Background/Purpose: Whether patients living with systemic autoimmune rheumatic diseases (SARDs) suffer from more severe complications of Coronavirus Disease 2019 (COVID-19) infection remains unknown.

Methods: We conducted a matched cohort study to examine COVID-19 infection outcomes of patients with SARDs using the TriNETX Research Network, which contains real-time electronic health record data from >52 million patients across 35 healthcare organizations. COVID-19 infections were identified by International Classification of Diseases 10^th Revision (ICD-10) codes or positive COVID-19 testing by polymerase chain reaction between January 20, 2020, and June 1, 2020. Patients with SARDs (including rheumatoid arthritis [RA], systemic lupus erythematosus [SLE], Sjogren’s syndrome, systemic sclerosis [SSc], idiopathic inflammatory myositis [IIM], mixed or undifferentiated connective tissue disease, systemic vasculitis, psoriatic arthritis [PsA], and ankylosing spondylitis [AS]) were identified by two ICD-10 codes for rheumatic disease greater than two months apart. For the comparison cohort, we matched one individual without SARDs based on age, sex, and race/ethnicity. Baseline characteristics were assessed in the 1 year prior to COVID-19 infection, and outcomes were assessed between 2 weeks and 3 months after COVID-19 infection. We calculated the risk difference and risk ratio (RR) for the association of SARD with each outcome.

Results: There were 716 patients with COVID-19 infection and SARD and 716 age-sex-race-matched comparators with COVID-19 infection but without SARD. After matching, the average age was 57 years, 79% were female, 54% were white, and 34% were Black or African American (Table 1). Patients with SARDs had higher rates of comorbidities than comparators, including hypertension, asthma, chronic kidney disease, and heart failure. Among patients with SARDs, the distribution of rheumatic disease was: 325 (45%) RA, 128 (18%) SLE, 71 (10%) Sjogren’s syndrome, 25 (3%) SSc, 20 (3%) IIM, 34 (5%) mixed or undifferentiated connective tissue disease, 61 (9%) systemic vasculitis, 44 (6%) PsA, and 22 (3%) AS. Of patients with SARDs, 289 (40%) were on prednisone, 140 (20%) were on hydroxychloroquine, and 84 (12%) were on tumor necrosis factor inhibitors. Patients with SARDs had higher risk of hospitalization (RR 1.23), intensive care unit admission (RR 1.75), mechanical ventilation (RR 1.77), acute kidney injury (RR 1.83), and congestive heart failure (RR 3.06) versus comparators without SARDs (all p< 0.05, Table 2). Mortality was numerically higher in patients with SARDs than comparators, although not statistically significant.

Conclusion: Patients with SARDs who develop COVID-19 infection may have higher risks of end-organ failure (including mechanical ventilation, acute kidney injury, and heart failure) compared to matched comparators without SARDs. Further studies are needed to identify risk factors associated with severe COVID-19 infection in patients living with SARDs.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/outcomes-of-coronavirus-disease-2019-infection-among-patients-living-with-rheumatic-diseases-a-matched-cohort-study-from-a-us-multi-center-research-network/