The Recent Outbreak of COVID-19 in China During the Omicron Variant Predominance: Clinical Features and Outcomes in Patients with Autoimmune Inflammatory Rheumatic Diseases

Yan Geng; Yong Fan; Xuerong Deng; Yu Wang; Juan Zhao; Lanlan Ji; Zhibo Song; Guangtao Li; Xiaohui Zhang; Xiaoying Sun; Hong Huang; Wenhui Xie; Zhuoli Zhang

doi:10.1007/s40744-023-00569-7

The Recent Outbreak of COVID-19 in China During the Omicron Variant Predominance: Clinical Features and Outcomes in Patients with Autoimmune Inflammatory Rheumatic Diseases

Rheumatol Ther. 2023 Aug;10(4):1039-1053. doi: 10.1007/s40744-023-00569-7. Epub 2023 Jun 19.

Authors

Yan Geng^#¹, Yong Fan^#¹, Xuerong Deng¹, Yu Wang¹, Juan Zhao¹, Lanlan Ji¹, Zhibo Song¹, Guangtao Li¹, Xiaohui Zhang¹, Xiaoying Sun¹, Hong Huang¹, Wenhui Xie¹, Zhuoli Zhang²

Affiliations

¹ Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8, Xishiku Street, West District, Beijing, 100034, China.
² Department of Rheumatology and Clinical Immunology, Peking University First Hospital, No. 8, Xishiku Street, West District, Beijing, 100034, China. zhuoli.zhang@126.com.

^# Contributed equally.

Abstract

Introduction: The impact of coronavirus disease 2019 (COVID-19) on vulnerable populations with autoimmune inflammatory rheumatic diseases (AIIRDs) has been variable with variants and of great concern. Here we report the clinical features, outcomes, and risk factors for infection and hospitalization in patients with AIIRDs in the first wave of infection in China in December 2022.

Methods: A real-world survey was conducted in Chinese patients with AIIRDs from 8 December 2022 to 13 January 2023. The survey was distributed via internet nationwide, clinic consultation, and to inpatients at a tertiary hospital in Beijing. Clinical features, outcomes, and vaccination status were collected.

Results: A total of 2005 patients with AIIRDs completed the survey. There were 1690 (84.3%) patients infected and only 48.2% of patients received COVID-19 vaccination. Most of the fully vaccinated patients received inactivated COVID-19 vaccines, including Sinovac (55.6%) and Sinopharm (27.2%), followed by recombinant subunit vaccine from Zhifei Longcom (2.0%). The independent protecting factors for infection were a time interval of less than 3 months from last vaccination (OR 0.53, p = 0.037) and rheumatoid arthritis (RA) as the underlying AIIRD (OR 0.62, p = 0.041). A total of 57 out of 1690 patients (3.4%) were hospitalized for COVID, with 46 (2.7%) experiencing severe/critical course and 6 deaths (0.4%). In multivariable logistic regression analysis, independent risk factors for hospitalization were age over 60 years (OR 11.52, p < 0.001), with comorbidity (OR 1.83, p = 0.045) and systemic lupus erythematosus (SLE) as the AIIRDs (OR 2.59, p = 0.036). Receiving booster vaccine was an independent protective factor for hospitalization (OR 0.53, 95% CI 0.30-0.98; p = 0.018).

Conclusion: Hesitation for vaccination is common among Chinese patients with AIIRDs. The time from last vaccination of less than 3 months and having RA decreased the risk of COVID infection. Older age and having comorbidity or SLE increased the risk of hospitalization, while booster vaccination reduced the risk.

Keywords: Autoimmune inflammatory rheumatic diseases; COVID-19; Outcome; Vaccination.

Abstract

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