A multidisciplinary registry of patients with autoimmune and immune-mediated diseases with symptomatic COVID-19 from a single center

J Autoimmun. 2021 Feb;117:102580. doi: 10.1016/j.jaut.2020.102580. Epub 2020 Nov 30.

Abstract

Background and aim: There is increasing interest regarding SARS-CoV-2 infection in patients with autoimmune and immune-mediated inflammatory diseases (AI/IMID) with some discrepancies in different cohorts about their risk and outcomes. The aim was to describe a multidisciplinary cohort of patients with AI/IMID and symptomatic SARS-CoV-2 infection in a single tertiary center and analyze sociodemographic, clinical, and therapeutic factors associated with poor outcomes.

Methods: A retrospective observational study was conducted from the 1st of March until May 29th, 2020 in a University tertiary hospital in Barcelona, Spain. Patients with an underlying AI/IMID and symptomatic SARS-CoV-2 infection were identified in our local SARS-CoV-2 infection database. Controls (2:1) were selected from the same database and matched by age and gender. The primary outcome was severe SARS-CoV-2 infection, which was a composite endpoint including admission to the intensive care unit (ICU), need for mechanical ventilation (MV), and/or death. Several covariates including age, sex, and comorbidities among others were combined into a multivariate model having severe SARS-CoV-2 as the dependent variable. Also, a sensitivity analysis was performed evaluating AID and IMID separately.

Results: The prevalence of symptomatic SARS-CoV-2 infection in a cohort of AI/IMID patients was 1.3%. Eighty-five patients with AI/IMID and symptomatic SARS-CoV-2 were identified, requiring hospitalization in 58 (68%) cases. A total of 175 patients admitted for SARS-CoV-2 (58 with AI/IMID and 117 matched-controls) were analyzed. In logistic regression analysis, a significant inverse association between AI/IMID group and severe SARS-CoV-2 (OR 0.28; 95% CI 0.12-0.61; p = 0.001), need of MV (OR 0.20; IC 95% 0.05-0.71; p = 0.014), and ICU admission (OR 0.25; IC 95% 0.10-0.62; p = 0.003) was found.

Conclusions: Patients with AI/IMID who require admission for SARS-CoV-2 infection have a lower risk of developing severe disease, including the need to stay in the ICU and MV.

Keywords: Adverse outcome; Autoimmune diseases; COVID-19; Immunosuppression; Severe acute respiratory syndrome coronavirus 2.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Autoimmune Diseases / epidemiology*
  • Autoimmune Diseases / mortality
  • COVID-19 / epidemiology*
  • COVID-19 / mortality
  • Cohort Studies
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • Intensive Care Units / statistics & numerical data
  • Interdisciplinary Communication
  • Male
  • Middle Aged
  • Prevalence
  • Registries*
  • Respiration, Artificial / statistics & numerical data
  • Retrospective Studies
  • Risk Factors
  • SARS-CoV-2 / physiology*
  • Spain / epidemiology
  • Survival Analysis
  • Treatment Outcome