Patients with rheumatic disease, COVID-19 more likely to require ventilation

Last updated: 06-21-2020

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Patients with rheumatic disease, COVID-19 more likely to require ventilation

Wallace reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Patients with rheumatic diseases plus COVID-19 are more likely to require mechanical ventilation, but demonstrated similar clinical features and hospitalization rates as those with COVID-19 only, according to data published in the Annals of the Rheumatic Diseases.

“The COVID-19 pandemic has had an incredible impact on every aspect of health care,” Zachary S. Wallace, MD, of Massachusetts General Hospital, told Healio Rheumatology. “In rheumatology, both patients and providers have had understandable concerns regarding the impact that COVID-19 would have on this unique patient population.”

“We know that immunosuppressive medications put rheumatic disease patients at higher risk for infection so there was worry that this population would be at particularly high risk for COVID-19 and its complications,” he added. “Adding to this potential risk were the many comorbidities — eg, renal disease, hypertension, cardiovascular disease — that patients with rheumatic diseases often suffer from as a result of the underlying condition and its treatment.”

To analyze the differences in COVID-19 manifestations and outcomes among patients with and without rheumatic diseases, D’Silva and colleagues conducted a comparative cohort study of individuals treated within the Partners Healthcare System in the greater Boston area. This system includes Massachusetts General Hospital and Brigham and Women’s Hospital. Participants included 52 patients with rheumatic diseases — 19 with rheumatoid arthritis, 10 with systemic lupus erythematosus, seven with polymyalgia rheumatica, seven with spondyloarthritis, three with myositis, three with vasculitis and one with sarcoidosis — who had tested positive for COVID-19.

Investigators compared these participants in a 1:2 ratio with 104 control individuals, matched based on age, sex and date of COVID-19 diagnosis. The researchers analyzed differences in demographics, as well as COVID-19 clinical features and outcomes. The main outcomes were hospitalization, intensive care admission, mechanical ventilation and mortality.

According to the researchers, 75% of patients with a rheumatic disease were receiving immunosuppressive medications. Patients with and without rheumatic disease had similar symptoms and laboratory findings. Additionally, a similar proportion of patients with and without rheumatic disease were hospitalized — 44% compared with 40%, respectively. Mortality was also similar between the two groups, at 6% among patients with rheumatic disease, compared with 4% among those without.

However, 48% of those with rheumatic disease required intensive care admission and mechanical ventilation, compared with 18% of those with COVID-19 only (multivariable OR = 3.11; 95% CI, 1.07-9.05).

“We found that patients with rheumatic diseases who had COVID-19 had similar odds of being hospitalized as patients without rheumatic diseases,” Wallace said. “However, those with rheumatic diseases, when sick and hospitalized, seemed to have higher odds of needed mechanical ventilation which is worrisome.”

“We do not know if the increased odds of severe respiratory failure are a result of immunosuppression, comorbidities, or other factors,” he added. “More studies will be needed to clarify factors driving these observations. We did not find a different in mortality between those with rheumatic diseases and comparators, but this may be because many of the patients with rheumatic conditions remained hospitalized.”

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