Autoimmune disease is associated with heightened long COVID risk but prior immunization is protective

Abstract

Objectives: Patients with autoimmune disease (AD) may be predisposed to Long COVID, yet the impact of primary autoantibody-associated AD and prior immunization remains unclear.

Methods: TriNetX, a global electronic health database, identified adults with confirmed SARS-CoV-2 infection between January 1, 2020 and September 21, 2023 and at least one follow-up visit >90 days later. Long COVID was defined as persistent or new symptoms ≥90 days after infection. Patients with and without pre-existing AD were propensity-score-matched on demographics and comorbidities. Logistic regression assessed odds of Long COVID, with additional sensitivity analyses performed.

Results: Among 2,472,196 patients with SARS-CoV-2, 289,206 had AD (+AD). After matching, baseline characteristics were similar. +AD patients had higher odds of all Long COVID symptoms compared with -AD patients. The highest odds were observed for disturbance to smell/taste (OR: 1.99; 95% CI: 1.88-2.11), hair loss (OR: 1.96; 95% CI: 1.89-2.04), abnormal movements/tremors (OR: 1.93; 95% CI: 1.88-1.98), and body aches (OR: 1.85; 95% CI: 1.81-1.89). Unvaccinated +AD patients had higher odds of all symptoms compared with matched unvaccinated -AD. Within +AD, primary autoantibody-associated AD demonstrated higher odds of most symptoms.

Conclusion: Pre-existing AD increases the risk of Long COVID, with the highest risk in primary autoantibody-associated AD. Prior vaccination mitigates the risk of most Long COVID symptoms in +AD patients, with heightened protection observed in primary autoantibody-associated AD.

Keywords: Autoimmune diseases; COVID-19; Epidemiology; Infection; Risk factors.