Rheumatology Research

COVID-19 severity and risk factors in Iranian patients with rheumatic diseases

Document Type : Original Article

Authors

1 Resident of Internal Medicine, Department of Internal Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

2 Professor of Rheumatology , Department of Internal Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

3 Assistant professor of Pulmonology, Department of Internal Medicine, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

4 Medical student, Tehran branch, The Islamic Azad University

10.32592/RR.2023.8.2.79

Abstract

 Since the beginning of COVID-19 pandemic, there was a concern whether patients with rheumatic diseases are at increased risk of severe COVID-19 in terms of the multi-system involvement, underlying comorbidities, and anti-rheumatic medications. We intended to evaluate the severity and mortality of COVID-19 in these patients, as well as the demographic, laboratory, and clinical risk factors associated with the disease. In patients with plasma chane reaction positive COVID-19 admitted to the hospital, laboratory and clinical measures after hospitalization and severity measures such as length of hospitalization, hospitalization in the intensive care unit, and mortality were compared between patients with and matched patients without a history of rheumatic disease. Moreover, risk factors associated with COVID-19 mortality in the case group were calculated by odds ratio (OR). We found no statistically significant difference in COVID-19 severity between the two groups (mortality rate of 22% in case and 25% in control groups, P-value = 0.83). Except for platelet markers, which were considerably greater in the case group despite not being related with the severity of the illness, the available laboratory measurements did not vary between these groups. In addition, we showed that age over 65 years (OR = 4.06), lactic dehydrogenase level, percentage of lung involvement and ischemic heart disease (OR = 6.24) were associated with poorer outcome in the patients with rheumatic diseases. Hence, we found that usage of conventional synthetic disease modifying anti-rheumatic drugs (OR = 2.3, P-value = 0.48) or daily treatment dose of prednisolone >10 mg/d (OR = 1.04) were not associated with COVID-19 mortality. Although the patients with rheumatic disease may be at increased risk of developing a COVID-19 infection, they do not experience more severe disease.

Keywords

Main Subjects

References
  1. Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med 2020;180(7):934-43. doi: 10.1001/jamainternmed.2020.0994
  2. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;395(10229):1054-62. doi: 10.1016/S0140-6736(20)30566-3
  3. Listing J, Gerhold K, Zink A. The risk of infections associated with rheumatoid arthritis, with its comorbidity and treatment. Rheumatology (Oxford) 2013;52(1):53-61. doi: 10.1093/rheumatology/kes305
  4. Wang Y, D'Silva KM, Jorge AM, Li X, Lyv H, Wei J, et al. Increased Risk of COVID-19 in Patients With Rheumatoid Arthritis: A General Population-Based Cohort Study. Arthritis Care Res (Hoboken) doi: 10.1002/acr.24831
  5. England BR, Roul P, Yang Y, Kalil AC, Michaud K, Thiele GM, et al. Risk of COVID-19 in Rheumatoid Arthritis: A National Veterans Affairs Matched Cohort Study in At-Risk Individuals. Arthritis Rheumatol 2021;73(12):2179-88. doi: 10.1002/art.41800
  6. Vakil-Gilani K, O'Rourke K. Are patients with rheumatologic diseases on chronic immunosuppressive therapy at lower risk of developing severe symptoms when infected with COVID-19? Clin Rheumatol 2020;39(7):2067-8. doi: 10.1007/s10067-020-05184-3
  7. Robinson PC, Yazdany J. The COVID-19 Global Rheumatology Alliance: collecting data in a pandemic. Nat Rev Rheumatol 2020;16(6):293-4. doi: 10.1038/s41584-020-0418-0
  8. Gianfrancesco M, Hyrich KL, Al-Adely S, Carmona L, Danila MI, Gossec L, et al. Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis 2020;79(7):859-66. doi: 10.1136/annrheumdis-2020-217871
  9. Strangfeld A, Schafer M, Gianfrancesco MA, Lawson-Tovey S, Liew JW, Ljung L, et al. Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry. Ann Rheum Dis 2021;80(7):930-42. doi: 10.1136/annrheumdis-2020-219498
  10. Perricone C, Triggianese P, Bartoloni E, Cafaro G, Bonifacio AF, Bursi R, et al. The anti-viral facet of anti-rheumatic drugs: Lessons from COVID-19. J Autoimmun 2020;111:102468. doi: 10.1016/j.jaut.2020.102468
  11. Benucci M, Damiani A, Infantino M, Manfredi M, Quartuccio L. Old and new antirheumatic drugs for the treatment of COVID-19. Joint Bone Spine 2020;87(3):195-7. doi: 10.1016/j.jbspin.2020.03.013
  12. Xie W, Wang Y, Zhang Z. Hydroxychloroquine reduces the risk of covid-19 in patients with rheumatic diseases: myth or reality? Ann Rheum Dis 2021;80(1):e6. doi: 10.1136/annrheumdis-2020-217556
  13. Goyal M. SLE patients are not immune to covid-19: importance of sending the right message across. Ann Rheum Dis 2021;80(2):e23. doi: 10.1136/annrheumdis-2020-217658
  14. Shah S, Das S, Jain A, Misra DP, Negi VS. A systematic review of the prophylactic role of chloroquine and hydroxychloroquine in coronavirus disease-19 (COVID-19). Int J Rheum Dis 2020;23(5):613-9. doi: 10.1111/1756-185X.13842
  15. Monti S, Montecucco C. Can hydroxychloroquine protect patients with rheumatic diseases from COVID-19? Response to: 'Does hydroxychloroquine prevent the transmission of COVID-19?' by Heldwein and Calado and 'SLE, hydroxychloroquine and no SLE patients with COVID-19: a comment' by Joob and Wiwanitkit. Ann Rheum Dis 2020;79(6):e62. doi: 10.1136/annrheumdis-2020-217524
  16. Valenzuela-Almada MO, Putman MS, Duarte-Garcia A. The protective effect of rheumatic disease agents in COVID-19. Best Pract Res Clin Rheumatol 2021;35(1):101659. doi: 10.1016/j.berh.2021.101659
  17. Santos CS, Morales CM, Alvarez ED, Castro CA, Robles AL, Sandoval TP. Determinants of COVID-19 disease severity in patients with underlying rheumatic disease. Clin Rheumatol 2020;39(9):2789-96. doi: 10.1007/s10067-020-05301-2
  18. Daniels SW, H.; Denning, D. W. Platelet size as a predictor for severity and mortality in COVID-19 patients: a systematic review and meta-analysis. medRxiv doi: 10.1101/2021.07.15.21260576
  19. Francone M, Iafrate F, Masci GM, Coco S, Cilia F, Manganaro L, et al. Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis. Eur Radiol 2020;30(12):6808-17. doi: 10.1007/s00330-020-07033-y
  20. Kastritis E, Kitas GD, Vassilopoulos D, Giannopoulos G, Dimopoulos MA, Sfikakis PP. Systemic autoimmune diseases, anti-rheumatic therapies, COVID-19 infection risk and patient outcomes. Rheumatol Int 2020;40(9):1353-60. doi: 10.1007/s00296-020-04629-x
  21. Grainger R, Kim AHJ, Conway R, Yazdany J, Robinson PC. COVID-19 in people with rheumatic diseases: risks, outcomes, treatment considerations. Nat Rev Rheumatol 2022;18(4):191-204. doi: 10.1038/s41584-022-00755-x
  22. Shin YH, Shin JI, Moon SY, Jin HY, Kim SY, Yang JM, et al. Autoimmune inflammatory rheumatic diseases and COVID-19 outcomes in South Korea: a nationwide cohort study. Lancet Rheumatol 2021;3(10):e698-e706. doi: 10.1016/S2665-9913(21)00151-X
  23. Reilev M, Kristensen KB, Pottegard A, Lund LC, Hallas J, Ernst MT, et al. Characteristics and predictors of hospitalization and death in the first 11 122 cases with a positive RT-PCR test for SARS-CoV-2 in Denmark: a nationwide cohort. Int J Epidemiol 2020;49(5):1468-81. doi: 10.1093/ije/dyaa140
  24. Serling-Boyd N, D'Silva KM, Hsu TY, Wallwork R, Fu X, Gravallese EM, et al. Coronavirus disease 2019 outcomes among patients with rheumatic diseases 6 months into the pandemic. Ann Rheum Dis 2021;80(5):660-6. doi: 10.1136/annrheumdis-2020-219279
  25. D'Silva KM, Jorge A, Cohen A, McCormick N, Zhang Y, Wallace ZS, et al. COVID-19 Outcomes in Patients With Systemic Autoimmune Rheumatic Diseases Compared to the General Population: A US Multicenter, Comparative Cohort Study. Arthritis Rheumatol 2021;73(6):914-20. doi: 10.1002/art.41619
  26. Bao J, Li C, Zhang K, Kang H, Chen W, Gu B. Comparative analysis of laboratory indexes of severe and non-severe patients infected with COVID-19. Clin Chim Acta 2020;509:180-94. doi: 10.1016/j.cca.2020.06.009
  27. Alvarez-Mon M, Ortega MA, Gasulla O, Fortuny-Profitos J, Mazaira-Font FA, Saurina P, et al. A Predictive Model and Risk Factors for Case Fatality of COVID-19. J Pers Med 2021;11(1). doi: 10.3390/jpm11010036
  28. Keddie S, Ziff O, Chou MKL, Taylor RL, Heslegrave A, Garr E, et al. Laboratory biomarkers associated with COVID-19 severity and management. Clin Immunol 2020;221:108614. doi: 10.1016/j.clim.2020.108614
  29. Mezgebe M, Jacobson BF, Mayne ES, Louw S. Change in platelet indices in patients with Coronavirus disease-2019 (COVID-19): A reflection of platelet activation and contribution to immunothrombosis? Int J Lab Hematol 2022;44(1):e46-e8. doi: 10.1111/ijlh.13705
  30. Peckham H, de Gruijter NM, Raine C, Radziszewska A, Ciurtin C, Wedderburn LR, et al. Male sex identified by global COVID-19 meta-analysis as a risk factor for death and ITU admission. Nat Commun 2020;11(1):6317. doi: 10.1038/s41467-020-19741-6
  31. Hasseli R, Mueller-Ladner U, Hoyer BF, Krause A, Lorenz HM, Pfeil A, et al. Older age, comorbidity, glucocorticoid use and disease activity are risk factors for COVID-19 hospitalisation in patients with inflammatory rheumatic and musculoskeletal diseases. RMD Open 2021;7(1). doi: 10.1136/rmdopen-2020-001464
  32. Chang TS, Ding Y, Freund MK, Johnson R, Schwarz T, Yabu JM, et al. Prior diagnoses and medications as risk factors for COVID-19 in a Los Angeles Health System. medRxiv doi: 10.1101/2020.07.03.20145581
  33. Grainger R, Machado PM, Robinson PC. Novel coronavirus disease-2019 (COVID-19) in people with rheumatic disease: Epidemiology and outcomes. Best Pract Res Clin Rheumatol 2021;35(1):101657. doi: 10.1016/j.berh.2020.101657

 

Rheumatology Research
Volume 8, Issue 2 - Serial Number 2
April 2023
Pages 79-90
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