Arthritis Rheumatol 2020 Dec 10. Epub 2020 Dec 10.
Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA.
Objective: Patients living with systemic autoimmune rheumatic diseases (SARDs) continue to be concerned about risks of severe COVID-19 outcomes.
Methods: Using a large multi-center electronic health record network, we conducted a comparative cohort study of patients with SARDs diagnosed with COVID-19 (identified by diagnostic code or positive molecular test) 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, intensive care unit (ICU) admission, mechanical ventilation, acute renal failure requiring renal replacement therapy (ARF), ischemic stroke, venous thromboembolism (VTE), and death.
Results: We initially identified 2,379 SARD patients with COVID-19 (mean age 58 years, 79% female) and 142,750 comparators (mean age 47 years, 54% female). In the primary matched model (2,379 SARD patients 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) versus comparators but did not have significantly higher risks of mechanical ventilation or death. In the extended model, all risks were largely attenuated except risk of VTE (RR 1.60, 95% CI: 1.14 to 2.25).
Conclusions: SARD patients with COVID-19 may be at higher risk of hospitalization, ICU admission, ARF, and VTE versus matched comparators. These risks may be largely mediated by comorbidities, except for risk of VTE.