Thompson Kevin, Shah Ami, Grunbaum Adam, Oyesanmi Olu
Internal Medicine, Citrus Memorial Hospital, Inverness, USA.
Internal Medicine, University of South Florida, Regional Medical Center Bayonet Point, Hudson, USA.
Cureus. 2022 Feb 28;14(2):e22685. doi: 10.7759/cureus.22685. eCollection 2022 Feb.
Background SARS-CoV-2 (COVID-19) is a positive-stranded ribonucleic acid (RNA) virus of the coronavirus family, which has resulted in one of the most serious pandemics, with more than 14 million cases confirmed globally. Rheumatoid arthritis (RA) is estimated to be prevalent in 0.5-1% of the U.S. population. So far, there has been little evidence of COVID-19 infection and its propensity to result in increased mortality or length of hospital stay in patients with RA. To contribute to this body of literature, this study will assess the degree to which COVID-19 is associated with increased mortality and length of hospital stay in patients with RA while also taking into account these patients' comorbidities. Methods Our retrospective study included 14,180 patients (age >18, median 58, range 18-90) who tested positive for COVID-19 or were assumed to have COVID-19 infection from January 1, 2020, through July 31, 2020. Patients were grouped based on the diagnosis of RA and COVID-19 infection versus those without RA. Patients who were diagnosed with systemic lupus erythematosus (SLE), chronic obstructive pulmonary disease, and hypertension were excluded. Covariates included age, body mass index (BMI), race, sex, maximum C-reactive protein value, maximum D-dimer value, and comorbid diabetes mellitus. Outcome measures were length of hospital stay (LOS), in-hospital mortality, intensive care unit (ICU) admission, ICU LOS, mechanical ventilation, time on mechanical ventilation, and discharge to hospice. The logistic regression model was used to estimate the probability of in-hospital mortality, ICU admission, placement on mechanical ventilation, discharge to hospice, and in-hospital mortality related to home anti-inflammatory use when comparing patients with RA and COVID-19 infection to COVID-19 infected patients without RA. Results Of the total 14,180 patients (males 57.1%, females 42.9%), 159 patients (1.1%), had a diagnosis of RA. There was no significant association between RA and hospital LOS, ICU admission, ICU LOS, LOS on mechanical ventilation, or discharge to hospice among those infected with COVID-19. Yet, RA was associated with higher mortality (OR: 1.65; 95% CI: 1.07-2.53; p=0.02) and placement on mechanical ventilation (OR: 1.82; 95% CI: 1.22-2.71; p<0.01) amidst patients infected with COVID-19. Conclusion This study suggests that patients with RA and COVID-19 have a significantly increased likelihood of in-hospital mortality and placement on mechanical ventilation. While challenging to realize in a pandemic situation, large studies nationwide are necessary to improve our understanding of COVID-19 infection in patients diagnosed with RA.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2，即新冠病毒）是冠状病毒家族中的一种正链核糖核酸（RNA）病毒，它引发了最严重的大流行之一，全球确诊病例超过1400万例。据估计，类风湿性关节炎（RA）在美国人群中的患病率为0.5%-1%。到目前为止，几乎没有证据表明新冠病毒感染及其导致类风湿性关节炎患者死亡率增加或住院时间延长的倾向。为了丰富这方面的文献，本研究将评估新冠病毒与类风湿性关节炎患者死亡率增加和住院时间延长的关联程度，同时考虑这些患者的合并症。
我们的回顾性研究纳入了2020年1月1日至2020年7月31日期间新冠病毒检测呈阳性或被假定感染新冠病毒的14180名患者（年龄>18岁，中位数58岁，范围18-90岁）。患者根据类风湿性关节炎和新冠病毒感染的诊断情况与未患类风湿性关节炎的患者进行分组。诊断为系统性红斑狼疮（SLE）、慢性阻塞性肺疾病和高血压的患者被排除。协变量包括年龄、体重指数（BMI）、种族、性别、最高C反应蛋白值、最高D-二聚体值以及合并糖尿病。观察指标包括住院时间（LOS）、院内死亡率、重症监护病房（ICU）入院率、ICU住院时间、机械通气、机械通气时间以及临终关怀出院情况。在比较类风湿性关节炎合并新冠病毒感染的患者与未患类风湿性关节炎的新冠病毒感染患者时，使用逻辑回归模型估计院内死亡率、ICU入院率、机械通气、临终关怀出院以及与家庭抗炎药物使用相关的院内死亡率的概率。
在总共14180名患者（男性57.1%，女性42.9%）中，159名患者（1.1%）被诊断为类风湿性关节炎。在感染新冠病毒的患者中，类风湿性关节炎与住院时间、ICU入院率、ICU住院时间、机械通气时间或临终关怀出院之间没有显著关联。然而，在感染新冠病毒的患者中，类风湿性关节炎与较高的死亡率（比值比：1.65；95%置信区间：1.07-2.53；p=0.02）和机械通气（比值比：1.82；95%置信区间：1.22-2.71；p<0.01）相关。
本研究表明，类风湿性关节炎合并新冠病毒感染的患者院内死亡率和机械通气的可能性显著增加。虽然在大流行情况下难以实现，但全国性的大型研究对于提高我们对类风湿性关节炎确诊患者新冠病毒感染的理解是必要的。
