Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
Department of Biostatistics, Korea University College of Medicine, Seoul, Korea.
Korean J Intern Med. 2023 May;38(3):417-426. doi: 10.3904/kjim.2022.352. Epub 2023 Apr 6.
BACKGROUND/AIMS: This study aimed to investigate the clinical characteristics and outcomes of fluorescent antinuclear antibody (FANA)-positive patients admitted for coronavirus disease 2019 (COVID-19) and identify FANA as a prognostic factor of mortality.
This retrospective study was conducted at a university-affiliated hospital with 1,048 beds from September 2020 to March 2022. The participants were consecutive patients who required oxygenation through a high-flow nasal cannula, non-invasive or mechanical ventilation, or extracorporeal membrane oxygenation, and conducted the FANA test within 48 hours of admission.
A total of 132 patients with severe COVID-19 were included in this study, of which 77 (58.3%) had FANA-positive findings (≥ 1:80). FANA-positive patients were older and had higher inflammatory markers and 28-day mortality than FANA- negative patients. In the multivariate Cox proportional hazard regression analysis, FANA-positive findings (hazard ratio [HR], 2.65; 95% confidence interval [CI], 1.04-6.74), age (per 1-year; HR, 1.05; 95% CI, 1.01-1.10), underlying pulmonary disease (HR, 3.16; 95% CI, 0.97-10.26), underlying hypertension (HR, 2.97; 95% CI, 1.28-6.87), and blood urea nitrogen > 20 mg/dL (HR, 3.72; 95% CI, 1.09-12.64) were independent predictors of 28-day mortality. Remdesivir (HR, 0.34; 95% CI, 0.15-0.74) was found to be an independent predictor that reduced mortality.
Our findings revealed an autoimmune phenomenon in patients with severe COVID-19, which provides an ancillary rationale for strategies to optimize immunosuppressive therapy. In particular, this study suggests the potential of FANA to predict the outcomes of COVID-19.
背景/目的：本研究旨在探讨因 2019 年冠状病毒病（COVID-19）住院的荧光抗核抗体（FANA）阳性患者的临床特征和结局，并确定 FANA 是死亡率的预后因素。
本回顾性研究于 2020 年 9 月至 2022 年 3 月在一家拥有 1048 张床位的大学附属医院进行。参与者为连续需要通过高流量鼻导管、无创或机械通气或体外膜氧合进行氧疗的患者，且在入院 48 小时内进行 FANA 检测。
本研究共纳入 132 例重症 COVID-19 患者，其中 77 例（58.3%）FANA 阳性（≥1:80）。FANA 阳性患者较 FANA 阴性患者年龄更大，炎症标志物水平更高，28 天死亡率也更高。在多变量 Cox 比例风险回归分析中，FANA 阳性发现（风险比[HR]，2.65；95%置信区间[CI]，1.04-6.74）、年龄（每增加 1 岁；HR，1.05；95%CI，1.01-1.10）、基础肺部疾病（HR，3.16；95%CI，0.97-10.26）、基础高血压（HR，2.97；95%CI，1.28-6.87）和血尿素氮>20mg/dL（HR，3.72；95%CI，1.09-12.64）是 28 天死亡率的独立预测因素。瑞德西韦（HR，0.34；95%CI，0.15-0.74）是降低死亡率的独立预测因素。
我们的研究结果表明，重症 COVID-19 患者存在自身免疫现象，这为优化免疫抑制治疗策略提供了辅助依据。特别是，本研究提示 FANA 可能有助于预测 COVID-19 的结局。
