Background/Purpose: The global dominance of the SARS-CoV-2 Omicron variant ensued shortly after its initial identification in South Africa on November 24, 2021. The outcomes of COVID-19 Omicron variant period had been found to be better than those of COVID-19 before the Omicron variant period. Patients with systemic lupus erythematosus (SLE) have been found to have a worse COVID-19 outcomes. However, whether the short outcomes of COVID-19 during the Omicron variant period are different from those before the Omicron period is still unclear. Utilizing the TriNetX Network, a worldwide federated health research network that leverages electronic medical records (EMR) from multiple centers, the study aimed to compare COVID-19 outcomes prior to and following the emergence of the Omicron variant in patients with SLE.

Methods: Using the EMR from the Global Collaborative Network database of TriNetX with 101 large health care organizations (HCOs) , we identified 22,782 and 20,668 COVID-19 patients with SLE aged 20–89 years before (between January 1, 2020 and October 31, 2021) and during (between January 1, 2022 and April 29, 2023) the Omicron variant dominance period predominance, respectively. The diagnoses of SLE and comorbidities 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). The two groups of COVID-19 infected SLE patients were matched for age, sex, ethnicity, tobacco use, diabetes mellitus, chronic kidney disease, hypertensive diseases, chronic lower respiratory diseases, ischemic heart diseases, heart failure, neoplasms, anxiety, dissociate, stress-related somatoform and other nonpsychotic mental disorders, mood disorders, mental and behavioral disorders due to psychoactive substance use, and use of immune suppressants. We performed Cox regression analyses to compare the incidences of various COVID-19 outcomes within 30 days after COVID-19 diagnosis date in the pre-Omicron period group compared with those in the Omicron period group, shown as hazard ratios (HRs) with 95% confidence intervals (CIs).

Results: We finally included 20,155 matched SLE patients in both groups. The mean ± standard deviation (SD) age was 52 ± 16 years, and 89% of study subjects were females. Patients of SLE who got COVID-19 before the Omicron period had a higher risks of hospitalization (HR, 1.43; 95% CI, 1.26–1.64), ICU admission (HR, 1.37; 95% CI, 1.21–1.55), sepsis (HR, 1.33; 95% CI, 1.16–1.53), use of mechanical ventilation (HR, 1.64; 95% CI, 1.33–2.03), mental illness (HR, 1.59; 95% CI, 1.26–2.00), hemodialysis (HR, 1.54; 95% CI, 1.17–2.02), atrial fibrillation (HR, 1.44; 95% CI, 1.000–2.085; p = 0.049), acute kidney injury (HR, 1.16; 95% CI, 1.04–1.29), and death (HR, 1.56; 95% CI, 1.30–1.89). However, the risks of stroke and venous thromboembolism/pulmonary embolism were not significantly different between both groups.

Conclusion: This global multicenter cohort study revealed that most short-term (30-day) COVID-19 outcomes were better during the Omicron period than before the Omicron period in patients with SLE.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/outcomes-of-covid-19-before-and-during-the-omicron-variant-period-in-patients-with-systemic-lupus-erythematosus-a-global-multicenter-cohort-study-using-the-trinetx-network/