethics Committee of Hospital 12 de Octubre Hospital in April 3th, with ref N° CEIm: 20/160. Randomization not detected. Blinding The control cohort was assembled from the Microbiology databases of the participating centres matched on a 1:1 basis with the rheumatic cohort on the date of COVID-19 diagnosis (“index date”), sex, and age, and blinded to outcome or other variables. Power Analysis not detected. Sex as a biological variable Factors studied in relation to the outcome were those common to all COVID patients, such as age (with a cut-off at 60 years), male sex, cardiovascular disease, obesity, diabetes, hypertension, and lung disease. 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:Whether specific diagnostics among these groups may have a different risk cannot be ruled-out due to statistical power limitation. In our previous prevalence analysis, hospital cases were more prevalent among SpA but not RA or PSA groups, and in AI/IMID groups but not SLE patients compared to the reference population [8]. Further analyses would be needed to evaluate the severity of specific rheumatic diseases. Concerning previous use of therapies by rheumatic patients, the use of glucocorticoids was associated with poorer outcome by bivariable analysis, whereas no substantial risk was detected neither for traditional immunosuppressants nor csDMARDS (methothrexate and leflunomide), nor for bDMARD (mostly anti-TNF-α). Interestingly, the use of ts/bDMARD was associated in the bivariable with lower odds of complications. They did not make it into the final models probably because of the collinearity with other variables and not being the full rheumatic sample included, thus encountering problems of statistical power. The potential therapeutic effect of anti-cytokine biologicals and Jakinibs on COVID-19 is being tested through numerous observational and randomised trials [17]. Since most of these drugs have long-lived pharmacological or immunological effects, a protective effect could hypothetically exist after SARS-CoV-2 infection. In our previous analysis of the prevalence of hospital PCR+ cases in rheumatic patients and the general population, a higher prevalence was observed i...
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.
-
