Risk Factors and Outcomes for COVID-19 in Autoimmune Inflammatory Diseases during the SARS-CoV-2 Pandemic: A Comparative Study

Background: Patients with autoimmune disease (AID) and coronavirus disease 2019 (COVID-19) could have higher mortality due to the co-morbidity and the use of immunosuppressive therapy. Objectives: To analyze the risk factors and outcomes of patients with AID and COVID-19 versus a control group. Methods: A prospective cohort study included patients with and without AID and COVID-19. Patients were paired by age and sex. Clinical, biochemical, immunological treatments, and outcomes (days of hospital stay, invasive mechanical ventilation [IMV], oxygen at discharge, and death) were collected. Results: We included 226 COVID-19 patients: 113 with AID (51.15 +/- 14.3 years) and 113 controls (53.45 +/- 13.3 years). The most frequent AIDS were Rheumatoid arthritis (26.5%), systemic lupus erythematosus (21%), and systemic sclerosis (14%). AID patients had lower lactate dehydrogenas, C-reactive protein, fibrinogen, IMV (P = 0.027), and oxygen levels at discharge (P = 0.0001) and lower death rates (P = 0.0001). Oxygen saturation (SaO(2)) < 88% at hospitalization provided risk for IMV (RR [relative risk] 3.83, 95% confidence interval [95%CI] 1.1-13.6, P = 0.038). Higher creatinine and LDH levels were associated with death in the AID group. SaO(2) <= 88% and CO-RADS 4 were risk factors for in-hospital mortality (RR 4.90, 95%CI 1.8-13.0, P = 0.001 and RR 7.60, 95%CI 1.4-39.7, P = 0.016, respectively). Anticoagulant therapy was protective (RR 0.36, 95%CI 0.1-0.9, P= 0.041) Conclusions: AID and COVID-19 patients had better outcomes than controls. Anticoagulation was associated with a lower death in patients with AID.

Automated summary

Patients with autoimmune diseases (AID) and COVID-19 have better outcomes compared to the control group. Anticoagulant therapy is associated with lower mortality in patients with AID.