Title:
Characteristics, outcomes, and mortality amongst 133,589 patients with prevalent autoimmune diseases diagnosed with, and 48,418 hospitalised for COVID-19: a multinational distributed network cohort analysis
Authors:
Eng Hooi Tan, Anthony G. Sena, Albert Prats-Uribe, Seng Chan You, Waheed-Ul-Rahman Ahmed, Kristin Kostka, Christian Reich, Scott L. Duvall, Kristine E. Lynch, Michael E. Matheny, Talita Duarte-Salles, Sergio Fernandez Bertolin, George Hripcsak, Karthik Natarajan, Thomas Falconer, Matthew Spotnitz, Anna Ostropolets, Clair Blacketer, Thamir M Alshammari, Heba Alghoul, Osaid Alser, Jennifer C.E. Lane, Dalia M Dawoud, Karishma Shah, Yue Yang, Lin Zhang, Carlos Areia, Asieh Golozar, Martina Recalde, Paula Casajust, Jitendra Jonnagaddala, Vignesh Subbian, David Vizcaya, Lana YH Lai, Fredrik Nyberg, Daniel R. Morales, Jose D. Posada, Nigam H. Shah, Mengchun Gong, Arani Vivekanantham, Aaron Abend, Evan P Minty, Marc A. Suchard, Peter Rijnbeek, Patrick B Ryan & Daniel Prieto-Alhambra
Published:
medRxiv, 27 November 2020
[Keep in mind that this article is a preprint and not yet peer reviewed.]
Abstract:
Objective: Patients with autoimmune diseases were advised to shield to avoid COVID-19, but information on their prognosis is lacking. We characterised 30-day outcomes and mortality after hospitalisation with COVID-19 among patients with prevalent autoimmune diseases, and compared outcomes after hospital admissions among similar patients with seasonal influenza.
Design: Multinational network cohort study Setting: Electronic health records data from Columbia University Irving Medical Center (CUIMC) (NYC, United States [US]), Optum [US], Department of Veterans Affairs (VA) (US), Information System for Research in Primary Care-Hospitalisation Linked Data (SIDIAP-H) (Spain), and claims data from IQVIA Open Claims (US) and Health Insurance and Review Assessment (HIRA) (South Korea).
Participants: All patients with prevalent autoimmune diseases, diagnosed and/or hospitalised between January and June 2020 with COVID-19, and similar patients hospitalised with influenza in 2017-2018 were included. Main outcome measures: 30-day complications during hospitalisation and death
Results: We studied 133,589 patients diagnosed and 48,418 hospitalised with COVID-19 with prevalent autoimmune diseases. The majority of participants were female (60.5% to 65.9%) and aged ≥50 years. The most prevalent autoimmune conditions were psoriasis (3.5 to 32.5%), rheumatoid arthritis (3.9 to 18.9%), and vasculitis (3.3 to 17.6%). Amongst hospitalised patients, Type 1 diabetes was the most common autoimmune condition (4.8% to 7.5%) in US databases, rheumatoid arthritis in HIRA (18.9%), and psoriasis in SIDIAP-H (26.4%). Compared to 70,660 hospitalised with influenza, those admitted with COVID-19 had more respiratory complications including pneumonia and acute respiratory distress syndrome, and higher 30-day mortality (2.2% to 4.3% versus 6.3% to 24.6%).
Conclusions: Patients with autoimmune diseases had high rates of respiratory complications and 30-day mortality following a hospitalization with COVID-19. Compared to influenza, COVID-19 is a more severe disease, leading to more complications and higher mortality. Future studies should investigate predictors of poor outcomes in COVID-19 patients with autoimmune diseases.