Risk factors for hospital admissions related to COVID-19 in patients with autoimmune inflammatory rheumatic diseases

Ann Rheum Dis. 2020 Nov;79(11):1393-1399. doi: 10.1136/annrheumdis-2020-217984. Epub 2020 Aug 7.

Abstract

Objectives: To describe patients with autoimmune inflammatory rheumatic diseases (AIRD) who had COVID-19 disease; to compare patients who required hospital admission with those who did not and assess risk factors for hospital admission related to COVID-19.

Methods: An observational longitudinal study was conducted during the pandemic peak of severe acute respiratory syndrome coronavirus 2 (1 March 2020 to 24 April). All patients attended at the rheumatology outpatient clinic of a tertiary hospital in Madrid, Spain with a medical diagnosis of AIRD and with symptomatic COVID-19 were included. The main outcome was hospital admission related to COVID-19. The covariates were sociodemographic, clinical and treatments. We ran a multivariable logistic regression model to assess risk factors for the hospital admission.

Results: The study population included 123 patients with AIRD and COVID-19. Of these, 54 patients required hospital admission related to COVID-19. The mean age on admission was 69.7 (15.7) years, and the median time from onset of symptoms to hospital admission was 5 (3-10) days. The median length of stay was 9 (6-14) days. A total of 12 patients died (22%) during admission. Compared with outpatients, the factors independently associated with hospital admission were older age (OR: 1.08; p=0.00) and autoimmune systemic condition (vs chronic inflammatory arthritis) (OR: 3.55; p=0.01). No statistically significant findings for exposure to disease-modifying antirheumatic drugs were found in the final model.

Conclusion: Our results suggest that age and having a systemic autoimmune condition increased the risk of hospital admission, whereas disease-modifying antirheumatic drugs were not associated with hospital admission.

Keywords: antirheumatic agents; communicable diseases; epidemiology; health care; imported; outcome assessment.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Ambulatory Care
  • Antirheumatic Agents / therapeutic use
  • Arthritis, Rheumatoid / drug therapy
  • Arthritis, Rheumatoid / epidemiology
  • Autoimmune Diseases / drug therapy
  • Autoimmune Diseases / epidemiology*
  • Betacoronavirus
  • COVID-19
  • Coronavirus Infections / therapy*
  • Diabetes Mellitus / epidemiology
  • Female
  • Glucocorticoids / therapeutic use
  • Heart Diseases / epidemiology
  • Hospitalization / statistics & numerical data*
  • Humans
  • Hypertension / epidemiology
  • Length of Stay / statistics & numerical data
  • Longitudinal Studies
  • Lung Diseases / epidemiology
  • Lupus Erythematosus, Systemic / drug therapy
  • Lupus Erythematosus, Systemic / epidemiology
  • Male
  • Middle Aged
  • Mixed Connective Tissue Disease / drug therapy
  • Mixed Connective Tissue Disease / epidemiology
  • Multivariate Analysis
  • Pandemics
  • Pneumonia, Viral / therapy*
  • Polymyalgia Rheumatica / drug therapy
  • Polymyalgia Rheumatica / epidemiology
  • Protective Factors
  • Rheumatic Diseases / drug therapy
  • Rheumatic Diseases / epidemiology*
  • Risk Factors
  • SARS-CoV-2
  • Sex Factors
  • Sjogren's Syndrome / drug therapy
  • Sjogren's Syndrome / epidemiology
  • Spain / epidemiology
  • Spondylarthropathies / drug therapy
  • Spondylarthropathies / epidemiology
  • Tumor Necrosis Factor Inhibitors / therapeutic use

Substances

  • Antirheumatic Agents
  • Glucocorticoids
  • Tumor Necrosis Factor Inhibitors