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High levels of immunosuppression are related to unfavourable outcomes in hospitalised patients with rheumatic diseases and COVID-19: first results of ReumaCoV Brasil registry

2021; BMJ; Volume: 7; Issue: 1 Linguagem: Inglês

10.1136/rmdopen-2020-001461

2056-5933

Cláudia Diniz Lopes Marques, Adriana María Kakehasi, Marcelo Medeiros Pinheiro, Lícia Maria Henrique da Mota, Cleandro Pires de Albuquerque, Carolina Rocha Silva, Gabriela P. J. Santos, Edgard Torres dos Reis-Neto, Pedro M. Matos, Guilherme Devidé, Andréa Tavares Dantas, Rina Dalva Neubarth Giorgi, Felipe Omura, Adriana de Oliveira Marinho, Lilian David Azevedo Valadares, Ana Karla Guedes de Melo, Francinne Machado Ribeiro, Gilda Aparecida Ferreira, Flavia Patricia de Sena Santos, Sandra Lúcia Euzébio Ribeiro, Nicole Pamplona Bueno de Andrade, Michel Alexandre Yazbek, Viviane Angelina de Souza, Eduardo S. Paiva, Valdeŕilio Feijó Azevedo, Ana Beatriz Santos Bacchiega de Freitas, José Roberto Provenza, Ricardo Acayaba de Toledo, Sheilla Fontenelle, Sueli Carneiro, Ricardo Machado Xavier, Gecilmara Salviato Pileggi, Ana Paula Monteiro Gomides,

Dermatological and COVID-19 studies

Objectives To evaluate risk factors associated with unfavourable outcomes: emergency care, hospitalisation, admission to intensive care unit (ICU), mechanical ventilation and death in patients with immune-mediated rheumatic disease (IMRD) and COVID-19. Methods Analysis of the first 8 weeks of observational multicentre prospective cohort study (ReumaCoV Brasil register). Patients with IMRD and COVID-19 according to the Ministry of Health criteria were classified as eligible for the study. Results 334 participants were enrolled, a majority of them women, with a median age of 45 years; systemic lupus erythematosus (32.9%) was the most frequent IMRD. Emergency care was required in 160 patients, 33.0% were hospitalised, 15.0% were admitted to the ICU and 10.5% underwent mechanical ventilation; 28 patients (8.4%) died. In the multivariate adjustment model for emergency care, diabetes (prevalence ratio, PR 1.38; 95% CI 1.11 to 1.73; p=0.004), kidney disease (PR 1.36; 95% CI 1.05 to 1.77; p=0.020), oral glucocorticoids (GC) (PR 1.49; 95% CI 1.21 to 1.85; p<0.001) and pulse therapy with methylprednisolone (PR 1.38; 95% CI 1.14 to 1.67; p=0.001) remained significant; for hospitalisation, age >50 years (PR 1.89; 95% CI 1.26 to 2.85; p=0.002), no use of tumour necrosis factor inhibitor (TNFi) (PR 2.51;95% CI 1.16 to 5.45; p=0.004) and methylprednisolone pulse therapy (PR 2.50; 95% CI 1.59 to 3.92; p<0.001); for ICU admission, oral GC (PR 2.24; 95% CI 1.36 to 3.71; p<0.001) and pulse therapy with methylprednisolone (PR 1.65; 95% CI 1.00 to 2.68; p<0.043); the two variables associated with death were pulse therapy with methylprednisolone or cyclophosphamide (PR 2.86; 95% CI 1.59 to 5.14; p<0.018). Conclusions Age >50 years and immunosuppression with GC and cyclophosphamide were associated with unfavourable outcomes of COVID-19. Treatment with TNFi may have been protective, perhaps leading to the COVID-19 inflammatory process.