학술논문

Factors associated with COVID-19-related death in people with rheumatic diseases: results from the COVID-19 Global Rheumatology Alliance physician-reported registry
Document Type
article
Author
Strangfeld, AnjaSchäfer, MartinGianfrancesco, Milena ALawson-Tovey, SaskiaLiew, Jean WLjung, LottaMateus, Elsa FRichez, ChristopheSantos, Maria JSchmajuk, GabrielaScirè, Carlo ASirotich, EmilySparks, Jeffrey ASufka, PaulThomas, ThierryTrupin, LauraWallace, Zachary SAl-Adely, SarahBachiller-Corral, JavierBhana, SulemanCacoub, PatriceCarmona, LoretoCostello, RuthCostello, WendyGossec, LaureGrainger, RebeccaHachulla, EricHasseli, RebeccaHausmann, Jonathan SHyrich, Kimme LIzadi, ZaraJacobsohn, LindsayKatz, PatriciaKearsley-Fleet, LianneRobinson, Philip CYazdany, JinoosMachado, Pedro MDahou, BrahimPinheiro, MarceloRibeiro, Francinne MChassin-Trubert, Anne-MarieIbáñez, SebastiánDong, LingliCajas, LuiHamoud, HeshamAvouac, JérômeBelin, VéroniqueBorie, RaphaëlChazerain, PascalChevalier, XavierClaudepierre, PascalClavel, GaëlleColette-Cedoz, Marie-EveCombe, BernardConstant, ElodieCostedoat-Chalumeau, NathalieDesmurs, MarieDevauchelle-Pensec, ValérieDevaux, MathildeDhote, RobinDieudonné, YannickDomont, FannyDuret, Pierre-MarieEbbo, MikaëlEbstein, EstherMahou, Soumaya ElFautrel, BrunoFelten, RenaudFlipo, René-MarcFoltz, ViolaineFroissart, AntoineGalland, JorisGaud-Listrat, VéroniqueGeorgin-Lavialle, SophieGiraud-Morelet, AudeQuitrec, Jeanine S Giraudet-LeGoupille, PhilippeGovindaraju-Audouard, SophieGrados, FranckGuillaume-Czitrom, SéverineHermet, MarionHittinger-Roux, AmbreHudry, ChristopheKone-Paut, IsabelleLa Batide Alanore, SylvainLafforgue, PierreLahalle, SophieLambrecht, IsabelleLanglois, VincentLarbre, Jean-PaulLedoult, EmmanuelLeroux, ChristopheLiote, FrédéricMaria, Alexandre TJMarotte, HubertMekinian, ArsèneMelki, IsabelleMesser, LaurentMichel, CatherineMorel, Gauthier
Source
Annals of the Rheumatic Diseases. 80(7)
Subject
Biomedical and Clinical Sciences
Clinical Sciences
Infectious Diseases
Autoimmune Disease
Arthritis
Coronaviruses
Emerging Infectious Diseases
Cardiovascular
Inflammatory and immune system
Good Health and Well Being
Aged
Antirheumatic Agents
COVID-19
Comorbidity
Female
Global Health
Glucocorticoids
Humans
Male
Middle Aged
Odds Ratio
Registries
Rheumatic Diseases
Rheumatology
SARS-CoV-2
antirheumatic agents
autoimmune diseases
epidemiology
glucocorticoids
outcome assessment
health care
COVID-19 Global Rheumatology Alliance
Immunology
Public Health and Health Services
Arthritis & Rheumatology
Clinical sciences
Language
Abstract
ObjectivesTo determine factors associated with COVID-19-related death in people with rheumatic diseases.MethodsPhysician-reported registry of adults with rheumatic disease and confirmed or presumptive COVID-19 (from 24 March to 1 July 2020). The primary outcome was COVID-19-related death. Age, sex, smoking status, comorbidities, rheumatic disease diagnosis, disease activity and medications were included as covariates in multivariable logistic regression models. Analyses were further stratified according to rheumatic disease category.ResultsOf 3729 patients (mean age 57 years, 68% female), 390 (10.5%) died. Independent factors associated with COVID-19-related death were age (66-75 years: OR 3.00, 95% CI 2.13 to 4.22; >75 years: 6.18, 4.47 to 8.53; both vs ≤65 years), male sex (1.46, 1.11 to 1.91), hypertension combined with cardiovascular disease (1.89, 1.31 to 2.73), chronic lung disease (1.68, 1.26 to 2.25) and prednisolone-equivalent dosage >10 mg/day (1.69, 1.18 to 2.41; vs no glucocorticoid intake). Moderate/high disease activity (vs remission/low disease activity) was associated with higher odds of death (1.87, 1.27 to 2.77). Rituximab (4.04, 2.32 to 7.03), sulfasalazine (3.60, 1.66 to 7.78), immunosuppressants (azathioprine, cyclophosphamide, ciclosporin, mycophenolate or tacrolimus: 2.22, 1.43 to 3.46) and not receiving any disease-modifying anti-rheumatic drug (DMARD) (2.11, 1.48 to 3.01) were associated with higher odds of death, compared with methotrexate monotherapy. Other synthetic/biological DMARDs were not associated with COVID-19-related death.ConclusionAmong people with rheumatic disease, COVID-19-related death was associated with known general factors (older age, male sex and specific comorbidities) and disease-specific factors (disease activity and specific medications). The association with moderate/high disease activity highlights the importance of adequate disease control with DMARDs, preferably without increasing glucocorticoid dosages. Caution may be required with rituximab, sulfasalazine and some immunosuppressants.