Clinical characteristics of 17 patients with COVID-19 and systemic autoimmune diseases: a retrospective study
Yao Huang, Zhe Chen, Yu Wang, Liang Han, Kai Qin, Wenya Huang, Ying Huang, Hui Wang, Pan Shen, Xin Ba, Weiji Lin, Hui Dong, Mingmin Zhang, Professor Shenghao Tu
Annals of the Rheumatic Diseases, doi:10.1136/annrheumdis-2020-217425
What is already known about this subject? ► On 12 March, WHO declared COVID-19 could be characterised as a pandemic. Till 22 April, more than 2.5 million cases of COVID-19 have been reported worldwide. ► Increasing data about COVID-19 based on the general population has been reported. However, little published works were found about COVID-19 in disease-specific groups. What does this study add? ► We analysed the epidemiology of 1255 inpatients with COVID-19 who were admitted to Wuhan Tongji Hospital. Additional 17 patients with systemic autoimmune diseases (AIDs) were further screened, the demographic characteristics, epidemiological history, comorbidities, clinical symptoms or signs on admission, chest CT findings, laboratory results on admission, therapies that were prescribed for COVID-19 as well as AIDs, and clinical outcomes were reported. The detailed information of patients with systemic AIDs was investigated.
Competing interests none declared. Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.
Patient consent for publication not required. Ethics approval This study was approved by the ethics Commission of Tongji Hospital, Tongji Medical College, Huazhong University of science and Technology (TJ-iRB20200365). Written informed consent was waived by Tongji Hospital for emerging infectious diseases and the urgent need to collect data. Provenance and peer review not commissioned; externally peer reviewed. data availability statement Data are available upon reasonable request by email to shtu@ tjh. tjmu. edu. cn. This article is made freely available for use in accordance with BMJ's website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, on January 16, 2022 by guest. Protected by copyright. http://ard.bmj.com/
References
Chen N, Zhou, Dong, epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study, Lancet,
doi:10.1016/S0140-6736(20)30211-7Clinicaltrials, Gov, Post-exposure prophylaxis / preemptive therapy for saRs-Coronavirus-2-full text view
Gautret, Parola, Hydroxychloroquine and azithromycin as a treatment of COViD-19: results of an open-label non-randomized clinical trial, Int J Antimicrob Agents,
doi:10.1016/j.ijantimicag.2020.105949Hari, Gs, Levy Ml, Developing a new definition and assessing new clinical criteria for septic shock: for the third international consensus definitions for sepsis and septic shock (sepsis-3), Nephron Clin Pract,
doi:10.1001/jama.2016.0289Hemminki, Huang, autoimmune diseases and hematological malignancies: exploring the underlying mechanisms from epidemiological evidence, Semin Cancer Biol,
doi:10.1016/j.semcancer.2019.06.005Kim Ahj, Sparks, Liew, a rush to judgment? rapid reporting and dissemination of results and its consequences regarding the use of hydroxychloroquine for COViD-19, Ann Intern Med,
doi:10.7326/M20-1223Li, Guan, Wu, early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia, N Engl J Med,
doi:10.1056/NEJMoa2001316Lu, Zhao, Li, Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding, Lancet,
doi:10.1016/S0140-6736(20)30251-8Smolen Js, Bijlsma, eUlaR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2019 update, Ann Rheum Dis,
doi:10.1136/annrheumdis-2019-216655Subramanian Vs, Ga, Tumor necrosis factor alpha reduces intestinal vitamin C uptake: a role for nF-κB-mediated signaling, Am J Physiol Gastrointest Liver Physiol,
doi:10.1152/ajpgi.00071.2018Yao, Ye, Zhang, in vitro antiviral activity and projection of optimized dosing design of hydroxychloroquine for the treatment of severe acute respiratory syndrome coronavirus 2 (saRs-CoV-2), Clin Infect Dis,
doi:10.1093/cid/ciaa237Zhou, Yu, Du, Clinical course and risk factors for mortality of adult inpatients with COViD-19 in Wuhan, China: a retrospective cohort study, Lancet,
doi:10.1016/S0140-6736(20)30566-3DOI record:
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"abstract": "<jats:sec><jats:title>Objectives</jats:title><jats:p>Increasing data about COVID-19 have been acquired from the general population. We aim to further evaluate the clinical characteristics of COVID-19 in patients with systemic autoimmune diseases (AIDs).</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We included all confirmed inpatients with COVID-19 and systemic AIDs in Wuhan Tongji Hospital from 29 January to 8 March 2020. We retrospectively collected and analysed information on epidemiology of 1255 inpatients and additional clinical characteristics of patients with systemic AIDs. Outcomes were followed up until 16 April 2020.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>Of the 1255 patients with COVID-19, the median age was 64.0 years and 53.1% were male. More than half (63.0%) had chronic comorbidities. The proportions of elderly, male and patients with comorbidities were significantly higher in intensive care unit (ICU) than in the general ward (p<0.001). 17 (0.61%) patients with systemic AIDs were further screened and analysed from 2804 inpatients. The median age was 64.0 years and 82.4% were female. All patients were living in Wuhan and two family clusters were found. 1 (5.9%) patient was admitted to ICU and one died. 10 (62.5%) of 16 patients changed or stopped their anti-AIDs treatments during hospitalisation, and 5 of them felt that the disease had worsened after the quarantine.</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>Older males with chronic comorbidities are more vulnerable to severe COVID-19. The lower proportion of COVID-19 in patients with systemic AIDs needs more high-quality human clinical trials and in-depth mechanism researches. Of note, the withdrawal of anti-AIDs treatments during hospitalisation can lead to flares of diseases.</jats:p></jats:sec>",
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