Davis Monique G, Akhlaq Anum, Aamer Sameen, Shuja Hina, Edigin Ehizogie, Sheikh Abu B
Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, USA.
Department of Internal Medicine, University of Mississippi Medical Center, Jackson, MS, USA.
J Community Hosp Intern Med Perspect. 2024 Jan 12;14(1):5-12. doi: 10.55729/2000-9666.1288. eCollection 2024.
Coronavirus-19, primarily a respiratory virus, affects multiple organs and can lead to exacerbation of autoimmune or systemic conditions. Patients with autoimmune diseases, rheumatoid arthritis particularly, are susceptible to infection and complications from COVID-19. RA has become well-associated with COVID-19 infections, but large-scale studies evaluating outcomes among this vulnerable group are limited.
For the retrospective analysis, we used the National Inpatient Sample database to compare COVID-19 patients with and without RA. A total of 1,050,040 adult hospitalizations were included in the study between January 1 to December 31, 2020: COVID-19 with RA ( = 21,545; 2.1%) and COVID-19 without RA ( = 1,028,495; 97.9%). The primary outcome was in-hospital mortality. Secondary outcomes included mechanical ventilation requirement, vasopressor use, cardiac arrest, cardiogenic shock, acute kidney injury, acute kidney injury requiring hemodialysis, gastrostomy, tracheostomy, length of stay, health care utilization costs, and disposition. A secondary analysis evaluating in-hospital mortality and mechanical ventilation with respect to age was conducted.
COVID-19 patients with RA had significantly increased in-hospital mortality compared to COVID-19 patients without RA (12.9% vs 11.1%, adjusted OR [aOR]: 1.2 [95% CI 1.1-1.3], < 0.001). This cohort also had significantly increased rates of mechanical ventilation, pressor use, and cardiogenic shock.
Given limited large evidence regarding COVID-19 with respect to RA, future research should be focused on this topic to improve outcomes for this subset of patients.
新型冠状病毒肺炎主要是一种呼吸道病毒，可累及多个器官，并可导致自身免疫性疾病或全身性疾病加重。自身免疫性疾病患者，尤其是类风湿关节炎患者，易感染新型冠状病毒肺炎并出现并发症。类风湿关节炎已与新型冠状病毒肺炎感染密切相关，但评估这一弱势群体预后的大规模研究有限。
在这项回顾性分析中，我们使用国家住院患者样本数据库比较了患有和未患类风湿关节炎的新型冠状病毒肺炎患者。2020年1月1日至12月31日期间，共有1,050,040例成人住院患者纳入研究：患有类风湿关节炎的新型冠状病毒肺炎患者（n = 21,545；2.1%）和未患类风湿关节炎的新型冠状病毒肺炎患者（n = 1,028,495；97.9%）。主要结局是住院死亡率。次要结局包括机械通气需求、血管活性药物使用、心脏骤停、心源性休克、急性肾损伤、需要血液透析的急性肾损伤、胃造口术、气管切开术、住院时间、医疗保健利用成本和出院情况。进行了一项关于住院死亡率和机械通气与年龄关系的二次分析。
与未患类风湿关节炎的新型冠状病毒肺炎患者相比，患有类风湿关节炎的新型冠状病毒肺炎患者的住院死亡率显著增加（12.9%对11.1%，调整后的比值比[aOR]：1.2[95%置信区间1.1 - 1.3]，P < 0.001）。该队列的机械通气、血管活性药物使用和心源性休克发生率也显著增加。
鉴于关于类风湿关节炎合并新型冠状病毒肺炎的大型证据有限，未来的研究应聚焦于该主题，以改善这部分患者的预后。
