Covid-19 Outcomes in Autoimmune Disease Patients

January 19, 2021

A research article published in Rheumatology last Fall summarized 30-day outcomes of autoimmune disease (AD) patients following hospitalization with COVID-19. Systemic inflammation present in many AD patients may increase the risk of blood clots and cardiovascular disease, which may lead to worse outcomes associated with pro-inflammatory cytokine storm. This has been found to occur during COVID-19 infections. Autoimmune disease is also currently considered a risk factor for severe COVID-19, which includes complications and hospitalization.

Electronic health records were collected from Columbia University Irving Medical Center and the Department of Veterans Affairs, as well as hospitalization and open claims insurance data from Spain, the U.S., and South Korea. AD patients diagnosed and/or hospitalized between January and June 2020 with COVID-19 were included, and their 30 day outcomes were compared to patients with at least one AD hospitalized with influenza from September 2017 through April 2018. Autoimmune diseases included in the study were: Type 1 diabetes, rheumatoid arthritis, psoriatic arthritis, psoriasis, multiple sclerosis, SLE, Addison’s disease, Graves’ disease, Hashimoto’s thyroiditis, Sjogren’s Syndrome, Myasthenia gravis, vasculitis, pernicious anaemia, Celiac disease, Crohn’s disease, ulcerative colitis, scleroderma, and sarcoidosis.

Over 48,000 AD patients hospitalized with COVID-19 were studied. The majority of cases included those 65+ years of age; 54.8% were female. The most common autoimmune diseases in patients diagnosed with COVID-19 included psoriasis, rheumatoid arthritis, and vasculitis. The most common co-morbidities were hypertension, heart disease, Type 2 diabetes, and high cholesterol. In all databases besides one, obesity was also a frequently diagnosed comorbidity. The most frequently prescribed medications in the year prior to COVID-19 diagnosis included systemic antibiotics, pharmacological treatments for GERD, and NSAIDs.

“The proportion of hospitalization episodes was higher in the cohort diagnosed with COVID-19 as compared to influenza,” even though researchers compared COVID-19 hospitalized patients against almost 400,000 patients with AD diagnosed with influenza. 70,660 patients hospitalized with influenza were included in the study.

At 30 days post-hospitalization, the most common severe outcomes included ARDS (acute respiratory distress syndrome) and pneumonia. “The presence of co-morbidities such as hypertension, diabetes and obesity among patients with autoimmune diseases was associated with higher rates of hospitalization, ventilation and death due to COVID-19.” In all, AD patients hospitalized with COVID-19 had higher 30 day mortality compared to AD patients hospitalized with influenza.

The researchers noted that while the study found a “greater proportion of hospitalization with COVID-19 as compared with influenza, the hospitalization rate may not directly reflect the severity of prognosis in COVID-19. The higher hospitalization rate could also be contributed by quarantine measures in the hospital after diagnosis or monitoring of patients receiving investigative treatments repurposed for COVID-19.”