COVID-19 于 SARS-CoV-2 大流行期间在自身免疫性炎症性疾病中的风险因素和结局：一项比较研究。
Risk Factors and Outcomes for COVID-19 in Autoimmune Inflammatory Diseases during the SARS-CoV-2 Pandemic: A Comparative Study.
机构信息
Department of Internal Medicine and Pathological Anatomy, Antonio Fraga Mouret National Medical Center, La Raza, México City, Mexico.
Department of High Specialty Medical Unit, Antonio Fraga Mouret National Medical Center, La Raza, México City, Mexico.
出版信息
Isr Med Assoc J. 2022 May;24(5):299-305.
BACKGROUND
Patients with autoimmune disease (AID) and coronavirus disease 2019 (COVID-19) could have higher mortality due to the co-morbidity and the use of immunosuppressive therapy.
OBJECTIVES
To analyze the risk factors and outcomes of patients with AID and COVID-19 versus a control group.
METHODS
A prospective cohort study included patients with and without AID and COVID-19. Patients were paired by age and sex. Clinical, biochemical, immunological treatments, and outcomes (days of hospital stay, invasive mechanical ventilation [IMV], oxygen at discharge, and death) were collected.
RESULTS
We included 226 COVID-19 patients: 113 with AID (51.15 ± 14.3 years) and 113 controls (53.45 ± 13.3 years). The most frequent AIDs were Rheumatoid arthritis (26.5%), systemic lupus erythematosus (21%), and systemic sclerosis (14%). AID patients had lower lactate dehydrogenas, C-reactive protein, fibrinogen, IMV (P = 0.027), and oxygen levels at discharge (P ≤ 0.0001) and lower death rates (P ≤ 0.0001). Oxygen saturation (SaO2) ≤ 88% at hospitalization provided risk for IMV (RR [relative risk] 3.83, 95% confidence interval [95%CI] 1.1-13.6, P = 0.038). Higher creatinine and LDH levels were associated with death in the AID group. SaO2 ≤ 88% and CO-RADS ≥ 4 were risk factors for in-hospital mortality (RR 4.90, 95%CI 1.8-13.0, P = 0.001 and RR 7.60, 95%CI 1.4-39.7, P = 0.016, respectively). Anticoagulant therapy was protective (RR 0.36, 95%CI 0.1-0.9, P = 0.041).
CONCLUSIONS
Patients with AID had better outcomes with COVID-19 than controls. Anticoagulation was associated with a lower death in patients with AID.
背景
由于合并症和免疫抑制治疗的使用，患有自身免疫性疾病（AID）和 2019 年冠状病毒病（COVID-19）的患者死亡率可能更高。
目的
分析患有 AID 和 COVID-19 的患者与对照组的风险因素和结局。
方法
一项前瞻性队列研究纳入了患有和不患有 AID 和 COVID-19 的患者。患者按年龄和性别配对。收集了临床、生化、免疫治疗以及结局（住院天数、有创机械通气[IMV]、出院时的氧气以及死亡）数据。
结果
我们纳入了 226 例 COVID-19 患者：113 例患有 AID（51.15 ± 14.3 岁），113 例为对照组（53.45 ± 13.3 岁）。最常见的 AID 是类风湿关节炎（26.5%）、系统性红斑狼疮（21%）和系统性硬化症（14%）。AID 患者的乳酸脱氢酶、C 反应蛋白、纤维蛋白原、IMV（P = 0.027）和出院时的氧气水平（P ≤ 0.0001）较低，死亡率也较低（P ≤ 0.0001）。住院时的血氧饱和度（SaO2）≤88%是需要接受 IMV 的风险因素（相对风险[RR] 3.83，95%置信区间[95%CI] 1.1-13.6，P = 0.038）。较高的肌酐和 LDH 水平与 AID 患者的死亡相关。SaO2 ≤ 88%和 CO-RADS ≥ 4 是住院期间死亡的危险因素（RR 4.90，95%CI 1.8-13.0，P = 0.001 和 RR 7.60，95%CI 1.4-39.7，P = 0.016）。抗凝治疗具有保护作用（RR 0.36，95%CI 0.1-0.9，P = 0.041）。
结论
患有 AID 的 COVID-19 患者的结局优于对照组。抗凝治疗与 AID 患者的死亡率降低相关。
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