Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital, 60 Fenwood Road, Boston, MA, 02115, USA.
Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, Rheumatology Associates, 55 Fruit Street, Boston, MA, 02114, USA; Harvard Medical School, Boston, MA, USA.
Semin Arthritis Rheum. 2023 Dec;63:152286. doi: 10.1016/j.semarthrit.2023.152286. Epub 2023 Oct 29.
To investigate risk factors and outcomes of repeat COVID-19 infections among patients with systemic autoimmune rheumatic diseases (SARDs).
We performed a case-control study investigating repeat COVID-19 infection within the Mass General Brigham Health Care System. We systematically identified all SARD patients with confirmed COVID-19 (15/Mar/2020 to 17/Oct/2022). Cases had confirmed repeat COVID-19 infections >60 days apart (index date: repeat COVID-19 date). Controls were matched to cases (up to 3:1) by calendar date of first infection and duration between first COVID-19 infection and index dates. We collected demographics, lifestyle, comorbidities, SARD features, and COVID-19 characteristics at initial infection and index date by medical record review. We used conditional logistic regression to identify associations with repeat COVID-19 infection, adjusting for potential confounders. We described the severity of repeat COVID-19 infection among cases.
Among 2203 SARD patients with COVID-19, we identified 76 cases with repeat COVID-19 infection (80.3 % female) and matched to 207 matched controls (77.8 % female) with no repeat infection. At first infection, cases were younger (mean 49.5 vs. 60.3 years, p < 0.0001), less likely to have hypertension (32.9 % vs. 45.9 %, p = 0.050), and less likely to have been hospitalized for COVID-19 (13.2 % vs. 24.6 %, p = 0.037) than controls. At index date, cases were more likely than controls to be rituximab users (18.4 % vs. 6.3 %, p = 0.0021). In the multivariable model, younger age (OR 0.67 per 10 years, 95 %CI 0.54-0.82), rituximab use vs. non-use (OR 3.38, 95 %CI 1.26-9.08), and methotrexate use vs. non-use (OR 2.24, 95 %CI 1.08-4.61) were each associated with repeat COVID-19 infection. Among those with repeat COVID-19 infection, 5/76 (6.6 %) were hospitalized and there were no deaths.
Younger age, rituximab, and methotrexate were each associated with repeat COVID-19 infection risk among patients with SARDs. Reassuringly, there were no deaths, and the hospitalization rate was low among those with repeat COVID-19 infection.
探讨系统性自身免疫性风湿病（SARD）患者 COVID-19 重复感染的危险因素和结局。
我们进行了一项病例对照研究，调查了马萨诸塞州综合医院系统内 SARD 患者的 COVID-19 重复感染情况。我们系统地确定了所有确诊 COVID-19（2020 年 3 月 15 日至 2022 年 10 月 17 日）的 SARD 患者。病例为 COVID-19 重复感染间隔>60 天（索引日期：重复 COVID-19 日期）。对照组按首次感染的日历日期和首次 COVID-19 感染与索引日期之间的时间间隔与病例（最多 3:1）匹配。我们通过病历回顾收集初次感染和索引日期的人口统计学、生活方式、合并症、SARD 特征和 COVID-19 特征。我们使用条件逻辑回归来确定与重复 COVID-19 感染相关的关联，同时调整潜在混杂因素。我们描述了病例中重复 COVID-19 感染的严重程度。
在 2203 例患有 COVID-19 的 SARD 患者中，我们确定了 76 例重复 COVID-19 感染病例（80.3%为女性），并与 207 例未重复感染的匹配对照（77.8%为女性）进行了匹配。初次感染时，病例组更年轻（平均年龄 49.5 岁 vs. 60.3 岁，p<0.0001），高血压（32.9% vs. 45.9%，p=0.050）和因 COVID-19 住院的可能性（13.2% vs. 24.6%，p=0.037）低于对照组。在索引日期，病例组比对照组更有可能是利妥昔单抗使用者（18.4% vs. 6.3%，p=0.0021）。在多变量模型中，年龄每增加 10 岁（95%CI 0.54-0.82）、使用利妥昔单抗与未使用者（OR 3.38，95%CI 1.26-9.08）和使用甲氨蝶呤与未使用者（OR 2.24，95%CI 1.08-4.61）与重复 COVID-19 感染相关。在重复 COVID-19 感染的患者中，5/76（6.6%）住院，无死亡。
年轻、利妥昔单抗和甲氨蝶呤与 SARD 患者的重复 COVID-19 感染风险相关。令人欣慰的是，重复 COVID-19 感染的患者中没有死亡，住院率也很低。
