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Patients with systemic autoimmune rheumatic diseases were at increased risk of adverse outcomes such as end-organ failure when infected with COVID-19, a researcher reported.

For instance, the rate of mechanical ventilation among COVID-19 patients with rheumatic disease was 5.5% versus 3.1% among controls, for a risk difference of 2.4% (95% CI 0.3-4.5 and a risk ratio of 1.77 (95% CI 1.06-2.96, P=0.03), according to Kristin M. D'Silva, MD, of Massachusetts General Hospital in Boston.

Rates of acute kidney injury were 5.9% among patients compared with 3.2% among controls, for a risk difference of 2.7% (95% CI 0.5-4.8) and a risk ratio of 1.83 (95% CI 1.11-3, P=0.02), she said in a presentation at the at the American College of Rheumatology virtual meeting.

It has not been determined whether patients with systemic autoimmune rheumatic diseases are more likely than others to experience severe complications of COVID-19.

To address this question, D'Silva and colleagues conducted a matched cohort study of patients included in the TriNETX Research Network, which represents more than 52 million individuals from 35 healthcare organizations.

COVID-19 infections confirmed with polymerase chain reaction tests between January and June 2020 were included.

A total of 716 patients with systemic rheumatic diseases and COVID-19 were compared with an equivalent number of age, sex, and race-matched patients with COVID-19 but without rheumatic disease.

The specific underlying systemic disease was rheumatoid arthritis in 45%, systemic lupus erythematosus in 18%, Sjogren's syndrome in 10%, mixed/undifferentiated connective tissue disease in 5%, systemic vasculitis in 9%, psoriatic arthritis in 6%, and small numbers with inflammatory myopathy, systemic sclerosis, or ankylosing spondylitis.

Patients' mean age was 57, almost 80% were women, and more than half were white. Compared with controls, patients had more comorbidities, including hypertension (49% vs 32%), diabetes (24% vs 17%, asthma (18% vs 9%), chronic kidney disease (19% vs 7%), and congestive heart failure (15% vs 5%).

Among the patients, 40% were taking prednisone, 20% were on hydroxychloroquine, and 12% were taking tumor necrosis factor inhibitors.

Rates of hospitalization were 24.4% among rheumatic patients compared with 19.8% for controls, for a risk difference of 4.6% (95% CI 0.3-8.9) and an RR of 1.23 (95% CI 1.01-1.50, P=0.04), she reported. Admission to the ICU was 6.8% among rheumatic patients versus 3.9% among controls, for a risk difference of 2.9% (95% CI 0.6-5.3) and an RR of 1.75 (95% CI 1.11-2.75, P=0.01).

For congestive heart failure, the rates were 6.8% among patients and 2.2% among controls, for a risk difference of 4.6% (95% CI 2.5-6.8) and an RR of 3.06 (95% CI 1.76-5.33, P<0.01).

Mortality rates were numerically higher among rheumatic patients, though this did not reach statistical significance. For patients, the mortality rate was 5% compared with 4.3% among controls, for a risk difference of 0.7% (95% CI -1.5 to 2.9) and an RR of 1.16 (95% CI 0.73-1.86, P=0.53).

A further concern was venous thromboembolism, because rheumatic disease may contribute to the risk of venous thromboembolic events, even beyond the mediating effects of comorbidities. "Patients with rheumatic disease should be monitored closely for venous thromboembolism during COVID-19 infection," D'Silva said.

Further studies will be needed to identify risk factors associated with severe COVID-19 among patients with systemic autoimmune rheumatic diseases, she concluded.

A study limitation was the potential for residual confounding because of its observational design.

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