Are COVID-19 patients with autoimmune disease at higher risk of adverse outcomes?

Patients with COVID-19 who also have an autoimmune (AI) disease are not at increased risk of intensive care unit (ICU) admission, intubation, or death compared to controls, a study has found.

“[W]e found that among patients hospitalized with COVID-19, individuals with AI disease and those on chronic immunosuppressive therapy did not have an increased risk of adverse events, such as ICU admission, intubation, and death,” the researchers said.

This retrospective cohort study included 186 patients with COVID-19 admitted to hospitals between 1 March 2020 and 15 April 2020 at the New York-Presbyterian Hospital/Columbia University Irving Medical Center. Of these, 62 had AI disease and 124 were age- and sex-matched controls.

A composite of ICU admission, intubation, and death was the primary outcome, while time to in-hospital death was the secondary one. The researchers obtained baseline demographics, comorbidities, medications, vital signs, and laboratory values. They used conditional logistic regression and Cox proportional hazards regression to assess the relationship between AI disease and clinical outcomes.

COVID-19 patients with AI disease were more likely to have at least one comorbidity (87.1 percent vs 74.2 percent; p=0.04), take chronic immunosuppressive drugs (66.1 percent vs 4.0 percent; p<0.01), and have had a solid organ transplant (16.1 percent vs 1.6 percent; p<0.01). No significant differences were seen in ICU admission (13.7 percent vs 19.4 percent; p=0.32), intubation (13.7 percent vs 17.7 percent; p=0.47), or death (16.1 percent vs 14.5 percent; p=0.78). [J Rheumatol 2021;48:454-462]

Multivariable analysis revealed no increased risk for a composite outcome of ICU admission, intubation, or death (adjusted odds ratio, 0.79, 95 percent CI, 0.37–1.67) among COVID-19 patients with AI disease. On Cox regression, no association was found between AI disease and in-hospital mortality (adjusted hazard ratio, 0.73, 95 percent CI, 0.33–1.63).

“On admission, individuals with AI disorders had similar symptoms, vital signs, and laboratory values, including those suggestive of cytokine storm, compared to their matched controls,” the researchers said, noting the similarity to findings observed by D’Silva and colleagues in their study. [Ann Rheum Dis 2020;79:1156-1162]

“Patients with AI disease, however, were more likely to receive corticosteroids (CS) during their hospital course, which was largely driven by the continuation of their home CS regimens,” they added.

Notably, the researchers found that inpatient initiation of CS or hydroxychloroquine therapy could induce adverse outcomes, although this could likely serve as a marker of disease severity as higher acuity patients were predisposed to receive these medications.

In the assessment of disease outcomes, recent studies reported a higher risk of respiratory failure among hospitalized COVID-19 patients with rheumatic disease. [Ann Rheum Dis 2020;79:1156-1162; Ann Rheum Dis 2020;79:1007-1013; Gastroenterology 2020;159:781-783]

The current study found no differences in the risk of intubation, death, or ICU admission between AI disease patients and controls. Additionally, after adjusting for smoking and comorbidities, as well as the clinically relevant variables of race/ethnicity and body mass index, patients with AI disease were not at higher risk for the composite outcome than matched controls. [Lancet 2020;395:1763-1770; Clin Infect Dis 2020;71:896-897; N Engl J Med 2020;382:2372-2374; Am J Prev Med 2020;59:137-139; J Racial Ethn Health Disparities 2020;7:398-402; J Infect 2020; 81:e110-111]

“Additional research is needed to better characterize the management of individuals with AI conditions in the context of COVID-19, particularly with regard to the use of additional immunosuppression in the inpatient setting,” the researchers said.