The Impact of Immunosuppression and Autoimmune Disease on Severe Outcomes in Patients Hospitalized with COVID-19
- PDF / 601,231 Bytes
- 9 Pages / 595.276 x 790.866 pts Page_size
- 61 Downloads / 189 Views
ORIGINAL ARTICLE
The Impact of Immunosuppression and Autoimmune Disease on Severe Outcomes in Patients Hospitalized with COVID-19 Enric Monreal 1 & Susana Sainz de la Maza 1 & Jose Ignacio Fernández-Velasco 2 & Elena Natera-Villalba 1 & Claudia Geraldine Rita 2 & Fernando Rodríguez-Jorge 1 & Álvaro Beltrán-Corbellini 1 & Ignacio Iturrieta-Zuazo 2 & Enrique Rodríguez de Santiago 3 & Mercedes Espiño 2 & Ana de Andrés 2 & Jesús Fortún 4 & Esther Barbero 5 & Mónica Vázquez 6 & Milagros Fernández Lucas 7 & Luis Manzano 8 & Beatriz Montero-Errasquín 9 & Lucienne Costa-Frossard 1 & Jaime Masjuan 1 & Luisa María Villar 2 & for the COVID-HRC group Received: 8 September 2020 / Accepted: 16 November 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Immunosuppression (IS) and autoimmune disease (AD) are prevalent in patients with severe coronavirus disease 2019 (COVID-19), but their impact on its clinical course is unknown. We investigated relationships between IS, AD, and outcomes in patients hospitalized with COVID-19. Data on consecutive admissions for COVID-19 were extracted retrospectively from medical records. Patients were assigned to one of four cohorts, according to whether or not they had an AD (AD and NAD) or were immunosuppressed (IS and NIS). The primary endpoint was development of severe acute respiratory distress syndrome (ARDS); secondary endpoints included death, and a composite of mechanical ventilation (MV) or death. A total of 789 patients were included: 569 (72.1%) male, 76 (9.6%) with an AD, and 63 (8.0%) with IS. Relative to the NIS-NAD cohort, patients in the IS-AD cohort had a significantly reduced risk of severe ARDS (adjusted hazard ratio [aHR] 0.42; 95% confidence interval [CI] 0.23–0.80; p = 0.008). No significant relationships between IS or AD status and either death or the composite of MV and death were identified, although a trend towards higher mortality was identified in the IS-NAD cohort (aHR vs NIS-NAD 1.71; 95% CI 0.94–3.12; p = 0.081). Patients in this cohort also had higher median serum levels of interleukin-6 compared with IS-AD patients (98.2 vs 21.6 pg/mL; p = 0.0328) and NIS-NAD patients (29.1 pg/mL; p = 0.0057). In conclusion, among patients hospitalized with COVID-19, those receiving immunosuppressive treatment for an AD may have a reduced risk of developing severe ARDS. Keywords COVID-19 . severe acute respiratory syndrome coronavirus 2 . autoimmune diseases . immunosuppression
* Enric Monreal [email protected]
5
Department of Pneumology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
6
Department of Rheumatology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
7
Department of Nephrology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Madrid, Spain
1
Department of Neurology, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, IRYCIS, Crta Colmenar Viejo, km 9,100, 28034 Madrid, Spain
2
Department of Immunology, Hospital U
Data Loading...
