ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1274

COVID-19 in Patients with Systemic Lupus Erythematosus

Ruth Fernandez-Ruiz1, Mala Masson1, Mimi Kim2, Benjamin Myers3, Rebecca Haberman4, Jose Scher4, Rochelle Castillo4, Allison Guttmann1, Philip Carlucci1, Kristina Deonaraine1, Michael Golpanian5, Kimberly Robins1, Miao Chang1, H. Michael Belmont6, Jill Buyon7, Ashira Blazer6, Amit Saxena8 and Peter Izmirly9, 1New York University School of Medicine, New York, 2Albert Einstein College of Medicine, Bronx, 3Cornell University, Ithica, NY, 4NYU School of Medicine, New York City, 5New York University, New York, NY, 6NYU School of Medicine, New York, NY, 7Department of Medicine, NYU School of Medicine, New York, NY, 8NYU School of Medicine, New York, 9Department of Medicine, New York University School of Medicine, New York, NY

Meeting: ACR Convergence 2020

Keywords: ,

Session Information

Date: Sunday, November 8, 2020

Title: SLE – Diagnosis, Manifestations, & Outcomes Poster II: Comorbidities

Session Type: Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Patients with systemic lupus erythematosus (SLE) represent a unique population in considering risk for coronavirus disease 2019 (COVID-19) with biologic, genetic, demographic, clinical and treatment issues all at play. By the nature of their chronic inflammatory autoimmune condition and regular use of immunosuppressive medications, these individuals would traditionally be considered at high risk of contracting the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and having a worse prognosis. Accordingly, we aimed to characterize patients with SLE affected by COVID-19 in New York City (NYC) and analyze associations of comorbidities and medications on outcomes.

Methods: Patients with SLE and COVID-19 (confirmed by RT-PCR testing), were identified through a longitudinal survey of an established NYU lupus cohort, query of New York University Langone Health and Bellevue Hospitals systems and referrals from rheumatologists at those institutions. All patients were age 18 or older and met SLE classification criteria or carried a rheumatologist’s diagnosis of SLE. Only English-, Spanish- or Mandarin-speaking patients were included in the study. Data were prospectively collected via a web-based questionnaire and review of electronic medical records. Baseline characteristics and medications were compared between the hospitalized and ambulatory patients with COVID-19. A logistic regression analysis was performed to identify independent predictors of hospital admission.

Results: A total of 41 SLE patients were confirmed COVID-19 positive by RT-PCR. The patients were predominantly female and encompassed the major racial/ethnic demographics seen in NYC. The most common symptoms of COVID-19+ patients were cough (78.4%), fever (64.9%), and shortness of breath (64.9%).  Of those SLE patients with COVID-19, 24 (59%) were hospitalized, 4 required ICU level of care, and 4 died, all of hypoxic respiratory failure, Table 1. Hospitalized patients tended to be older, non-white, Hispanic, and have higher BMI, antiphospholipid syndrome, a history of lupus nephritis and at least one medical comorbidity, Table 2. There was no difference between the groups in use of hydroxychloroquine, systemic steroids or immunosuppressants. Logistic regression analysis identified the following independent predictors of being hospitalized with COVID-19: race (OR = 7.78 for non-white vs. white; 95% CI: 1.13 to 53.58; p=0.037), the presence of at least one comorbidity (OR=4.66; 95% CI: 1.02 to 21.20; p=0.047), and BMI (OR = 1.08 per increase in kg/m2; 95% CI: 0.99 to 1.18; p=0.096). 

Conclusion: Patients with SLE and COVID-19 have a high rate of hospitalization but similar mortality rate to the general population in NYC. Risk factors such as non-white race, higher BMI, and the presence of one or more comorbidities were identified as independent predictors of hospitalization in SLE patients who develop COVID-19. The use of hydroxychloroquine and immunosuppressants did not appear to influence the outcomes of patients with SLE in the setting of COVID-19. Further studies are needed to understand additional risk factors for poor COVID-19 outcomes in patients with SLE.

Table 1. Characteristics of hospitalized SLE patients with COVID-19. Values are expressed as % (N) for categorical variables and median (range) for continuous variables. * Two patients remained hospitalized as of June 15, 2020 † Supplemental oxygen administered via nasal canula, high-flow nasal canula, simple or Venturi mask. ‡ One patient had end stage renal disease (ESRD) and was on hemodialysis at baseline (not included). § Laboratory results are peak values if >1 available, or only available value. ¶ Three patients were DNR/DNI. CRP, C-Reactive Protein; COVID-19, Coronavirus Disease 2019; DNR/DNI, Do Not Intubate/Do Not Resuscitate; ECMO, Extracorporeal Membrane Oxygenation; ESR, Erythrocyte Sedimentation Rate; ICU, Intensive Care Unit; IL-6, Interleukin-6; MV, Mechanical Ventilation; O2, Oxygen.

Table 2. Comparison of hospitalized and ambulatory SLE patients with confirmed COVID-19. Values are expressed as % (N) for categorical variables and mean ± standard deviation (SD) or median (interquartile range [IQR]) for continuous variables. * Categorical variables compared using Fisher’s exact test; continuous variables compared using the two-sample T-test or Mann Whitney U Test. Age: T-test; BMI: Mann Whitney U Test (chosen by whichever gave more conservative p-value). † Median (IQR); N=23 for Hospitalized group ‡ Immunosuppressants include non-biologic agents (azathioprine, cyclophosphamide, mycophenolate mofetil, mycophenolic acid, sirolimus, tacrolimus) and biologic agents (anakinra, abatacept, belimumab, rituximab, tocilizumab). § Comorbidities refers to at least one of the following: congestive heart failure, active malignancy, pregnancy, diabetes mellitus, asthma, chronic obstructive pulmonary disease. APLS, Antiphospholipid Syndrome; BMI, Body Mass Index; COVID-19, Coronavirus Disease 2019; COVID-19+, positive testing for SARS-CoV-2 by polymerase chain reaction; LN, Lupus Nephritis; SLE, Systemic Lupus Erythematosus.

Disclosure: R. Fernandez-Ruiz, None; M. Masson, None; M. Kim, None; B. Myers, None; R. Haberman, Janssen, 5; J. Scher, UCB, 5, Novartis, 2, 5, Pfizer, 2, 5, Janssen, 5, Sanofi, 5, Abbvie, 5; R. Castillo, None; A. Guttmann, None; P. Carlucci, None; K. Deonaraine, None; M. Golpanian, None; K. Robins, None; M. Chang, None; H. Belmont, Exagen, 5; J. Buyon, None; A. Blazer, None; A. Saxena, Glaxo Smith Kline, 1, Bristol Myers Squibb, 1; P. Izmirly, GSK, 5.

To cite this abstract in AMA style:

Fernandez-Ruiz R, Masson M, Kim M, Myers B, Haberman R, Scher J, Castillo R, Guttmann A, Carlucci P, Deonaraine K, Golpanian M, Robins K, Chang M, Belmont H, Buyon J, Blazer A, Saxena A, Izmirly P. COVID-19 in Patients with Systemic Lupus Erythematosus [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/covid-19-in-patients-with-systemic-lupus-erythematosus/. Accessed .

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