Wei Qi, Mease Philip J, Chiorean Michael, Iles-Shih Lulu, Matos Wanessa F, Baumgartner Andrew, Molani Sevda, Hwang Yeon Mi, Belhu Basazin, Ralevski Alexandra, Hadlock Jennifer
Institute for Systems Biology, Seattle, WA, USA.
Providence St. Joseph Health/Swedish Medical Center, Rheumatology, Seattle, WA, USA.
medRxiv. 2023 Jun 28:2023.06.26.23291904. doi: 10.1101/2023.06.26.23291904.
COVID-19 outcomes, in the context of immune-mediated inflammatory diseases (IMIDs), are incompletely understood. Reported outcomes vary considerably depending on the patient population studied. It is essential to analyse data for a large population, while considering the effects of the pandemic time period, comorbidities, long term use of immunomodulatory medications (IMMs), and vaccination status.
In this retrospective case-control study, patients of all ages with IMIDs were identified from a large U.S. healthcare system. COVID-19 infections were identified based on SARS-CoV-2 NAAT test results. Controls without IMIDs were selected from the same database. Severe outcomes were hospitalisation, mechanical ventilation (MV), and death. We analysed data from 1 March 2020 to 30 August 2022, looking separately at both pre-Omicron and Omicron predominant periods. Factors including IMID diagnoses, comorbidities, long term use of IMMs, and vaccination and booster status were analysed using multivariable logistic regression (LR) and extreme gradient boosting (XGB).
Out of 2 167 656 patients tested for SARS-CoV-2, there were 290 855 with confirmed COVID-19 infection: 15 397 patients with IMIDs and 275 458 controls (patients without IMIDs). Age and most chronic comorbidities were risk factors for worse outcomes, whereas vaccination and boosters were protective. Patients with IMIDs had higher rates of hospitalisation and mortality compared with controls. However, in multivariable analyses, few IMIDs were rarely risk factors for worse outcomes. Further, asthma, psoriasis and spondyloarthritis were associated with reduced risk. Most IMMs had no significant association, but less frequently used IMM drugs were limited by sample size. XGB outperformed LR, with the AUROCs for models across different time periods and outcomes ranging from 0·77 to 0·92.
For patients with IMIDs, as for controls, age and comorbidities were risk factors for worse COVID-19 outcomes, whereas vaccinations were protective. Most IMIDs and immunomodulatory therapies were not associated with more severe outcomes. Interestingly, asthma, psoriasis and spondyloarthritis were associated with less severe COVID-19 outcomes than those expected for the population overall. These results can help inform clinical, policy and research decisions.
Pfizer, Novartis, Janssen, NIH.
在免疫介导的炎症性疾病（IMIDs）背景下，新冠病毒病（COVID-19）的预后情况尚未完全明确。所报告的预后情况因所研究的患者群体不同而有很大差异。在考虑大流行时间段、合并症、免疫调节药物（IMMs）的长期使用以及疫苗接种状况的影响时，分析大量人群的数据至关重要。
在这项回顾性病例对照研究中，从美国一个大型医疗系统中识别出所有年龄段的IMIDs患者。根据严重急性呼吸综合征冠状病毒2（SARS-CoV-2）核酸扩增检测（NAAT）结果确定COVID-19感染情况。从同一数据库中选取无IMIDs的对照。严重后果包括住院、机械通气（MV）和死亡。我们分析了2020年3月1日至2022年8月30日的数据，分别观察了奥密克戎毒株出现之前和以奥密克戎毒株为主的时期。使用多变量逻辑回归（LR）和极端梯度提升（XGB）分析包括IMID诊断、合并症、IMMs的长期使用以及疫苗接种和加强针接种状况等因素。
在2167656例接受SARS-CoV-2检测的患者中，有290855例确诊为COVID-19感染：15397例IMIDs患者和275458例对照（无IMIDs的患者）。年龄和大多数慢性合并症是预后较差的危险因素，而疫苗接种和加强针接种具有保护作用。与对照组相比，IMIDs患者的住院率和死亡率更高。然而，在多变量分析中，很少有IMIDs是预后较差的危险因素。此外，哮喘、银屑病和脊柱关节炎与风险降低相关。大多数IMMs没有显著关联，但较少使用的IMM药物受样本量限制。XGB的表现优于LR，不同时间段和预后模型的曲线下面积（AUROC）在0.77至0.92之间。
对于IMIDs患者，与对照组一样，年龄和合并症是COVID-19预后较差的危险因素，而疫苗接种具有保护作用。大多数IMIDs和免疫调节疗法与更严重的后果无关。有趣的是，哮喘、银屑病和脊柱关节炎与COVID-19的严重程度低于总体人群预期的情况相关。这些结果有助于为临床、政策和研究决策提供参考。
辉瑞、诺华、杨森、美国国立卫生研究院。
