First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
AKESIOS Dialysis Center, Xanthi, Greece.
Clin Rheumatol. 2023 Dec;42(12):3375-3385. doi: 10.1007/s10067-023-06769-4. Epub 2023 Sep 21.
This study aimed to determine whether the introduction of anti-SARS-CoV-2 vaccines and the dominance of the omicron variant had a significant impact on the outcome of COVID-19 in patients with systemic autoimmune rheumatic diseases (SAIRDs).
Using data entered to the Greek Rheumatology Society COVID-19 registry, we investigated the incidence of hospitalization and death due to COVID-19, during the successive periods of the pandemic according to the prevalent strain (wild-type, Alpha, Delta, Omicron) in vaccinated and unvaccinated patients. Variables independently associated with hospitalization and death were explored using multivariate regression analyses, while Kaplan-Meier curves were used to depict survival data.
From August 2020 until June 30, 2022, 456 cases (70.2% females) of COVID-19 with a mean age (± SD) of 51.4 ± 14.0 years were reported. In unvaccinated patients, the proportions of hospitalization and death were 24.5% and 4%, compared to 12.5% and 0.8% in the vaccinated group (p < 0.001 for both comparisons). The rates of hospitalization for the wild-type, Alpha, Delta, and Omicron periods were 24.7%, 31.3%, 25.9%, and 8.1% respectively (p < 0.0001), while the case fatality rates were 2.7%, 4%, 7%, and 0%, respectively (p = 0.001). Using multivariable regression analysis, factors independently associated with hospitalization were infection by a non-Omicron variant, being non-vaccinated, exposure to rituximab, older age, and respiratory and cardiovascular disease. Independent predictors for death were contracting COVID-19 during the Alpha or Delta period, pulmonary disease, and older age, while being vaccinated was protective.
In this 2-year analysis, the rates of hospitalization and death among patients with SAIRDs have declined significantly. Vaccination and the dominance of the Omicron variant appear to be the major determinants for this shift. Key points • During the late phase of the pandemic, the proportion of severe COVID-19 cases, defined as requiring hospitalization or resulting in death, in patients with systemic autoimmune rheumatic diseases has declined. • Anti-SARS-CoV-2 vaccination and the dominance of the Omicron strain are the key factors that have independently contributed to this shift.
本研究旨在确定抗 SARS-CoV-2 疫苗的引入和奥密克戎变异株的主导地位是否对系统性自身免疫性风湿病（SAIRD）患者 COVID-19 的结局产生重大影响。
使用希腊风湿病学会 COVID-19 登记处输入的数据，我们根据流行株（野生型、Alpha、Delta、Omicron）调查了疫苗接种和未接种患者在大流行的连续时期因 COVID-19 住院和死亡的发生率。使用多变量回归分析探讨与住院和死亡相关的独立变量，同时使用 Kaplan-Meier 曲线描绘生存数据。
从 2020 年 8 月至 2022 年 6 月 30 日，报告了 456 例（70.2%为女性）COVID-19 病例，平均年龄（±SD）为 51.4±14.0 岁。在未接种疫苗的患者中，住院和死亡的比例分别为 24.5%和 4%，而接种疫苗组的比例分别为 12.5%和 0.8%（p<0.001 均）。野生型、Alpha、Delta 和 Omicron 期的住院率分别为 24.7%、31.3%、25.9%和 8.1%（p<0.0001），而病死率分别为 2.7%、4%、7%和 0%（p=0.001）。使用多变量回归分析，与住院相关的独立因素是感染非奥密克戎变异株、未接种疫苗、接触利妥昔单抗、年龄较大以及呼吸和心血管疾病。死亡的独立预测因素是在 Alpha 或 Delta 期感染 COVID-19、肺部疾病和年龄较大，而接种疫苗具有保护作用。
在这项为期 2 年的分析中，SAIRD 患者的住院和死亡比例显著下降。疫苗接种和奥密克戎变异株的主导地位似乎是这种转变的主要决定因素。关键点•在大流行后期，需要住院或导致死亡的严重 COVID-19 病例（定义为需要住院或导致死亡）在系统性自身免疫性风湿病患者中的比例有所下降。•抗 SARS-CoV-2 疫苗接种和奥密克戎株的主导地位是导致这种转变的独立因素。
