Immunosuppression (IS) and autoimmune disease (AD) are prevalent in patients with severe coronavirus disease 2019 (COVID-19), but their impact on its clinical course is unknown. We investigated relationships between IS, AD, and outcomes in patients hospitalized with COVID-19. Data on consecutive admissions for COVID-19 were extracted retrospectively from medical records. Patients were assigned to one of four cohorts, according to whether or not they had an AD (AD and NAD) or were immunosuppressed (IS and NIS). The primary endpoint was development of severe acute respiratory distress syndrome (ARDS); secondary endpoints included death, and a composite of mechanical ventilation (MV) or death. A total of 789 patients were included: 569 (72.1%) male, 76 (9.6%) with an AD, and 63 (8.0%) with IS. Relative to the NIS-NAD cohort, patients in the IS-AD cohort had a significantly reduced risk of severe ARDS (adjusted hazard ratio [aHR] 0.42; 95% confidence interval [CI] 0.23–0.80; p = 0.008). No significant relationships between IS or AD status and either death or the composite of MV and death were identified, although a trend towards higher mortality was identified in the IS-NAD cohort (aHR vs NIS-NAD 1.71; 95% CI 0.94–3.12; p = 0.081). Patients in this cohort also had higher median serum levels of interleukin-6 compared with IS-AD patients (98.2 vs 21.6 pg/mL; p = 0.0328) and NIS-NAD patients (29.1 pg/mL; p = 0.0057). In conclusion, among patients hospitalized with COVID-19, those receiving immunosuppressive treatment for an AD may have a reduced risk of developing severe ARDS.

免疫抑制（IS）和自身免疫性疾病（AD）在患有严重冠状病毒病2019（COVID-19）的患者中普遍存在，但对其临床过程的影响尚不清楚。我们调查了IS，AD和COVID-19住院患者的结局之间的关系。从病历中回顾性提取了连续入院的COVID-19数据。根据患者是否患有AD（AD和NAD）或免疫抑制（IS和NIS），将其分为四个队列之一。主要终点是严重急性呼吸窘迫综合征（ARDS）的发展。次要终点包括死亡，以及机械通气（MV）或死亡的复合物。总共包括789名患者：男性569名（72.1％），AD患儿76名（9.6％），IS患病63名（8.0％）。相对于NIS-NAD群组，p  = 0.008）。尽管在IS-NAD人群中发现了死亡率升高的趋势（aHR vs NIS-NAD 1.71； 95％CI 0.94-3.12； AHR vs NIS-NAD 1.71； 95％CI 0.94–3.12； 95％CI 0.94–3.12; p  = 0.081）。与IS-AD患者（98.2 vs 21.6 pg / mL；p  = 0.0328）和NIS-NAD患者（29.1 pg / mL；p  = 0.0057）相比，该队列患者的白细胞介素6的中位血清水平也更高。总之，在住院COVID-19的患者中，接受AD免疫抑制治疗的患者发生严重ARDS的风险可能降低。