Eastern Health, Melbourne, Victoria, Australia.
Infectious Diseases Department, Eastern Health, Melbourne, Victoria, Australia.
Intern Med J. 2024 Oct;54(10):1634-1643. doi: 10.1111/imj.16488. Epub 2024 Aug 13.
Patients with autoimmune inflammatory rheumatic disease (AIIRD) are at higher risk of severe infections because of their underlying diseases and immunosuppression. Our objective was to elucidate the epidemiological and clinical characteristics of patients with AIIRD presenting with COVID-19 and their relation to disease severity. We explored whether variables, including underlying diagnosis, disease-modifying antirheumatic drugs (DMARDs) and COVID-19 vaccine status, were associated with more severe forms of COVID-19 infection.
Between 1 January 2020 and 30 June 2022, 151 patients with AIIRD and COVID-19 infection were analysed using a binary regression model and a multinomial regression model.
The average age was 61.5 years, and average Charlson Comorbidity Index (CCI) was 2.1; 106 (70.2%) patients were diagnosed with rheumatoid arthritis (RA), and 70 (46.4%) patients were receiving prednisolone. In the multivariable logistic regression model, ages between 50 and 69 years (odds ratio (OR) = 5.85; 95% confidence interval (CI) = 1.35-25.25) and older than 70 years (OR = 5.29; 95% CI = 1.21-23.14), prior prednisolone treatment (OR = 7.09; 95% CI = 2.63-19.11) and vaccination status including one and two doses (OR = 0.19; 95% CI = 0.05-0.69) and three and four doses (OR = 0.09; 95% CI = 0.02-0.35) were all statistically significant factors related to changes in the severity level of COVID-19.
Severity of COVID-19 infection in patients with AIIRD is affected by age, background steroid use and vaccination status. Factors including sex, comorbidity, diagnosis of AIIRDs and use of DMARDs, including conventional synthetic, biologics and targeted DMARDs, were not significantly associated with COVID-19 severity.
由于自身疾病和免疫抑制，患有自身免疫性炎症性风湿病（AIIRD）的患者发生严重感染的风险更高。我们的目的是阐明患有 COVID-19 的 AIIRD 患者的流行病学和临床特征及其与疾病严重程度的关系。我们探讨了包括基础诊断、疾病修饰抗风湿药物（DMARDs）和 COVID-19 疫苗接种状态在内的变量是否与 COVID-19 感染的更严重形式相关。
在 2020 年 1 月 1 日至 2022 年 6 月 30 日期间，使用二元回归模型和多项回归模型分析了 151 例患有 AIIRD 和 COVID-19 感染的患者。
平均年龄为 61.5 岁，平均 Charlson 合并症指数（CCI）为 2.1；106（70.2%）例患者被诊断为类风湿关节炎（RA），70（46.4%）例患者正在接受泼尼松龙治疗。在多变量逻辑回归模型中，年龄在 50-69 岁（优势比（OR）=5.85；95%置信区间（CI）=1.35-25.25）和 70 岁以上（OR=5.29；95%CI=1.21-23.14）、先前接受泼尼松龙治疗（OR=7.09；95%CI=2.63-19.11）以及接种疫苗状态，包括一剂和两剂（OR=0.19；95%CI=0.05-0.69）和三剂和四剂（OR=0.09；95%CI=0.02-0.35）均与 COVID-19 严重程度的变化相关统计学意义。
AIIRD 患者 COVID-19 感染的严重程度受年龄、背景类固醇使用和疫苗接种状态的影响。包括性别、合并症、AIIRD 诊断以及使用包括传统合成药、生物制剂和靶向 DMARDs 在内的 DMARDs 等因素与 COVID-19 严重程度无显著相关性。
