Grupo Peruano de Estudio de Enfermedades Autoinmunes Sistémicas, Universidad Científica del Sur, Lima, Peru.
Rheumatology Department, Hospital Nacional Guillermo Almenara Irigoyen EsSalud, Lima, Peru.
Clin Rheumatol. 2021 Nov;40(11):4725-4734. doi: 10.1007/s10067-021-05833-1. Epub 2021 Jun 30.
The identification of risk factors for COVID-19 adverse course in autoimmune rheumatic diseases (ARDs) is of the utmost importance when approaching patient management; however, data are scarce in relation to the Latin American population. The objective of this study was to determine predictors of hospitalization for COVID-19 patients from an ARD community cohort.
A real setting longitudinal study (March to November 2020) in an ARD community cohort was carried out. Potential predictors of hospitalization for COVID-19 examined included (1) sociodemographic variables (age, gender, education, tobacco use, socioeconomic status, and co-inhabitants), (2) comorbidities, (3) time to COVID-19 diagnosis, and (4) ARD's features: clinical (disease type, disease duration, activity), treatment [corticosteroids use/doses, use of synthetic DMARDs (cDMARDs, tsDMARDs, and bDMARDs)], treatment schedule and non-adherence, and the Multidimensional Health Assessment Questionnaire (MDHAQ). Univariable and multivariable regression analysis were conducted; OR and 95% CI (p < 0.05) were determined.
One thousand and one hundred forty-eight patients with ARDs were included; 154 had COVID-19; of these 139 (90.3%) were women, aged 52.5 (13.7) years; 33.1% had hypertension and 61.0% an affected organ by ARD. Infection was detected 8.4 (10.1) days after symptoms started; there were 33 hospitalized patients (rate 21.4%). Predictors of hospitalization by multivariable analysis were age (OR: 1.06; CI: 1.01-1.10; p: 0.01), comorbidities: hypertension (OR: 3.95; 95% CI: 1.40-10.95, p: 0.01) and neoplasm (OR: 9.0; 95% CI: 1.6-52.3; p: 0.01), number of organs involved by ARD (OR: 2.26; 95% CI: 1.16-4.41; p: 0.02), and infection diagnosis delay (OR: 1.36; 95% CI: 1.03-1.80; p: 0.01).
In our ARD patients with COVID-19, older age, comorbidities (neoplasm and hypertension), and a delay in COVID-19 diagnosis were predictors of hospitalization. The only ARD-associated predictor feature was the number of organs involved. Key Points • Patients with ARD and COVID-19 have an adverse course in comparison to the general population. • Previous predictors of COVID-19 hospitalization, including known risk factors (such as older age and comorbidities) and systemic manifestations, should be taken into account in the management of these patients. • Delayed diagnosis of COVID-19 impacts negatively on prognosis. • Availability of diagnostic tests is of utmost importance.
当涉及到患者管理时，确定 COVID-19 不良病程在自身免疫性风湿病（ARD）患者中的风险因素至关重要；然而，与拉丁美洲人群相关的数据却很少。本研究的目的是确定自身免疫性风湿病社区队列中 COVID-19 患者住院的预测因素。
对自身免疫性风湿病社区队列进行了一项真实环境的纵向研究（2020 年 3 月至 11 月）。检查的 COVID-19 住院预测因素包括：（1）社会人口统计学变量（年龄、性别、教育程度、吸烟状况、社会经济地位和共同居住者），（2）合并症，（3）COVID-19 诊断时间，以及（4）ARD 的特征：临床（疾病类型、疾病持续时间、活动度）、治疗[皮质类固醇的使用/剂量、使用合成 DMARDs（cDMARDs、tsDMARDs 和 bDMARDs）]、治疗方案和不依从性，以及多维健康评估问卷（MDHAQ）。进行了单变量和多变量回归分析；确定了比值比（OR）和 95%置信区间（CI）（p<0.05）。
纳入了 1148 名患有 ARD 的患者；154 名患有 COVID-19；其中 139 名（90.3%）为女性，年龄为 52.5（13.7）岁；33.1%患有高血压，61.0%的患者有器官受累。感染是在症状开始后 8.4（10.1）天发现的；有 33 名住院患者（发病率 21.4%）。多变量分析的住院预测因素包括年龄（OR：1.06；95%CI：1.01-1.10；p：0.01）、合并症：高血压（OR：3.95；95%CI：1.40-10.95，p：0.01）和肿瘤（OR：9.0；95%CI：1.6-52.3；p：0.01）、ARD 受累器官数量（OR：2.26；95%CI：1.16-4.41；p：0.02）和感染诊断延迟（OR：1.36；95%CI：1.03-1.80；p：0.01）。
在我们患有 COVID-19 的 ARD 患者中，年龄较大、合并症（肿瘤和高血压）以及 COVID-19 诊断延迟是住院的预测因素。唯一与 ARD 相关的预测特征是受累器官的数量。关键点• 与一般人群相比，患有 ARD 和 COVID-19 的患者病程不良。• 先前 COVID-19 住院的预测因素，包括已知的危险因素（如年龄较大和合并症）以及全身表现，应在这些患者的管理中加以考虑。• COVID-19 的诊断延迟对预后有负面影响。• 诊断检测的可用性至关重要。
