Mathew Jithin, Jain Siddharth, Susngi Terence, Naidu Shankar, Dhir Varun, Sharma Aman, Jain Sanjay, Sharma Shefali Khanna
Division of Clinical Immunology and Rheumatology, Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Department of Internal Medicine, Postgraduate Institute of Medical Education and Research,Chandigarh, India.
Rheumatol Adv Pract. 2023 Feb 28;7(1):rkad025. doi: 10.1093/rap/rkad025. eCollection 2023.
There is dearth of data regarding the outcomes of coronavirus disease 2019 (COVID-19) among rheumatic and musculoskeletal disease (RMD) patients from Southeast Asia. We report the clinicodemographic profile and identify predictors of COVID-19 outcomes in a large cohort of Indian RMD patients.
This prospective cohort study, carried out at the Postgraduate Institute of Medical Education and Research, Chandigarh (a tertiary care centre in India), included RMD patients affected with COVID-19 between April 2020 and October 2021. Demographic and clinical and 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.
A total of 64 severe acute respiratory syndrome coronavirus-2-infected RMD patients [age 41.5 (19-85) years; 46 (72%) females] were included. Eighteen (28%) patients had severe COVID-19. Twenty-three (36%) required respiratory support [11 (17%) required mechanical ventilation]. Thirty-six (56%) patients required hospitalization [median duration of stay 10 (1-42) days]; 17 (27%) required intensive care unit admission. Presence of co-morbidities [odds ratio (OR) = 4.5 (95% CI: 1.4, 14.7)] was found to be an independent predictor of COVID-19 severity. Co-morbidities [OR = 10.7 (95% CI: 2.5, 45.4)] and underlying lupus [OR = 7.0 (95% CI: 1.2, 40.8)] were independently associated with COVID-19 hospitalization. Ongoing rheumatic disease activity [OR = 6.8 (95% CI: 1.3, 35.4)] and underlying diagnosis of lupus [OR = 7.1 (95% CI: 1.2, 42.4)] and SSc [OR = 9.5 (95% CI: 1.5, 61.8)] were found to be strong independent predictors of mortality. Age, sex, underlying RMD-associated interstitial lung disease and choice of immunosuppressive therapy were not associated with COVID-19 severity or adverse outcomes.
The presence of co-morbidities was independently associated with COVID-19 severity and hospitalization. Ongoing rheumatic disease activity and the presence of lupus or SSc independently predicted mortality. Age, sex, type of immunosuppressive therapy and presence of RMD-associated interstitial lung disease did not affect COVID-19 severity or outcomes in Indian RMD patients.
关于东南亚风湿性和肌肉骨骼疾病（RMD）患者中2019冠状病毒病（COVID-19）的预后数据匮乏。我们报告了一大群印度RMD患者的临床人口统计学特征，并确定了COVID-19预后的预测因素。
这项前瞻性队列研究在印度昌迪加尔的医学教育与研究研究生学院（一家三级医疗中心）进行，纳入了2020年4月至2021年10月期间感染COVID-19的RMD患者。记录了COVID-19以及潜在RMD的人口统计学、临床和实验室详细信息。使用逐步多变量逻辑回归确定死亡率、住院率和重症COVID-19的预测因素。
共纳入64例严重急性呼吸综合征冠状病毒2感染的RMD患者[年龄41.5（19 - 85）岁；46例（72%）为女性]。18例（28%）患者患有重症COVID-19。23例（36%）需要呼吸支持[11例（17%）需要机械通气]。36例（56%）患者需要住院治疗[中位住院时间10（1 - 42）天]；17例（27%）需要入住重症监护病房。合并症的存在[比值比（OR） = 4.5（95%置信区间：1.4，14.7）]被发现是COVID-19严重程度的独立预测因素。合并症[OR = 10.7（95%置信区间：2.5，45.4）]和潜在的狼疮[OR = 7.0（95%置信区间：1.2，40.8）]与COVID-19住院独立相关。正在进行的风湿性疾病活动[OR = 6.8（95%置信区间：1.3，35.4）]以及狼疮[OR = 7.1（95%置信区间：1.2，42.4）]和系统性硬化症[OR = 9.5（95%置信区间：1.5，61.8）]的潜在诊断被发现是死亡率的强独立预测因素。年龄、性别、潜在的RMD相关间质性肺病和免疫抑制治疗的选择与COVID-19严重程度或不良预后无关。
合并症的存在与COVID-19严重程度和住院独立相关。正在进行的风湿性疾病活动以及狼疮或系统性硬化症的存在独立预测死亡率。年龄、性别、免疫抑制治疗类型和RMD相关间质性肺病的存在并未影响印度RMD患者的COVID-19严重程度或预后。
