A multidisciplinary registry of patients with autoimmune and immune-mediated diseases with symptomatic COVID-19 from a single center,Journal of Autoimmunity

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A multidisciplinary registry of patients with autoimmune and immune-mediated diseases with symptomatic COVID-19 from a single center
Journal of Autoimmunity ( IF 7.9 ) Pub Date : 2020-11-30 , DOI: 10.1016/j.jaut.2020.102580
Juan C Sarmiento-Monroy ₁ , Gerard Espinosa ₂ , Maria-Carlota Londoño ₃ , Fernanda Meira ₄ , Berta Caballol ₅ , Sara Llufriu ₆ , Josep Lluis Carrasco ₇ , Aina Moll-Udina ₈ , Luis F Quintana ₉ , Priscila Giavedoni ₁₀ , Julio Ramírez ₁₁ , Jose Inciarte-Mundo ₁ , Elisabeth Solana ₆ , Yolanda Blanco ₆ , Eugenia Martinez-Hernandez ₆ , Maria Sepúlveda ₆ , Victor Llorenç ₈ , Sergio Prieto-González ₂ , Georgina Espígol-Frigolé ₂ , Jose C Milisenda ₁₁ , Maria C Cid ₂ , Jose M Mascaró ₁₀ , Isabel Blanco ₁₂ , Joan Albert Barberá ₁₂ , Oriol Sibila ₁₂ , Jordi Gratacos-Ginès ₅ , Alfredo Adán ₈ , Alvaro Agustí ₁₂ , Raimon Sanmartí ₁ , Julian Panés ₅ , Ricard Cervera ₂ , Jordi Vila ₁₃ , Alex Soriano ₄ , José A Gómez-Puerta ₁ ,

Affiliation

Rheumatology Department, Hospital Clínic, Barcelona, Catalonia, Spain.
Department of Autoimmune Diseases, IDIBAPS, University of Barcelona, Hospital Clínic, Barcelona, Catalonia, Spain.
Liver Unit, Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS) and Centro de Investigación en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), University of Barcelona, Barcelona, Catalonia, Spain.
Department of Infectious Diseases, Hospital Clinic, IDIBAPS, Barcelona, Spain.
Department of Gastroenterology, Hospital Clínic, Barcelona, Catalonia, Spain.
Department of Neurology, Hospital Clínic, Barcelona, Catalonia, Spain.
Biostatistics, Department of Basic Clinical Practice, University of Barcelona, Barcelona, Catalonia, Spain.
Group of Ocular Inflammation, Clinical and Experimental Studies, Institut d'Investigacions Biomèdiques Agustí Pi i Sunyer (IDIBAPS), Hospital Clínic, Barcelona, Catalonia, Spain.
Department of Nephrology and Renal Transplantation, Hospital Clínic, Centro de Referencia en Enfermedad Glomerular Compleja del Sistema Nacional de Salud (CSUR), Department of Medicine, University of Barcelona, IDIBAPS, Barcelona, Catalonia, Spain.
Department of Dermatology, Hospital Clínic, Universitat de Barcelona, Barcelona, Catalonia, Spain.
Muscle Research Unit, Department of Internal Medicine, Hospital Clínic, University of Barcelona, CIBERER, Barcelona, Catalonia, Spain.
Department of Pulmonary Medicine, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Barcelona, Catalonia, Spain.
Department of Clinical Microbiology, Biomedical Diagnostic Center, Hospital Clinic, Barcelona Institute for Global Health, University of Barcelona, Barcelona, Catalonia, Spain.

Background and aim

There is increasing interest regarding SARS-CoV-2 infection in patients with autoimmune and immune-mediated inflammatory diseases (AI/IMID) with some discrepancies in different cohorts about their risk and outcomes. The aim was to describe a multidisciplinary cohort of patients with AI/IMID and symptomatic SARS-CoV-2 infection in a single tertiary center and analyze sociodemographic, clinical, and therapeutic factors associated with poor outcomes.

Methods

A retrospective observational study was conducted from the 1st of March until May 29th, 2020 in a University tertiary hospital in Barcelona, Spain. Patients with an underlying AI/IMID and symptomatic SARS-CoV-2 infection were identified in our local SARS-CoV-2 infection database. Controls (2:1) were selected from the same database and matched by age and gender. The primary outcome was severe SARS-CoV-2 infection, which was a composite endpoint including admission to the intensive care unit (ICU), need for mechanical ventilation (MV), and/or death. Several covariates including age, sex, and comorbidities among others were combined into a multivariate model having severe SARS-CoV-2 as the dependent variable. Also, a sensitivity analysis was performed evaluating AID and IMID separately.

Results

The prevalence of symptomatic SARS-CoV-2 infection in a cohort of AI/IMID patients was 1.3%. Eighty-five patients with AI/IMID and symptomatic SARS-CoV-2 were identified, requiring hospitalization in 58 (68%) cases. A total of 175 patients admitted for SARS-CoV-2 (58 with AI/IMID and 117 matched-controls) were analyzed. In logistic regression analysis, a significant inverse association between AI/IMID group and severe SARS-CoV-2 (OR 0.28; 95% CI 0.12–0.61; p = 0.001), need of MV (OR 0.20; IC 95% 0.05–0.71; p = 0.014), and ICU admission (OR 0.25; IC 95% 0.10–0.62; p = 0.003) was found.

Conclusions

Patients with AI/IMID who require admission for SARS-CoV-2 infection have a lower risk of developing severe disease, including the need to stay in the ICU and MV.

中文翻译：

来自单一中心的具有症状的 COVID-19 自身免疫性和免疫介导疾病患者的多学科登记

背景和目的

人们对自身免疫性和免疫介导的炎症性疾病 (AI/IMID) 患者的 SARS-CoV-2 感染越来越感兴趣，但不同人群的风险和结果存在一些差异。目的是描述单个三级中心的 AI/IMID 和有症状 SARS-CoV-2 感染患者的多学科队列，并分析与不良结果相关的社会人口统计学、临床和治疗因素。

方法

2020年3月1日至5月29日在西班牙巴塞罗那的一所大学三级医院进行了一项回顾性观察研究。我们当地的 SARS-CoV-2 感染数据库中确定了患有潜在 AI/IMID 和有症状的 SARS-CoV-2 感染的患者。对照组（2:1）是从同一数据库中选择的，并按年龄和性别进行匹配。主要结局是严重的 SARS-CoV-2 感染，这是一个复合终点，包括入住重症监护病房 (ICU)、需要机械通气 (MV) 和/或死亡。包括年龄、性别和合并症等在内的几个协变量被组合成一个以严重 SARS-CoV-2 作为因变量的多变量模型。此外，还进行了敏感性分析，分别评估 AID 和 IMID。

结果

AI/IMID 患者队列中出现症状的 SARS-CoV-2 感染率为 1.3%。确定了 85 名 AI/IMID 和有症状的 SARS-CoV-2 患者，其中 58 例 (68%) 需要住院治疗。总共分析了 175 名因 SARS-CoV-2 入院的患者（58 名患有 AI/IMID 的患者和 117 名匹配对照患者）。在逻辑回归分析中，AI/IMID 组与重症 SARS-CoV-2 之间存在显着负相关（OR 0.28；95% CI 0.12–0.61；p = 0.001），需要 MV（OR 0.20；IC 95% 0.05–0.71）；p = 0.014），并入ICU（OR 0.25；IC 95% 0.10–0.62；p = 0.003）。