Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry

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Abstract

Objectives

COVID-19 outcomes in people with rheumatic diseases remain poorly understood. The aim was to examine demographic and clinical factors associated with COVID-19 hospitalisation status in people with rheumatic disease.

Methods

Case series of individuals with rheumatic disease and COVID-19 from the COVID-19 Global Rheumatology Alliance registry: 24 March 2020 to 20 April 2020. Multivariable logistic regression was used to estimate ORs and 95% CIs of hospitalisation. Age, sex, smoking status, rheumatic disease diagnosis, comorbidities and rheumatic disease medications taken immediately prior to infection were analysed.

Results

A total of 600 cases from 40 countries were included. Nearly half of the cases were hospitalised (277, 46%) and 55 (9%) died. In multivariable-adjusted models, prednisone dose ≥10 mg/day was associated with higher odds of hospitalisation (OR 2.05, 95% CI 1.06 to 3.96). Use of conventional disease-modifying antirheumatic drug (DMARD) alone or in combination with biologics/Janus Kinase inhibitors was not associated with hospitalisation (OR 1.23, 95% CI 0.70 to 2.17 and OR 0.74, 95% CI 0.37 to 1.46, respectively). Non-steroidal anti-inflammatory drug (NSAID) use was not associated with hospitalisation status (OR 0.64, 95% CI 0.39 to 1.06). Tumour necrosis factor inhibitor (anti-TNF) use was associated with a reduced odds of hospitalisation (OR 0.40, 95% CI 0.19 to 0.81), while no association with antimalarial use (OR 0.94, 95% CI 0.57 to 1.57) was observed.

Conclusions

We found that glucocorticoid exposure of ≥10 mg/day is associated with a higher odds of hospitalisation and anti-TNF with a decreased odds of hospitalisation in patients with rheumatic disease. Neither exposure to DMARDs nor NSAIDs were associated with increased odds of hospitalisation.

Related collections

Most cited references 33

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Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

Chaolin Huang, Yeming Wang, Xingwang Li … (2020)

Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.

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Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

Fei Zhou, Ting Yu, Ronghui Du … (2020)

Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.

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Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention

Zunyou Wu, Jennifer M. McGoogan (2020)

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Author and article information

Journal

Journal ID (nlm-ta): Ann Rheum Dis

Journal ID (iso-abbrev): Ann. Rheum. Dis

Journal ID (hwp): annrheumdis

Journal ID (publisher-id): ard

Title: Annals of the Rheumatic Diseases

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Print): 0003-4967

ISSN (Electronic): 1468-2060

Publication date (Print): May 2020

Publication date (Electronic): 29 May 2020

Electronic Location Identifier: annrheumdis-2020-217871

Affiliations

[1 ] departmentDepartment of Medicine, Division of Rheumatology , University of California San Francisco , San Francisco, California, USA

[2 ] departmentCentre for Epidemiology Versus Arthritis , The University of Manchester , Manchester, UK

[3 ] departmentNational Institute of Health Research Manchester Biomedical Research Centre , Manchester University NHS Foundation Trust , Manchester, Greater Manchester, UK

[4 ] Instituto de Salud Musculoesquelética , Madrid, Spain

[5 ] departmentDivision of Clinical Immunology and Rheumatology, Department of Medicine , The University of Alabama at Birmingham , Birmingham, Alabama, USA

[6 ] departmentInstitut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM , Sorbonne Universite , Paris, France

[7 ] departmentAPHP, Rheumatology Department , Hopital Universitaire Pitie Salpetriere , Paris, France

[8 ] departmentCentre for Genetics and Genomics Versus Arthritis , The University of Manchester , Manchester, UK

[9 ] Portuguese League Against Rheumatic Diseases (LPCDR) , Lisbon, Portugal

[10 ] departmentHealth Research & Policy, Division of Epidemiology and Department of Medicine, Division of Immunology & Rheumatology , Stanford School of Medicine , Stanford, California, USA

[11 ] departmentForschungsbereich Epidemiologie , Deutsches Rheuma-Forschungszentrum Berlin , Berlin, Germany

[12 ] University of Washington , Seattle, Washington, USA

[13 ] Crystal Run Healthcare , Middletown, New York, USA

[14 ] Irish Children's Arthritis Network (iCAN) , Tipperary, Ireland

[15 ] departmentDepartment of Medicine , University of Otago , Wellington, New Zealand

[16 ] Boston Children’s Hospital , Boston, Massachusetts, USA

[17 ] Harvard Medical School , Boston, Massachusetts, USA

[18 ] departmentDepartment of Health Research Methods, Evidence, and Impact , McMaster University , Hamilton, Ontario, Canada

[19 ] Canadian Arthritis Patient Alliance , Toronto, Ontario, Canada

[20 ] Healthpartners , St Paul, Minnesota, USA

[21 ] Massachusetts General Hospital , Boston, Massachusetts, USA

[22 ] departmentCentre for Rheumatology & Department of Neuromuscular Diseases , University College London (UCL) , London, UK

[23 ] University College London Hospitals (UCLH) National Institute for Health Research (NIHR) Biomedical Research Centre (BRC) , London, UK

[24 ] Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS trust , London, UK

[25 ] departmentFaculty of Medicine , The University of Queensland , Herston, Queensland, Australia

[26 ] departmentMetro North Hospital & Health Service , Royal Brisbane and Women's Hospital , Herston, Queensland, Australia

Author notes

[Correspondence to ] Dr Philip C Robinson, Faculty of Medicine, The University of Queensland, Herston, QLD 4029, Australia; philip.robinson@ 123456uq.edu.au

Author information

Laure Gossec http://orcid.org/0000-0002-4528-310X

Pedro M Machado http://orcid.org/0000-0002-8411-7972

Philip C Robinson http://orcid.org/0000-0002-3156-3418

Article

Publisher ID: annrheumdis-2020-217871

DOI: 10.1136/annrheumdis-2020-217871

PMC ID: 7299648

PubMed ID: 32471903

SO-VID: c96bd06c-690a-439d-aa37-31720f1703a2

License:

This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

History

Date received : 04 May 2020

Date revision received : 10 May 2020

Date accepted : 11 May 2020

Custom metadata

access-type free

ScienceOpen disciplines: Immunology

Keywords: tumor necrosis factor inhibitors,arthritis, rheumatoid,lupus erythematosus, systemic,hydroxychloroquine,methotrexate

Data availability:

ScienceOpen disciplines: Immunology

Keywords: tumor necrosis factor inhibitors, arthritis, rheumatoid, lupus erythematosus, systemic, hydroxychloroquine, methotrexate