Research Report, Summarized by Mary McNeil, SjSC
In a study published in December, 2020 in Arthritis and Rheumatology, researchers compared the COVID-19 outcomes of patients with systemic autoimmune rheumatic diseases (SARDs) such as Sjögren’s (317), lupus (528), rheumatoid arthritis (1,181), to non-SARD patients with COVID-19. SARDs are diseases where the immune system attacks connective tissues. The data was gathered from a large multi-center electronic health record network in the U.S. Thirty day outcomes were assessed including hospitalization, intensive care unit (ICU) admission, mechanical ventilation, acute renal failure requiring renal replacement therapy, ischemic stroke, venous thromboembolism (VTE/blood clots) and death.
In their primary statistical model, 2,379 COVID-19 SARD patients were matched on age, sex, ethnicity, and body mass index with 2,379 non-SARD patients with COVID-19. SARD patients had a significantly higher risk of hospitalization, ICU admission, acute renal failure, and VTE than matched comparators. The SARD patients had a slightly higher risk of ischemic strokes but it was not statistically significant. There was no significantly higher risk of mechanical ventilation, death or the composite outcome of ICU, ventilation or death.
In a second extended model of COVID-19 patients included in the study group, 2,374 SARD patients were matched with 2,374 non-SARD patients with two additional variables: comorbidities (hypertension, heart disease, chronic kidney disease, asthma, chronic obstructive pulmonary disease, type 2 diabetes) and prior health care utilization. The extended model found that SARD patients were no longer more likely to be hospitalized, admitted to ICU, or to experience acute renal failure than control patients but they continued to show a 60% higher VTE risk than did non-SARD patients. The analysis of the extended model confirms that co-morbidities are a key factor for the excess risk of severe outcomes in both SARD and non-SARD patients.
Researchers suggested that patients living with SARDs may be at higher risk of VTE due to a chronic inflammatory state. “SARD patients with COVID-19 should be closely monitored for thrombotic complications”. However, they were not able to determine the risk of VTE in specific SARD diseases and suggested further research is warranted. They also emphasized “the need for continued vigilance to physical distancing recommendations to prevent COVID-19 transmission especially in patients with SARDs and significant comorbidities”.
D’Silva, K. and Jorge, A. et.al.