Predictors of COVID-19 severity and outcomes in Indian patients with rheumatic diseases: a prospective cohort study
Dr Jithin Mathew, Siddharth Jain, Terence Susngi, Gsrsnk Naidu, Varun Dhir, Aman Sharma, Sanjay Jain, Shefali Khanna, Dr Siddharth Jain, Dr Shefali K Sharma
doi:10.1093/rap/rkad025/7059537
Objectives: There is dearth of data regarding COVID-19 outcomes amongst rheumatic and musculoskeletal diseases (RMD) patients from South-East-Asia. We report the clinico-demographic profile and identify predictors of COVID-19 outcomes in a large cohort of Indian RMD patients.
Methods : This prospective cohort study done at PGIMER, Chandigarh (tertiary care centre in India) included RMD patients affected with COVID-19 between April 2020-October 2021. Demographic and clinico-laboratory details of COVID-19 and underlying RMD were noted. Predictors of mortality, hospitalization, and severe COVID-19 were identified using stepwise multivariable logistic regression. Results: A total of 64 SARS-CoV-2 infected RMD patients [age 41.5 (19-85 years); 46 (72%) females] were included. 18(28%) patients had severe COVID-19. 23 (36%) required respiratory support [11 (17%) required mechanical ventilation]. 36 (56%) patients required hospitalization [median duration of stay 10(1-42) days]; 17 (27%) required intensive care unit (ICU) admission. Presence of comorbidities [OR=4.5(1.4-14.7)] was found to independently predict COVID-19 severity. Comorbidities [OR=10.7(2.5-45.4)] and underlying lupus [OR=7.0(1.2-40.8)] were independently associated with COVID-19-hospitalization. Ongoing rheumatic disease activity [OR=6.8(1.3-35.4)] and underlying diagnosis of lupus [OR=7.1(1.2-42.4)] and systemic sclerosis (SSc) [OR=9.5(1.5-61.8)] were found to be strong independent predictors of mortality. Age, gender, underlying RMD-interstitial lung disease (ILD) and choice of immunosuppressive therapy were not associated with COVID-19 severity or adverse outcomes. Conclusion: Presence of comorbidities was independently associated with COVID-19 severity and hospitalization. Ongoing rheumatic disease activity and presence of lupus or SSc independently predicted mortality. Age, gender, type of immunosuppressive therapy and presence of RMD-ILD did not affect COVID-19 severity or outcomes in Indian RMD patients.
Conflict of Interest: The authors have declared no conflicts of interest
References
Akiyama, Hamdeh, Micic, Sakuraba, Prevalence and clinical outcomes of COVID-19 in patients with autoimmune diseases: a systematic review and meta-analysis, Ann Rheum Dis
Alarcón, Izadi, Duarte-García, Reátegui-Sokolova, Clarke, Characteristics associated with poor COVID-19 outcomes in individuals with systemic lupus erythematosus: data from the COVID-19 Global Rheumatology Alliance, Ann Rheum Dis
Alqahtani, Oyelade, Aldhahir, Alghamdi, Almehmadi et al., Prevalence, Severity and Mortality associated with COPD and Smoking in patients with COVID-19: A Rapid Systematic Review and Meta-Analysis. Bhatt GC, PLOS ONE
Andersen, Bates, Rashidi, Olex, Mannon et al., Long-term use of immunosuppressive medicines and in-hospital COVID-19 outcomes: a retrospective cohort study using data from the National COVID Cohort Collaborative, Lancet Rheumatol
Annamalai, Santhanam, Mohanasundaram, Nambi, Sankaran et al., COVID-19 and Rheumatic Diseases in Tamil Nadu -A multicenter retrospective observational study, Indian J Rheumatol
Bower, Frisell, Giuseppe, Delcoigne, Ahlenius et al., Impact of the COVID-19 pandemic on morbidity and mortality in patients with inflammatory joint diseases and in the general population: a nationwide Swedish cohort study, Ann Rheum Dis
Brenner, Ungaro, Gearry, Kaplan, Kissous-Hunt et al., Corticosteroids, But Not TNF Antagonists, Are Associated With Adverse COVID-19 Outcomes in Patients With Inflammatory Bowel Diseases: Results From an International Registry, Gastroenterology
Conway, Grimshaw, Konig, Putman, Duarte-García et al., SARS-CoV-2 Infection and COVID-19 Outcomes in Rheumatic Diseases: A Systematic Literature Review and Meta-Analysis, Arthritis Rheumatol
Dessie, Zewotir, Mortality-related risk factors of COVID-19: a systematic review and metaanalysis of 42 studies and 423,117 patients, BMC Infect Dis
Drake, Docherty, Harrison, Quint, Adamali et al., Outcome of Hospitalization for COVID-19 in Patients with Interstitial Lung Disease. An International Multicenter Study, Am J Respir Crit Care Med
Francesconi, Cantini, Profili, Mannoni, Bellini et al., COVID-19 epidemiology in rheumatic diseases in Tuscany: A case-control study, Joint Bone Spine
Gianfrancesco, Hyrich, Al-Adely, Carmona, Danila et al., Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry, Ann Rheum Dis
Gianfrancesco, Leykina, Izadi, Taylor, Sparks et al., Association of Race and Ethnicity With COVID-19 Outcomes in Rheumatic Disease: Data From the COVID-19 Global Rheumatology Alliance Physician Registry, Arthritis Rheumatol
Hasseli, Mueller-Ladner, Hoyer, Krause, Lorenz et al., Older age, comorbidity, glucocorticoid use and disease activity are risk factors for COVID-19 hospitalisation in patients with inflammatory rheumatic and musculoskeletal diseases, RMD Open
Jung, Kim, Kim, Choi, Chung et al., Effect of hydroxychloroquine preexposure on infection with SARS-CoV-2 in rheumatic disease patients: a population-based cohort study, Clin Microbiol Infect Off Publ Eur Soc Clin Microbiol Infect Dis
Lee, Choi, Yang, Lee, Park et al., Interstitial lung disease increases susceptibility to and severity of COVID-19, Eur Respir J
Liang, Guan, Chen, Li, Xu, Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China, Lancet Oncol
Mahil, Dand, Mason, Yiu, Tsakok et al., Factors associated with adverse COVID-19 outcomes in patients with psoriasis-insights from a global registry-based study, J Allergy Clin Immunol
Nuñez, Leon, Mucientes, Rodriguez-Rodriguez, Urgelles et al., Risk factors for hospital admissions related to COVID-19 in patients with autoimmune inflammatory rheumatic diseases, Ann Rheum Dis
Pablos, Galindo, Carmona, Lledó, Retuerto et al., Clinical outcomes of hospitalised patients with COVID-19 and chronic inflammatory and autoimmune rheumatic diseases: a multicentric matched cohort study, Ann Rheum Dis
Robinson, Yazdany, Racial and ethnic differences in COVID-19 outcomes: a call to action, Lancet Rheumatol
Salvarani, Mancuso, Gradellini, Viani, Pandolfi et al., Susceptibility to COVID-19 in Patients Treated With Antimalarials: A Population-Based Study in Emilia-Romagna, Northern Italy, Arthritis Rheumatol
Sattui, Conway, Putman, Seet, Gianfrancesco et al., Outcomes of COVID-19 in patients with primary systemic vasculitis or polymyalgia rheumatica from the COVID-19 Global Rheumatology Alliance physician registry: a retrospective cohort study, Lancet Rheumatol
Scirè, Carrara, Zanetti, Landolfi, Chighizola et al., COVID-19 in rheumatic diseases in Italy: first results from the Italian registry of the Italian Society for Rheumatology (CONTROL-19), Clin Exp Rheumatol
Scully, Haverfield, Ursin, Tannenbaum, Klein, Considering how biological sex impacts immune responses and COVID-19 outcomes, Nat Rev Immunol
Shin, Shin, Moon, Jin, Kim et al., Autoimmune inflammatory rheumatic diseases and COVID-19 outcomes in South Korea: a nationwide cohort study, Lancet Rheumatol
Shobha, Chanakya, Haridas, Kumar, Chebbi et al., Do all patients with rheumatic Diseases have a higher risk of COVID 19? Initial results from the Karnataka Rheumatology Association COVID 19 Cohort Study (KRACC), Indian J Rheumatol
Silva, Cohen, Mccormick, Zhang, Wallace, COVID-19 Outcomes in Patients With Systemic Autoimmune Rheumatic Diseases Compared to the General Population: A US Multicenter, Comparative Cohort Study, Arthritis Rheumatol
Snfmi, Severity of COVID-19 and survival in patients with rheumatic and inflammatory diseases: data from the French RMD COVID-19 cohort of 694 patients, Ann Rheum Dis
Topless, Gaffo, Stamp, Robinson, Dalbeth et al., Gout and the risk of COVID-19 diagnosis and death in the UK Biobank: a population-based study, Lancet Rheumatol
Wang, Ma, Xu, Liu, Chen et al., Prevalence and risk of COVID-19 in patients with rheumatic diseases: a systematic review and meta-analysis, Clin Rheumatol
Yang, Koh, Moon, Yoo, Ha et al., Allergic disorders and susceptibility to and severity of COVID-19: A nationwide cohort study, J Allergy Clin Immunol
Zanetti, Carrara, Landolfi, Rozza, Chighizola et al., Increased COVID-19 mortality in patients with rheumatic diseases: results from the CONTROL-19 study by the Italian Society for Rheumatology, Clin Exp Rheumatol
