Mehrotra-Varma Jai, Kumthekar Anand, Henry Sonya, Fleysher Roman, Hou Wei, Duong Tim Q
Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.
Department of Medicine, Division of Rheumatology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York.
ACR Open Rheumatol. 2023 Sep;5(9):465-473. doi: 10.1002/acr2.11580. Epub 2023 Aug 2.
To investigate the clinical outcomes of patients with rheumatoid arthritis (RA) with COVID-19.
This retrospective study consisted of 361 patients with RA+ and 45,954 patients with RA- (March 2020 to August 2022) who tested positive for SARS-CoV-2 by polymerase-chain-reaction in the Montefiore Health System, which serves a large low-income, minority-predominant population in the Bronx and was an epicenter of the initial pandemic and subsequent surges. Primary outcomes were hospitalization, critical illness, and all-cause mortality associated with SARS-CoV-2 infection. Comparisons were made with and without adjustment for covariates, as well as with 1083 matched controls of patients with RA- and COVID-19.
Patients with RA+ and COVID-19 were older (62.2 ± 23.5 vs. 45.5 ± 26.3; P < 0.001), were more likely females (83.1% vs. 55.8%; P < 0.001), were Black (35.5% vs. 30.3%; P < 0.05), and had higher rates of comorbidities (P < 0.05), hospitalization (52.4% vs. 32.5%; P < 0.005), critical illness (10.5% vs. 6.9%; P < 0.05), and mortality (11.1% vs. 6.2%; P < 0.01) compared with patients with RA- and COVID-19. Patients with RA+ with COVID-19 had higher odds of critical illness (adjusted odds ratio [aOR] = 1.46, 95% confidence interval [CI]: 1.09-1.93; P = 0.008) but no differences in hospitalization (aOR = 1.18 [95% CI: 0.93-1.49]; P = 0.16) and mortality (aOR = 1.34 [95% CI: 0.92-1.89]; P = 0.10) after adjusting for covariates. Odds ratio analysis identified age, hospitalization status, female sex, chronic kidney disease, chronic obstructive pulmonary disease, and Black race to be significant risk factors for COVID-19-related mortality. Pre-COVID-19 steroid and biologic therapy to treat RA were not significantly associated with worse outcomes (P > 0.05). Outcomes were not different between patients with RA+ and propensity-matched RA- controls (P > 0.05).
Our findings suggest that risk factors for adverse COVID-19 outcomes were not attributed to RA per se but rather age and preexisting medical conditions of patients with RA.
研究类风湿关节炎（RA）合并新型冠状病毒肺炎（COVID-19）患者的临床结局。
这项回顾性研究纳入了蒙特菲奥里医疗系统中361例RA阳性患者和45954例RA阴性患者（2020年3月至2022年8月），这些患者通过聚合酶链反应检测出SARS-CoV-2呈阳性。该医疗系统服务于布朗克斯区大量低收入、以少数族裔为主的人群，是疫情初期及后续疫情高峰的中心。主要结局为与SARS-CoV-2感染相关的住院治疗、危重症及全因死亡率。对协变量进行调整和未调整的情况下进行了比较，同时与1083例匹配的RA阴性合并COVID-19患者对照。
RA阳性合并COVID-19的患者年龄更大（62.2±23.5岁 vs. 45.5±26.3岁；P<0.001），女性比例更高（83.1% vs. 55.8%；P<0.001），黑人比例更高（35.5% vs. 30.3%；P<0.05），合并症发生率更高（P<0.05），住院率更高（52.4% vs. 32.5%；P<0.005），危重症发生率更高（10.5% vs. 6.9%；P<0.05），死亡率更高（11.1% vs. 6.2%；P<0.01），与RA阴性合并COVID-19的患者相比。调整协变量后，RA阳性合并COVID-19的患者发生危重症的几率更高（调整后的优势比[aOR]=1.46，95%置信区间[CI]：1.09-1.93；P=0.008），但住院率（aOR=1.18[95%CI：0.93-1.49]；P=0.16）和死亡率（aOR=1.34[95%CI：0.92-1.89]；P=0.10）无差异。优势比分析确定年龄、住院状态、女性性别、慢性肾脏病、慢性阻塞性肺疾病和黑人种族是COVID-19相关死亡的重要危险因素。COVID-19之前用于治疗RA的类固醇和生物疗法与更差的结局无显著关联（P>0.05）。RA阳性患者与倾向匹配的RA阴性对照患者的结局无差异（P>0.05）。
我们的研究结果表明，COVID-19不良结局的危险因素并非归因于RA本身，而是RA患者的年龄和既往存在的医疗状况。
