Patel Naomi J, Srivatsan Shruthi, Kowalski Emily N, King Andrew, Wang Xiaosong, Vanni Kathleen Mm, Qian Grace, Hanberg Jennifer S, Bade Katarina J, Saavedra Alene A, Mueller Kevin T, Hang Buuthien, Williams Zachary K, Johnson Colebrooke, Negron Madison, Sparks Jeffrey A, Wallace Zachary S
Harvard Medical School, Boston, MA, USA.
Rheumatology Unit, Massachusetts General Hospital, Boston, Massachusetts, USA.
RMD Open. 2025 Mar 5;11(1):e005114. doi: 10.1136/rmdopen-2024-005114.
To investigate the risk factors for severe acute COVID-19 outcomes in the Omicron era among individuals with systemic autoimmune rheumatic diseases (SARDs).
We identified patients with confirmed SARDs and COVID-19 (positive PCR and/or antigen test) from 1 September 2022 to 15 March 2024 in the Mass General Brigham healthcare system. We estimated the associations of baseline characteristics with the odds of hospitalisation due to COVID-19 infection, verified by medical record review, using multivariable logistic regression.
Of 2061 patients with SARDs and COVID-19 during the Omicron era (75% female, mean age 62.2 years), 134 (6.5%) were hospitalised due to COVID-19, mostly due to respiratory symptoms (84, 63%). Of those hospitalised, 11 (8%) required mechanical ventilation and 20 (15%) died. Older age (adjusted OR (aOR) 1.05 per year), Black race (vs White race, aOR 4.15), ever smoking (vs never, aOR 1.76), CD20 inhibitor use (vs antimalarial monotherapy, aOR 2.22) and glucocorticoid use (vs non-use, aOR 2.07) were significantly associated with higher odds of hospitalisation. Female sex (vs male, aOR 0.63), booster SARS-CoV-2 vaccination (vs initial series, aOR 0.49) and vaccination within either 3 months or 3-6 months prior to infection (aOR 0.41 and aOR 0.38, respectively, vs none within 12 months) were significantly associated with lower odds of hospitalisation.
Some patients with SARDs remain at higher risk of severe COVID-19 in the Omicron era. Patients who are older, Black, have more comorbidities, use CD20 inhibitors and/or glucocorticoids, or have not been vaccinated recently may benefit from risk-mitigating strategies, including booster vaccines and pre-exposure prophylaxis.
调查在奥密克戎时代，患有系统性自身免疫性风湿病（SARDs）的个体出现严重急性新冠病毒病（COVID-19）不良结局的风险因素。
我们在马萨诸塞州综合医院布莱根医疗系统中，确定了2022年9月1日至2024年3月15日期间确诊患有SARDs和COVID-19（PCR和/或抗原检测呈阳性）的患者。我们通过多变量逻辑回归分析，利用病历审查来评估基线特征与因COVID-19感染住院几率之间的关联。
在奥密克戎时代的2061例患有SARDs和COVID-19的患者中（75%为女性，平均年龄62.2岁），134例（6.5%）因COVID-19住院，主要原因是呼吸道症状（84例，63%）。在这些住院患者中，11例（8%）需要机械通气，20例（15%）死亡。年龄较大（调整优势比[aOR]为每年1.05）、黑人种族（与白人种族相比，aOR为4.15）、曾经吸烟（与从不吸烟相比，aOR为1.76）、使用CD20抑制剂（与抗疟单药治疗相比，aOR为2.22）以及使用糖皮质激素（与未使用相比，aOR为2.07）与较高的住院几率显著相关。女性（与男性相比，aOR为0.63）、接种新冠病毒加强疫苗（与初始系列疫苗相比，aOR为0.49）以及在感染前3个月内或3至6个月内接种疫苗（分别与12个月内未接种相比，aOR为0.41和aOR为0.38）与较低的住院几率显著相关。
在奥密克戎时代，一些患有SARDs的患者仍然面临严重COVID-19的较高风险。年龄较大、黑人、合并症较多、使用CD20抑制剂和/或糖皮质激素，或最近未接种疫苗的患者，可能会从包括加强疫苗和暴露前预防在内的风险缓解策略中获益。
