Background/Purpose: Poor COVID-19 outcomes in patients with systemic lupus erythematosus (SLE) has been found to be associated with glucocorticoid dose, male sex, older age, mycophenolate, rituximab, cyclophosphamide, moderate or high SLE disease activity, and comorbidities including kidney disease and cardiovascular disease/hypertension. However, the influence of mental illness on COVID-19 outcomes had not been addressed.TriNetX, a global federated health research network, has been used in several studies to investigate the outcomes and clinical features. Therefore, we aimed to assess the association of mental illness and COVID-19 outcomes in patients with SLE using electronic medical records (EMR) in the TriNetX Network. The aim of the study was to assess the association of short-term outcomes of COVID-19 with mental illness in patients with SLE.

Methods: The study identified SLE patients aged 20–89 years who got COVID-19 between January 1, 2020 and April 28, 2023 with and without a history of mental illness before COVID-19 infection. The diagnoses of SLE and mental illness (mental and behavioral disorders due to psychoactive substance use, mood [affective] disorders, or anxiety, dissociative, stress-related, somatoform and other nonpsychotic mental disorders) were based on International Classification of Diseases tenth revision (ICD-10), while the diagnosis of COVID-19 was based on ICD-10, Current Procedural Terminology (CPT) Codes, or Logical Observation Identifiers Names and Codes (LOINC). Propensity score was used to match COVID-19 infected SLE patients with and without a history of mental illness for potential confounders, we conducted Cox regression analyses to examine the association between mental illness and COVID-19 outcomes shown as hazard ratios (HRs) with 95% confidence intervals (CIs).

Results: We finally included 12,485 patients with SLE who had a history of mental illness and 12,485 matched SLE patients without a history of mental illness. The mean ± standard deviation (SD) age was 51.5 ± 15.8 years in the mental illness group and 51.6 ± 17.4 years in the non-mental illness group, respectively. The proportion of females was 89.2% in the mental illness group and 88.4% in the non-mental illness group. SLE patients with mental illness had a higher risk of hospitalization (HR, 1.26; 95% CI, 1.17–1.35), Intensive Care Unit (ICU) admission (HR, 1.47; 95% CI, 1.24–1.73), mechanical ventilation (HR, 1.50; 95% CI, 1.11–2.03), sepsis (HR, 1.24; 95% CI, 1.03–1.51) and cerebral vascular accident (CVA) (HR, 1.66; 95% CI, 1.41–1.96) than SLE patients without mental illness. However, the risk of mortality was lower in SLE patients with mental illness than in SLE patients without mental illness (HR, 0.73; 95% CI, 0.57–0.93).

Conclusion: This global multicenter matched cohort study showed that mental illness was associated with an increased risk of hospitalization, ICU admission, mechanical ventilation, sepsis and CVA, but a decreased risk of death within 30 days after the date of COVID-19 diagnosis in patients with SLE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/mental-illness-and-outcomes-of-covid-19-in-patients-with-systemic-lupus-erythematosus-a-global-multicenter-cohort-study/