Department of Rheumatology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Emergency Medicine, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Immunol. 2024 Mar 4;15:1295472. doi: 10.3389/fimmu.2024.1295472. eCollection 2024.
Data with fine granularity about COVID-19-related outcomes and risk factors were still limited in the idiopathic inflammatory myopathies (IIMs) population. This study aimed to investigate clinical factors associated with hospitalized and severe COVID-19 in patients with IIMs, particularly those gauged by myositis-specific antibodies.
This retrospective cohort study was conducted in the Renji IIM cohort in Shanghai, China, under an upsurge of SARS-CoV-2 omicron variant infections from December 2022 to January 2023. Clinical data were collected and analyzed by multivariable logistic regression to determine risk factors. High-dimensional flow cytometry analysis was performed to outline the immunological features.
Among 463 infected patients in the eligible cohort (n=613), 65 (14.0%) were hospitalized, 19 (4.1%) suffered severe COVID-19, and 10 (2.2%) died. Older age (OR=1.59/decade, 95% CI 1.18 to 2.16, p=0.003), requiring family oxygen supplement (2.62, 1.11 to 6.19, 0.028), patients with anti-synthetase syndrome (ASyS) (2.88, 1.12 to 7.34, 0.027, vs. other dermatomyositis), higher IIM disease activity, and prednisone intake >10mg/day (5.59, 2.70 to 11.57, <0.001) were associated with a higher risk of hospitalization. Conversely, 3-dose inactivated vaccination reduced the risk of hospitalization (0.10, 0.02 to 0.40, 0.001, vs. incomplete vaccination). Janus kinase inhibitor (JAKi) pre-exposure significantly reduced the risk of severe COVID-19 in hospitalized patients (0.16, 0.04 to 0.74, 0.019, vs. csDMARDs). ASyS patients with severe COVID-19 had significantly reduced peripheral CD4+ T cells, lower CD4/CD8 ratio, and fewer naive B cells but more class-switched memory B cells compared with controls.
ASyS and family oxygen supplement were first identified as risk factors for COVID-19-related hospitalization in patients with IIMs. JAKi pre-exposure might protect IIM patients against severe COVID-19 complications.
关于 COVID-19 相关结局和风险因素的数据在特发性炎性肌病（IIM）人群中仍然有限。本研究旨在调查与 IIM 患者住院和严重 COVID-19 相关的临床因素，特别是那些由肌炎特异性抗体评估的因素。
这是一项在中国上海仁济 IIM 队列中进行的回顾性队列研究，研究对象为 2022 年 12 月至 2023 年 1 月期间 SARS-CoV-2 奥密克戎变异株感染期间的患者。通过多变量逻辑回归分析收集和分析临床数据，以确定风险因素。采用高维流式细胞术分析概述免疫特征。
在符合条件的队列中（n=613），463 名感染患者中，65 名（14.0%）住院，19 名（4.1%）患严重 COVID-19，10 名（2.2%）死亡。年龄较大（每十年 1.59，95%CI 1.18 至 2.16，p=0.003）、需要家庭吸氧补充（2.62，1.11 至 6.19，0.028）、抗合成酶综合征（ASyS）（2.88，1.12 至 7.34，0.027，vs. 其他皮肌炎）、更高的 IIM 疾病活动度和泼尼松日摄入量>10mg/天（5.59，2.70 至 11.57，<0.001）与住院风险增加相关。相反，3 剂灭活疫苗接种降低了住院风险（0.10，0.02 至 0.40，0.001，vs. 不完全接种）。住院患者中，JAKi 暴露前治疗显著降低了严重 COVID-19 的风险（0.16，0.04 至 0.74，0.019，vs. csDMARDs）。与对照组相比，患有严重 COVID-19 的 ASyS 患者外周血 CD4+T 细胞明显减少，CD4/CD8 比值降低，幼稚 B 细胞减少，而类别转换记忆 B 细胞增多。
ASyS 和家庭吸氧补充被首次确定为 IIM 患者 COVID-19 相关住院的危险因素。JAKi 暴露前治疗可能会保护 IIM 患者免受严重 COVID-19 并发症的影响。
