Characteristics of SARS-CoV-2 Infection in an Actively Monitored Cohort of Patients with Lupus Nephritis
Bogdan Obrișcă, Alexandra Vornicu, Roxana Jurubiță, Valentin Mocanu, George Dimofte, Andreea Andronesi, Bogdan Sorohan, Camelia Achim, Georgia Micu, Raluca Bobeică, Constantin Dina, Gener Ismail
Biomedicines, doi:10.3390/biomedicines10102423
1) Background: We sought to investigate the impact of the COVID-19 pandemic in patients with lupus nephritis (LN); (2) Methods: A total of 95 patients with LN actively monitored in our department between 26 February 2020, when the first case of COVID-19 was diagnosed in Romania, and 1 May 2021, were included in the study. Multivariate logistic regression analysis was performed to identify the independent risk factors for SARS-CoV-2 infection; (3) Results: A total of 15 patients (15.8%) had a confirmed SARS-CoV-2 infection during a total follow-up time of 105.9 patient-years (unadjusted incidence rate: 14.28 SARS-CoV-2 infections per 100 patient-years). Median time to SARS-CoV-2 infection was 9.3 months (IQR: 7.2-11.3). The majority of patients had a mild form of SARS-CoV-2 infection (73.3%), while the remaining had moderate forms. None of the patients had a severe infection or a SARS-CoV-2-related death. The most frequent symptom was fatigue (73.3%), followed by loss of taste/smell (53.3%) and fever (46.7%). Forty percent of those with SARS-CoV-2 infection were hospitalized for a median 11.5 days (IQR:3.75-14). In the multivariate logistic regression analysis, a current oral corticosteroid dose ≥ 15 mg/day was associated with a 7.69-fold higher risk (OR, 7.69; 95%, 1.3-45.46), while the use of hydroxychloroquine was associated with a 91% lower risk for a SARS-CoV-2 infection (OR, 0.09; 95%CI, 0.01-0.59). ( 4 ) Conclusions: Our study confirms that the SARS-CoV-2 infection-associated morbidity might only be moderately increased in patients with LN. The current oral corticosteroid dose was the only independent predictor of infection occurrence, while use of hydroxychloroquine was associated with a protective effect.
Conflicts of Interest: The authors declare no conflict of interest.
References
Abella, Jolkovsky, Biney, Uspal, Hyman et al., Efficacy and Safety of Hydroxychloroquine vs Placebo for Pre-exposure SARS-CoV-2 Prophylaxis among Health Care Workers: A Randomized Clinical Trial, JAMA Intern. Med,
doi:10.1001/jamainternmed.2020.6319
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,
doi:10.1136/annrheumdis-2020-218946
Alzahrani, Alghamdi, Almaqati, Clinical characteristics and outcome of COVID-19 in patients with rheumatic diseases, Rheumatol. Int,
doi:10.1007/s00296-021-04857-9
Aringer, Costenbader, Daikh, Brinks, Mosca et al., European League Against Rheumatism/American College of Rheumatology classification criteria for systemic lupus erythematosus, Ann. Rheum. Dis,
doi:10.1136/annrheumdis-2018-214819
Batu, Akca, Kısaarslan, Sa G, Demir et al., The performances of the ACR 1997, SLICC 2012, and EULAR/ACR 2019 classification criteria in pediatric systemic lupus erythematosus, J. Rheumatol,
doi:10.3899/jrheum.200871
Bomback, Canetta, Ahn, Ahmad, Radhakrishnan et al., How COVID-19 has changed the management of glomerular diseases, Clin. J. Am. Soc. Nephrol,
doi:10.2215/CJN.04530420
Boulware, Pullen, Bangdiwala, Pastick, Lofgren et al., A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for COVID-19, N. Engl. J. Med,
doi:10.1056/NEJMoa2016638
Chen, Yao, Yan, Su, Wang et al., The plight of patients with Lupus Nephritis during the outbreak of COVID-19 in Wuhan, China, J. Rheumatol,
doi:10.3899/jrheum.200452
Espinosa, Prieto-González, Llevadot, Marco-Hernández, Martínez-Artuña et al., The impact of SARS-CoV-2 coronavirus infection in patients with systemic lupus erythematosus from a single center in Catalonia, Clin. Rheumatol,
doi:10.1007/s10067-021-05675-x
Fernandez-Ruiz, Paredes, Niewold, COVID-19 in patients with systemic lupus erythematosus: Lessons learned from the inflammatory disease, Transl. Res,
doi:10.1016/j.trsl.2020.12.007
Geleris, Sun, Platt, Zucker, Baldwin et al., Observational Study of Hydroxychloroquine in Hospitalized Patients with COVID-19, N. Engl. J. Med,
doi:10.1056/NEJMoa2012410
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,
doi:10.1136/annrheumdis-2020-217871
Mageau, Aldebert, Van Gysel, Papo, Timsit et al., SARS-CoV-2 infection among inpatients with systemic lupus erythematosus in France: A nationwide epidemiological study, Ann. Rheum. Dis,
doi:10.1136/annrheumdis-2021-220010
Martelli Júnior, Marques, Marques, Gomes De Lucena, Martelli et al., Correspondence on "Clinical course of coronavirus disease 2019 (COVID-19) in a series of 17 patients with systemic lupus erythematosus under long-term treatment with hydroxychloroquine, Ann. Rheum. Dis,
doi:10.1136/annrheumdis-2021-220410
Obris, Jurubit, Andronesi, Sorohan, Achim et al., Histological predictors of renal outcome in lupus nephritis: The importance of tubulointerstitial lesions and scoring of glomerular lesions, Lupus,
doi:10.1177/0961203318776109
Obris, Sorohan, Tut, Ismail, Advances in lupus nephritis pathogenesis: From bench to bedside, Int. J. Mol. Sci,
doi:10.3390/ijms22073766
Obris, Vornicu, Jurubit, Achim, Bobeică et al., Corticosteroids are the major contributors to the risk for serious infections in autoimmune disorders with severe renal involvement, Clin. Rheumatol,
doi:10.1007/s10067-021-05646-2
Petri, Orbai, Alarcón, Gordon, Merrill et al., Derivation and validation of the systemic lupus international collaborating clinics classification criteria for systemic lupus erythematosus, Arthritis Rheum,
doi:10.1002/art.34473
Ramirez, Gerosa, Beretta, Bellocchi, Argolini et al., COVID-19 in systemic lupus erythematosus: Data from a survey on 417 patients, Semin. Arthritis. Rheum,
doi:10.1016/j.semarthrit.2020.06.012
Saadoun, Vieira, Vautier, Baraliakos, Andreica et al., SARS-CoV-2 outbreak in immune-mediated inflammatory diseases: The Euro-COVIMID multicentre cross-sectional study, Lancet Rheumatol,
doi:10.1016/S2665-9913(21)00112-0
Sakthiswary, Chuah, Chiang, Liew, Aizat, COVID-19 in systemic lupus erythematosus: A pooled analysis and systematic review of case reports and series, Lupus,
doi:10.1177/09612033211045057
Willicombe, Thomas, Mcadoo, COVID-19 and Calcineurin Inhibitors: Should They Get Left Out in the Storm?, J. Am. Soc. Nephrol,
doi:10.1681/ASN.2020030348
{ 'indexed': {'date-parts': [[2022, 9, 29]], 'date-time': '2022-09-29T02:11:52Z', 'timestamp': 1664417512139},
'reference-count': 26,
'publisher': 'MDPI AG',
'issue': '10',
'license': [ { 'start': { 'date-parts': [[2022, 9, 28]],
'date-time': '2022-09-28T00:00:00Z',
'timestamp': 1664323200000},
'content-version': 'vor',
'delay-in-days': 0,
'URL': 'https://creativecommons.org/licenses/by/4.0/'}],
'content-domain': {'domain': [], 'crossmark-restriction': False},
'abstract': '<jats:p>(1) Background: We sought to investigate the impact of the COVID-19 pandemic in '
'patients with lupus nephritis (LN); (2) Methods: A total of 95 patients with LN actively '
'monitored in our department between 26 February 2020, when the first case of COVID-19 was '
'diagnosed in Romania, and 1 May 2021, were included in the study. Multivariate logistic '
'regression analysis was performed to identify the independent risk factors for SARS-CoV-2 '
'infection; (3) Results: A total of 15 patients (15.8%) had a confirmed SARS-CoV-2 infection '
'during a total follow-up time of 105.9 patient-years (unadjusted incidence rate: 14.28 '
'SARS-CoV-2 infections per 100 patient-years). Median time to SARS-CoV-2 infection was 9.3 '
'months (IQR: 7.2–11.3). The majority of patients had a mild form of SARS-CoV-2 infection '
'(73.3%), while the remaining had moderate forms. None of the patients had a severe infection '
'or a SARS-CoV-2-related death. The most frequent symptom was fatigue (73.3%), followed by '
'loss of taste/smell (53.3%) and fever (46.7%). Forty percent of those with SARS-CoV-2 '
'infection were hospitalized for a median 11.5 days (IQR:3.75–14). In the multivariate '
'logistic regression analysis, a current oral corticosteroid dose ≥ 15 mg/day was associated '
'with a 7.69-fold higher risk (OR, 7.69; 95%, 1.3–45.46), while the use of hydroxychloroquine '
'was associated with a 91% lower risk for a SARS-CoV-2 infection (OR, 0.09; 95%CI, 0.01–0.59). '
'(4) Conclusions: Our study confirms that the SARS-CoV-2 infection-associated morbidity might '
'only be moderately increased in patients with LN. The current oral corticosteroid dose was '
'the only independent predictor of infection occurrence, while use of hydroxychloroquine was '
'associated with a protective effect.</jats:p>',
'DOI': '10.3390/biomedicines10102423',
'type': 'journal-article',
'created': {'date-parts': [[2022, 9, 29]], 'date-time': '2022-09-29T00:58:47Z', 'timestamp': 1664413127000},
'page': '2423',
'source': 'Crossref',
'is-referenced-by-count': 0,
'title': 'Characteristics of SARS-CoV-2 Infection in an Actively Monitored Cohort of Patients with Lupus '
'Nephritis',
'prefix': '10.3390',
'volume': '10',
'author': [ {'given': 'Bogdan', 'family': 'Obrișcă', 'sequence': 'first', 'affiliation': []},
{'given': 'Alexandra', 'family': 'Vornicu', 'sequence': 'additional', 'affiliation': []},
{'given': 'Roxana', 'family': 'Jurubiță', 'sequence': 'additional', 'affiliation': []},
{'given': 'Valentin', 'family': 'Mocanu', 'sequence': 'additional', 'affiliation': []},
{'given': 'George', 'family': 'Dimofte', 'sequence': 'additional', 'affiliation': []},
{ 'ORCID': 'http://orcid.org/0000-0002-5590-7879',
'authenticated-orcid': False,
'given': 'Andreea',
'family': 'Andronesi',
'sequence': 'additional',
'affiliation': []},
{ 'ORCID': 'http://orcid.org/0000-0003-3574-4635',
'authenticated-orcid': False,
'given': 'Bogdan',
'family': 'Sorohan',
'sequence': 'additional',
'affiliation': []},
{'given': 'Camelia', 'family': 'Achim', 'sequence': 'additional', 'affiliation': []},
{'given': 'Georgia', 'family': 'Micu', 'sequence': 'additional', 'affiliation': []},
{'given': 'Raluca', 'family': 'Bobeică', 'sequence': 'additional', 'affiliation': []},
{'given': 'Constantin', 'family': 'Dina', 'sequence': 'additional', 'affiliation': []},
{'given': 'Gener', 'family': 'Ismail', 'sequence': 'additional', 'affiliation': []}],
'member': '1968',
'published-online': {'date-parts': [[2022, 9, 28]]},
'reference': [ { 'key': 'ref1',
'unstructured': 'WHO Coronavirus Disease (COVID-19) Dashboard\nhttps://covid19.who.int/'},
{'key': 'ref2', 'doi-asserted-by': 'publisher', 'DOI': '10.1056/NEJMcp2009249'},
{'key': 'ref3', 'doi-asserted-by': 'publisher', 'DOI': '10.1177/0961203318776109'},
{'key': 'ref4', 'doi-asserted-by': 'publisher', 'DOI': '10.3390/ijms22073766'},
{'key': 'ref5', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/S2665-9913(21)00112-0'},
{'key': 'ref6', 'doi-asserted-by': 'publisher', 'DOI': '10.1007/s10067-021-05646-2'},
{'key': 'ref7', 'doi-asserted-by': 'publisher', 'DOI': '10.1136/annrheumdis-2021-220010'},
{'key': 'ref8', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.semarthrit.2020.06.012'},
{'key': 'ref9', 'doi-asserted-by': 'publisher', 'DOI': '10.1007/s10067-021-05675-x'},
{'key': 'ref10', 'doi-asserted-by': 'publisher', 'DOI': '10.1136/annrheumdis-2020-218946'},
{'key': 'ref11', 'doi-asserted-by': 'publisher', 'DOI': '10.3899/jrheum.200452'},
{'key': 'ref12', 'doi-asserted-by': 'publisher', 'DOI': '10.3899/jrheum.200871'},
{'key': 'ref13', 'doi-asserted-by': 'publisher', 'DOI': '10.1002/art.34473'},
{'key': 'ref14', 'doi-asserted-by': 'publisher', 'DOI': '10.1136/annrheumdis-2018-214819'},
{ 'key': 'ref15',
'article-title': 'Coronavirus Disease 2019 (COVID-19) Treatment Guidelines. National '
'Institutes of Health',
'author': 'COVID-19 Treatment Guidelines Panel'},
{'key': 'ref16', 'doi-asserted-by': 'publisher', 'DOI': '10.1136/annrheumdis-2020-217871'},
{'key': 'ref17', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.trsl.2020.12.007'},
{'key': 'ref18', 'doi-asserted-by': 'publisher', 'DOI': '10.1177/09612033211045057'},
{'key': 'ref19', 'doi-asserted-by': 'publisher', 'DOI': '10.1007/s00296-021-04857-9'},
{'key': 'ref20', 'doi-asserted-by': 'publisher', 'DOI': '10.1136/annrheumdis-2021-220410'},
{'key': 'ref21', 'doi-asserted-by': 'publisher', 'DOI': '10.1056/NEJMoa2016638'},
{'key': 'ref22', 'doi-asserted-by': 'publisher', 'DOI': '10.1001/jamainternmed.2020.6319'},
{'key': 'ref23', 'doi-asserted-by': 'publisher', 'DOI': '10.1056/NEJMoa2012410'},
{'key': 'ref24', 'doi-asserted-by': 'publisher', 'DOI': '10.1097/MNH.0000000000000662'},
{'key': 'ref25', 'doi-asserted-by': 'publisher', 'DOI': '10.2215/CJN.04530420'},
{'key': 'ref26', 'doi-asserted-by': 'publisher', 'DOI': '10.1681/ASN.2020030348'}],
'container-title': 'Biomedicines',
'original-title': [],
'language': 'en',
'link': [ { 'URL': 'https://www.mdpi.com/2227-9059/10/10/2423/pdf',
'content-type': 'unspecified',
'content-version': 'vor',
'intended-application': 'similarity-checking'}],
'deposited': { 'date-parts': [[2022, 9, 29]],
'date-time': '2022-09-29T01:33:44Z',
'timestamp': 1664415224000},
'score': 1,
'resource': {'primary': {'URL': 'https://www.mdpi.com/2227-9059/10/10/2423'}},
'subtitle': [],
'short-title': [],
'issued': {'date-parts': [[2022, 9, 28]]},
'references-count': 26,
'journal-issue': {'issue': '10', 'published-online': {'date-parts': [[2022, 10]]}},
'alternative-id': ['biomedicines10102423'],
'URL': 'http://dx.doi.org/10.3390/biomedicines10102423',
'relation': {},
'ISSN': ['2227-9059'],
'subject': ['General Biochemistry, Genetics and Molecular Biology', 'Medicine (miscellaneous)'],
'container-title-short': 'Biomedicines',
'published': {'date-parts': [[2022, 9, 28]]}}