https://doi.org/10.4081/reumatismo.2023.1542
Trends in severe outcomes in SARS-CoV-2-positive hospitalized patients with rheumatic diseases: a monocentric observational and case-control study in northern Italy
Submitted: 20 December 2022
Accepted: 18 June 2023
Published: 17 July 2023
Accepted: 18 June 2023
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SUPPLEMENTARY FILE: 67
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
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Rheumatic disease patients are at greater risk of infection due to their disease, comorbidities, and immunosuppressive therapy. COVID-19 outcomes in this patient setting appeared to be similar to those of the general population. However, data on this topic were mainly related to small studies on a limited number of patients. Consequently, to date, this field remains poorly explored, particularly in the pre-vaccine era. This monocentric study aimed to describe the intrahospital mortality in rheumatic patients with SARS-CoV-2 consecutively hospitalized from 21 February to 31 December 2020, before anti-SARS-CoV-2 vaccine administration spread, compared with non-rheumatic patients. Of 2491 included patients, 65 [3%, median (interquartile range) age 75 (64.76-82.239 years, 65% women] were suffering from rheumatic diseases. A total of 20 deaths were reported [case fatality rate 31%, 95% confidence interval (CI): 19-42] compared with 433 deaths (19%, 95% CI: 17-20) in patients without rheumatic diseases (p=0.024). However, the rheumatic disease was not associated with a significant increase in univariate mortality hazards (hazard ratio 1.374, 95% CI: 0.876-2.154), and after adjustment (hazard ratio 1.199, 95% CI: 0.759-1.894) by age, sex and Charlson comorbidity index. The incidence of intensive care unit admission, death, and discharge in the case-control study was comparable between rheumatic and non-rheumatic patients. The presence of rheumatic diseases in SARS-CoV-2-hospitalized patients did not represent an independent risk factor for severe disease or mortality.
Civil Protection Department, Presidency of the Council of Ministers, Italian Government. Coronavirus dashboards. Available from: http://arcg.is/C1unv. Accessed: 14/05/2022.
ISTAT. Popolazione e famiglie. Available from: https://www.istat.it/it/popolazione-e-famiglie?dati. Accessed: 10/12/2022.
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: 191-204.
DOI: https://doi.org/10.1038/s41584-022-00755-x
Meroni PL, Zavaglia D, Girmenia C. Vaccinations in adults with rheumatoid arthritis in an era of new disease-modifying anti-rheumatic drugs. Clin Exp Rheumatol 2018; 36: 317-28.
Listing J, Gerhold K, Zink A. The risk of infections associated with rheumatoid arthritis with its comorbidity and treatment. Rheumatology 2013; 52: 53-61.
DOI: https://doi.org/10.1093/rheumatology/kes305
Huang Y, Chen Z, Wang Y, Han L, Qin K, Huang W, et al. Clinical characteristics of 17 patients with covid-19 and systemic autoimmune diseases: a retrospective study. Ann Rheum Dis 2020; 79: 1163-9.
DOI: https://doi.org/10.1136/annrheumdis-2020-217425
Freites Nuñez DD, Leon L, Mucientes A, Rodriguez-Rodriguez L, Font Urgelles J, Madrid García AM, et al. Risk factors for hospital admissions related to covid-19 in patients with autoimmune inflammatory rheumatic diseases. Ann Rheum Dis 2020; 79: 1393-9.
DOI: https://doi.org/10.1136/annrheumdis-2020-217984
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: 859-66.
DOI: https://doi.org/10.1136/annrheumdis-2020-217871
Fredi M, Cavazzana I, Moschetti L, Andreoli L, Franceschini F; Brescia Rheumatology covid-19 study group. Covid-19 in patients with rheumatic diseases in northern Italy: a single-centre observational and case-control study. Lancet Rheumatol 2020; 2: e549-56.
DOI: https://doi.org/10.1016/S2665-9913(20)30169-7
Pablos JL, Galindo M, Carmona L, Lledó A, Retuerto M, Blanco R, et al. Clinical outcomes of hospitalised patients with covid-19 and chronic inflammatory and autoimmune rheumatic diseases: a multicentric matched cohort study. Ann Rheum Dis 2020; 79: 1544-9.
DOI: https://doi.org/10.1136/annrheumdis-2020-218296
Pang R, Zhao J, Gan Z, Hu Z, Xue X, Wu Y, et al. Evolution of covid-19 in patients with autoimmune rheumatic diseases. Aging (Albany NY) 2020; 12: 23427-35.
DOI: https://doi.org/10.18632/aging.202193
Faye AS, Lee KE, Laszkowska M, Kim J, Blackett JW, McKenney AS, et al. Risk of adverse outcomes in hospitalized patients with autoimmune disease and covid-19: a matched cohort study from new york city. J Rheumatol 2021; 48: 454-62.
DOI: https://doi.org/10.3899/jrheum.200989
Montero F, Martínez-Barrio J, Serrano-Benavente B, González T, Rivera J, Molina Collada J, et al. Coronavirus disease 2019 (covid-19) in autoimmune and inflammatory conditions: clinical characteristics of poor outcomes. Rheumatol Int 2020; 40: 1593-8.
DOI: https://doi.org/10.1007/s00296-020-04676-4
Cordtz R, Lindhardsen J, Soussi BG, Vela J, Uhrenholt L, Westermann R, et al. Incidence and severeness of covid-19 hospitalization in patients with inflammatory rheumatic disease: a nationwide cohort study from Denmark. Rheumatology (Oxford) 2021; 60: SI59-67.
DOI: https://doi.org/10.1093/rheumatology/keaa897
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: 660-6.
DOI: https://doi.org/10.1136/annrheumdis-2020-219279
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: 914-20.
DOI: https://doi.org/10.1002/art.41619
Gianfrancesco MA, Hyrich KL, Gossec L, Strangfeld A, Carmona L, Mateus EF, et al. Rheumatic disease and covid-19: initial data from the covid-19 global rheumatology alliance provider registries. Lancet Rheumatol 2020; 2: e250-3.
DOI: https://doi.org/10.1016/S2665-9913(20)30095-3
Enginar AU, Gundogdu M. The course of covid-19 in patients with Behçet's disease. Reumatologia 2021; 59: 356-61.
DOI: https://doi.org/10.5114/reum.2021.112347
Hsu TY, D'Silva KM, Patel NJ, Wang J, Mueller AA, Fu X, et al. Laboratory trends, hyperinflammation, and clinical outcomes for patients with a systemic rheumatic disease admitted to hospital for covid-19: a retrospective, comparative cohort study. Lancet Rheumatol 2021; 3: e638-47.
DOI: https://doi.org/10.1016/S2665-9913(21)00140-5
Kjeldsen J, Nielsen J, Ellingsen T, Knudsen T, Nielsen RG, Larsen MD, et al. Outcome of covid-19 in hospitalized patients with chronic inflammatory diseases. a population based national register study in Denmark. J Autoimmun 2021; 120: 102632.
DOI: https://doi.org/10.1016/j.jaut.2021.102632
Thompson K, Shah A, Grunbaum A, Oyesanmi O. Investigation into the effect of covid-19 infection on length of hospital stay and mortality in patients with rheumatoid arthritis. Cureus 2022; 14: e22685.
DOI: https://doi.org/10.7759/cureus.22685
Peach E, Rutter M, Lanyon P, Grainge MJ, Hubbard R, Aston J, et al. Risk of death among people with rare autoimmune diseases compared with the general population in England during the 2020 covid-19 pandemic. Rheumatology (Oxford) 2021; 60: 1902-9.
DOI: https://doi.org/10.1093/rheumatology/keaa855
Andersen KM, Bates BA, Rashidi ES, Olex AL, Mannon RB, Patel RC, et al. Long-term use of immunosuppressive medicines and in-hospital covid-19 outcomes: a retrospective cohort study using data from the national covid cohort collaborative. Lancet Rheumatol 2022; 4: e33-41.
DOI: https://doi.org/10.1016/S2665-9913(21)00325-8
Curtis JR, Zhou X, Rubin DT, Reinisch W, Yazdany J, Robinson PC, et al. Characteristics, comorbidities, and outcomes of sars-cov-2 infection in patients with autoimmune conditions treated with systemic therapies: a population-based study. J Rheumatol 2022; 49: 320-9.
DOI: https://doi.org/10.3899/jrheum.210888
Conway R, Grimshaw AA, Konig MF, Putman M, Duarte-García A, Tseng LY, et al. Sars-cov-2 infection and covid-19 outcomes in rheumatic diseases: a systematic literature review and meta-analysis. Arthritis Rheumatol 2022; 74: 766-75.
DOI: https://doi.org/10.1002/art.42030
Mazumder A, Arora M, Sra MS, Gupta A, Behera P, Gupta M, et al. Geographical variation in case fatality rate and doubling time during the covid-19 pandemic. Epidemiol Infect 2020; 148: e163.
DOI: https://doi.org/10.1017/S0950268820001685
Bellou V, Tzoulaki I, van Smeden M, Moons KGM, Evangelou E, Belbasis L. Prognostic factors for adverse outcomes in patients with covid-19: a field-wide systematic review and meta-analysis. Eur Respir J 2022; 59: 2002964.
DOI: https://doi.org/10.1183/13993003.02964-2020
Kroon FPB, Najm A, Alunno A, Schoones JW, Landewé RBM, Machado PM, et al. Risk and prognosis of sars-cov-2 infection and vaccination against sars-cov-2 in rheumatic and musculoskeletal diseases: a systematic literature review to inform eular recommendations. Ann Rheum Dis 2022; 81: 422-32.
DOI: https://doi.org/10.1136/annrheumdis-2021-221575
Zanetti A, Carrara G, Landolfi G, Rozza D, Chighizola CB, Alunno A, et al. Increased COVID-19 mortality in patients with rheumatic diseases: results from the control-19 study by the Italian Society for Rheumatology. Clin Exp Rheumatol 2022; 40: 2038-43.
DOI: https://doi.org/10.55563/clinexprheumatol/fmyozh
Krasselt M, Baerwald C, Seifert O. Covid-19 vaccination coverage in patients with rheumatic diseases in a german outpatient clinic: an observational study. Vaccines (Basel) 2022; 10: 253.
DOI: https://doi.org/10.3390/vaccines10020253
Putman M, Kennedy K, Sirotich E, Liew JW, Sattui SE, Moni TT, et al. Covid-19 vaccine perceptions and uptake: results from the covid-19 global rheumatology alliance vaccine survey. Lancet Rheumatol 2022; 4: e237-40.
Goulenok T, Francois C, Mendes C, Farhi F, Alexandra JF, Rouzaud D, et al. Improving covid-19 vaccine coverage in patients with autoimmune and inflammatory diseases. J Rheumatol 2022; 49: 118-9.
DOI: https://doi.org/10.3899/jrheum.210534
Papagoras C, Fragoulis GE, Zioga N, Simopoulou T, Deftereou K, Kalavri E, et al. Better outcomes of covid-19 in vaccinated compared to unvaccinated patients with systemic rheumatic diseases. Ann Rheum Dis 2022; 81: 1013-6.
DOI: https://doi.org/10.1136/annrheumdis-2021-221539
How to Cite
Ughi, N., Bernasconi, D., Gagliardi, C., Del Gaudio, F., Dicuonzo, A., Maloberti, A., … Epis, O. (2023). Trends in severe outcomes in SARS-CoV-2-positive hospitalized patients with rheumatic diseases: a monocentric observational and case-control study in northern Italy. Reumatismo, 75(2). https://doi.org/10.4081/reumatismo.2023.1542
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