COVID-19 长期自身免疫性炎症性风湿学结局：一项跨国队列研究。

Long-Term Autoimmune Inflammatory Rheumatic Outcomes of COVID-19 : A Binational Cohort Study.

机构信息

Medical and Population Genetics and Cardiovascular Disease Initiative, Broad Institute of MIT and Harvard, Cambridge, Massachusetts (M.S.K.).

Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea, and Center for Digital Health, Medical Science Research Institute, Kyung Hee University College of Medicine, Seoul, South Korea (H.L.).

出版信息

Ann Intern Med. 2024 Mar;177(3):291-302. doi: 10.7326/M23-1831. Epub 2024 Mar 5.

DOI:10.7326/M23-1831

PMID:38437702

Abstract

BACKGROUND

Some data suggest a higher incidence of diagnosis of autoimmune inflammatory rheumatic diseases (AIRDs) among patients with a history of COVID-19 compared with uninfected patients. However, these studies had methodological shortcomings.

OBJECTIVE

To investigate the effect of COVID-19 on long-term risk for incident AIRD over various follow-up periods.

DESIGN

Binational, longitudinal, propensity-matched cohort study.

SETTING

Nationwide claims-based databases in South Korea (K-COV-N cohort) and Japan (JMDC cohort).

PARTICIPANTS

10 027 506 Korean and 12 218 680 Japanese patients aged 20 years or older, including those with COVID-19 between 1 January 2020 and 31 December 2021, matched to patients with influenza infection and to uninfected control patients.

MEASUREMENTS

The primary outcome was onset of AIRD (per appropriate codes from the International Classification of Diseases, 10th Revision) 1, 6, and 12 months after COVID-19 or influenza infection or the respective matched index date of uninfected control patients.

RESULTS

Between 2020 and 2021, among the 10 027 506 Korean participants (mean age, 48.4 years [SD, 13.4]; 50.1% men), 394 274 (3.9%) and 98 596 (0.98%) had a history of COVID-19 or influenza, respectively. After propensity score matching, beyond the first 30 days after infection, patients with COVID-19 were at increased risk for incident AIRD compared with uninfected patients (adjusted hazard ratio, 1.25 [95% CI, 1.18 to 1.31]) and influenza-infected control patients (adjusted hazard ratio, 1.30 [CI, 1.02 to 1.59]). The risk for incident AIRD was higher with more severe acute COVID-19. Similar patterns were observed in the Japanese cohort.

LIMITATIONS

Referral bias due to the pandemic; residual confounding.

CONCLUSION

SARS-CoV-2 infection was associated with increased risk for incident AIRD compared with matched patients without SARS-CoV-2 infection or with influenza infection. The risk for incident AIRD was higher with greater severity of acute COVID-19.

PRIMARY FUNDING SOURCE

National Research Foundation of Korea.

摘要

背景

一些数据表明，与未感染的患者相比，有 COVID-19 病史的患者自身免疫性炎症性风湿病 (AIRD) 的诊断发生率更高。然而，这些研究存在方法学上的缺陷。

目的

调查 COVID-19 对不同随访期间 AIRD 发病风险的长期影响。

设计

两国、纵向、倾向匹配队列研究。

设置

韩国（K-COV-N 队列）和日本（JMDC 队列）全国范围内的基于索赔的数据库。

参与者

10027506 名韩国人和 12218680 名日本人，年龄 20 岁或以上，包括 2020 年 1 月 1 日至 2021 年 12 月 31 日期间患有 COVID-19 的患者，与流感感染患者和未感染的对照患者相匹配。

测量

主要结局是 COVID-19 或流感感染后 1、6 和 12 个月，或未感染对照患者各自的匹配索引日期后发生 AIRD（根据国际疾病分类第 10 版的适当代码）。

结果

在 2020 年至 2021 年间，在 10027506 名韩国参与者中（平均年龄 48.4 岁[SD，13.4]；50.1%为男性），分别有 394274（3.9%）和 98596（0.98%）有 COVID-19 或流感病史。经过倾向评分匹配后，在感染后 30 天内，COVID-19 患者发生 AIRD 的风险高于未感染患者（调整后的危险比，1.25[95%CI，1.18 至 1.31]）和流感感染对照患者（调整后的危险比，1.30[CI，1.02 至 1.59]）。急性 COVID-19 越严重，发生 AIRD 的风险越高。在日本队列中也观察到类似的模式。