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

Author

Valderílio Feijó Azevedo, Sueli Carneiro, Francinne Machado Ribeiro, Ana Karla G Melo, Ricardo Xavier, Claudia Diniz Lopes Marques, Adriana Maria Kakehasi, Marcelo Medeiros Pinheiro, Licia Maria Henrique Mota, Cleandro Pires Albuquerque, Carolina Rocha Silva, Gabriela Porfirio Jardim Santos, Edgard Torres Reis-Neto, Pedro Matos, Guilherme Devide, Andrea Dantas, Rina Dalva Giorgi, Adriana de Oliveira Marinho, Lilian David Azevedo Valadares, Gilda Aparecida Ferreira, Flavia Patricia de Sena Santos, Sandra Lucia Euzebio Ribeiro, Nicole Pamplona Bueno Andrade, Michel Alexandre Yazbek, Viviane Angelina de Souza, Eduardo S Paiva, Ana Beatriz Santos Bacchiega de Freitas, José Roberto Provenza, Ricardo Acayaba de Toledo, Sheilla Fontenelle, Gecilmara Cristina Salviato Pileggi, Ana Paula Monteiro Gomides Reis, and Felipe Omura

Subjects
Medicine
Abstract

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; p50 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; p50 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.

Published
2021
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2. High levels of immunosuppression are related to unfavourable outcomes in hospitalised patients with rheumatic diseases and COVID-19: first results of ReumaCoV Brasil registry

Author

Claudia Diniz Lopes Marques, Adriana Maria Kakehasi, Marcelo Medeiros Pinheiro, Licia Maria Henrique Mota, Cleandro Pires Albuquerque, Carolina Rocha Silva, Gabriela Porfirio Jardim Santos, Edgard Torres Reis-Neto, Pedro Matos, Guilherme Devide, Andrea Dantas, Rina Dalva Giorgi, Felipe Omura, Adriana de Oliveira Marinho, Lilian David Azevedo Valadares, Ana Karla G Melo, Francinne Machado Ribeiro, Gilda Aparecida Ferreira, Flavia Patricia de Sena Santos, Sandra Lucia Euzebio Ribeiro, Nicole Pamplona Bueno Andrade, Michel Alexandre Yazbek, Viviane Angelina de Souza, Eduardo S Paiva, Valderilio Feijo Azevedo, Ana Beatriz Santos Bacchiega de Freitas, José Roberto Provenza, Ricardo Acayaba de Toledo, Sheilla Fontenelle, Sueli Carneiro, Ricardo Xavier, Gecilmara Cristina Salviato Pileggi, and Ana Paula Monteiro Gomides Reis

Subjects
medicine.medical_specialty, Cyclophosphamide, medicine.medical_treatment, Immunology, Infections, law.invention, Rheumatology, law, Internal medicine, Diabetes mellitus, Epidemiology, therapeutics, Immunology and Allergy, Medicine, autoimmune diseases, Prospective cohort study, outcome assessment, Mechanical ventilation, business.industry, Immunosuppression, medicine.disease, outcome and process assessment, Intensive care unit, health care, Pacientes, epidemiology, Covid-19, business, Reumatismo, Kidney disease, medicine.drug
Abstract

ObjectivesTo 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.MethodsAnalysis 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.Results334 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; p50 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; pConclusionsAge >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.

Published
2021

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