Background
Over the month of April, Spain has become the European country with more confirmed cases of COVID-19 infection, after surpassing Italy on April 2nd. The community of Castile and León in ...Spain is one of the most affected by COVID-19 infection and the province of León has a total of 3711 cases and 425 deaths so far. Rheumatic patients should be given special attention regarding COVID-19 infection due to their immunocompromised state resulting from their underlying immune conditions and use of targeted immune-modulating therapies. Studying epidemiological and clinical characteristics of patients with rheumatic diseases infected with SARS-CoV2 is pivotal to clarify determinants of COVID-19 disease severity in patients with underlying rheumatic disease.
Objectives
To describe epidemiological characteristics of patients with rheumatic diseases hospitalized with COVID-19 and determine risk factors associated with mortality in a third level Hospital setting in León, Spain.
Methods
We performed a prospective observational study, from 1st March 2020 until the 1st of June including adults with rheumatic diseases hospitalized with COVID-19 and performed a univariate and multivariate logistic regression model to estimate ORs and 95% CIs of mortality. Age, sex, comorbidities, rheumatic disease diagnosis and treatment, disease activity prior to infection, radiographic and laboratorial results at arrival were analysed.
Results
During the study period, 3711 patients with COVID-19 were admitted to our hospital, of whom 38 (10%) had a rheumatic or musculoskeletal disease. Fifty-three percent were women, with a mean age at hospital admission of 75.3 (IQR 68–83) years. The median length of stay was 11 days. A total of 10 patients died (26%) during their hospital admission. Patients who died from COVID-19 were older (median age 78.4 IQR 74.5–83.5) than those who survived COVID-19 (median age 75.1 IQR 69.3–75.8) and more likely to have arterial hypertension (9 90% vs 14 50% patients; OR 9 (95% CI 1.0–80.8),
p
0.049), dyslipidaemia (9 (90%) vs 12 (43%); OR 12 (95% CI 1.33–108),
p
0.03), diabetes ((9 (90%) vs 6 (28%) patients; OR 33,
p
0.002), interstitial lung disease (6 (60%) vs 6 (21%); OR 5.5 (95% CI 1.16–26),
p
0.03), cardiovascular disease (8 (80%) vs 11 (39%); OR 6.18 (95% IC 1.10–34.7,
p
0.04) and a moderate/high index of rheumatic disease activity (7 (25%) vs 6(60%); OR 41.4 (4.23–405.23),
p
0.04). In univariate analyses, we also found that patients who died from COVID-19 had higher hyperinflammation markers than patients who survived: C-reactive protein (181 (IQR 120–220) vs 107.4 (IQR 30–150;
p
0.05); lactate dehydrogenase (641.8 (IQR 465.75–853.5) vs 361 (IQR 250–450),
p
0.03); serum ferritin (1026 (IQR 228.3–1536.3) vs 861.3 (IQR 389–1490.5),
p
0.04); D-dimer (12,019.8 (IQR 843.5–25,790.5) vs 1544.3 (IQR 619–1622),
p
0.04). No differences in sex, radiological abnormalities, rheumatological disease, background therapy or symptoms before admission between deceased patients and survivors were found. In the multivariate analysis, the following risk factors were associated with mortality: rheumatic disease activity (
p
= 0.003), dyslipidaemia (
p
= 0.01), cardiovascular disease (
p
= 0.02) and interstitial lung disease (
p
= 0.02). Age, hypertension and diabetes were significant predictors in univariate but not in multivariate analysis. Rheumatic disease activity was significantly associated with fever (
p
= 0.05), interstitial lung disease (
p
= 0.03), cardiovascular disease (
p
= 0.03) and dyslipidaemia (
p
= 0.01).
Conclusions
Our results suggest that comorbidities, rheumatic disease activity and laboratorial abnormalities such as C-reactive protein (CRP), D-Dimer, lactate dehydrogenase (LDH), serum ferritin elevation significantly associated with mortality whereas previous use of rheumatic medication did not. Inflammation is closely related to severity of COVID-19.
Key Points
•
Most patients recover from COVID-19
.
•
The use of DMARDs, corticosteroids and biologic agents did not increase the odds of mortality in our study
.
•
Rheumatic disease activity might be associated with mortality
.
ObjectivesOur goal with this study was to determine the most important predictors for each of the main adverse pregnancy outcomes in SLE patients.MethodsPatients with systemic lupus erythematosus ...were retrospectively analyzed from 1990 to 2020. Maternal and fetal complications in pregnant women with SLE were retrieved. We compared clinical and analytical characteristics of SLE patients with adverse pregnancy outcomes to controls with SLE diagnosis without adverse pregnancy outcomes. Qualitative data were analyzed by Chi-square test and Fisher’s exact test. Continuous variables were analyzed by using Student’s t test. Multiple logistic regression was performed to determine the predictive factors for adverse pregnancy outcomes with adjustment of confounding factors.Results135 multiparous women were included (43% with adverse pregnancy outcomes). A total of 57 pregnancies (42%) were linked to adverse outcomes. The occurrence of abortion was correlated with anti-DNAds (β=0.71. p=0.04), renal involvement (β=0.28, p 0.03), antiphospholipid antibodies (β=0.29, p 0.03), ESR elevation (β =0.81, p=0.02) and CPR elevation (β =0.91, p=0.01). Stillbirth was also correlated with renal involvement (β= 0.26, p =0.04), antiphospholipid antibodies (β=0.22, p=0.03) and ESR elevation (β =0.53, p=0.02). Preeclampsia was correlated with direct Coombs positivity (β=0.42, p=0.01), serositis (β=0.31, p=0.02), ESR elevation (β =0.52, p=0.03) and CPR elevation (β =0.32, p=0.04). Neonatal Lupus was correlated with anti-RNP (β=0.16, p=0.03) and anti-Ro/SSA (β=0.16, p 0.02).Abstract PO.8.179 Table 1Multiple logistic regression analysis showing association between adverse pregnancy outcome and ESR, CPR, anti-DNAds, APA, renal involvement, direct coombs positivity, anti-RO and anti-RNPConclusionsThe most unfavorable pregnancy outcome in women with SLE was spontaneous abortion. Renal involvement, anti-DNAds positivity, antiphospholipid antibody positivity, anti-Ro/SSA, elevated ESR and a younger age at disease onset increased the risk of pregnancy complications.
PurposeTo analyze the causes and identify predictive factors of mortality of Systemic Lupus Erythematosus (SLE), and to assess the time evolution and chronological changes in Spain.MethodsWe ...performed a cross-sectional and retrospective study analyzing data from the RELESSER cohort (Spanish Registry of SLE of the Spanish Society of Rheumatology). Sociodemographic, clinical and serological variables, comorbidities and treatments, as well as indicators of disease activity, damage and severity were recorded. We excluded patients with lost information about the death variable and analyzed the differential features of deceased patients in comparisons with survivors through different time stages according to the date of diagnosis: until the 1980's; the 1990's and the first decade of the 21st century. Variables associated with mortality in univariate analysis were entered into different multivariate models to determine which ones were independently associated with the outcome of the disease in each decade.ResultsA total of 3665 patients were included, mostly caucasian female with similar general features regardless of the different time stages analyzed. The 18.4% until the 1980’s, the 5.97% in the 1990’s and up to 2.84% of the individuals in the first decade of the 21st century, had died. The main age of death was similar in the different groups, around 55-58 years old (Table). The vascular events were the leading cause of death until the 1980’s, while in the last two decades, were SLE activity followed by infections.The older age at diagnosis was predictor of mortality in our cohort. Neither gender nor delay in diagnosis was independently associated with mortality, with the exception of the female sex, which behaved as a protective factor until the 1980’s.The mortality predictors in our cohort were the presence of hypocomplementemia, organ damage, ischemic disease and hospitalizations until the 1980’s; thrombocytopenia, thrombosis, antiphospholipid syndrome and valve disease in the 1990’s; nephritis, organ damage, depression, severe infections and ischemic disease in the first decade of the 21st century. Conversely, skin involvement was related to greater survival over the last two decades of the study.The use of high doses of corticosteroids was predictor of mortality in each time stage, as well as the use of cyclophosphamide and rituximab from the year 2000. Antimalarial treatment was linked to improved survival in all the decades analyzed as well as the use of mycophenolate in the 1990’s.ConclusionsIn the RELESSER cohort, the main causes of death were disease activity and infections, with the exception until the 1980’s, which were vascular events.The older age at diagnosis, the use of corticosteroids and comorbidities, were associated with a significant increase in mortality in SLE, while antimalarial treatment was linked to improved survival. Data indicate that organ damage is a risk factor and skin involvement is a protective factor against mortality. Differentially, female sex until the 1980’s was independently associated to improved survival, and depression at the beginning of the 21st century was linked to mortality.
PDF
