RESUMEN
BackgroundD-dimer and fibrinogen elevation has been observed in severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection which is associated with higher incidence of venous thromboembolism (VTE) and higher mortality rates. [1-3]. Autoimmune Rheumatic Diseases (ARDs) are associated with higher rates of VTE compared to general population [4]. Whether patients with ARDs infected with SARS-CoV2 have similar D-dimer and fibrinogen trends compared to patients without ARDs is unknown.ObjectivesCompare D-dimer and fibrinogen levels in patients with ARDs infected with SARS-CoV2 to patients without ARDs.MethodsPatients with ARDs infected with SARS-CoV2 were identified retrospectively from the electronic medical records (EMR) of Hamad Medical Corporation and matched (age and sex) to controls (1:3). D-dimer and fibrinogen levels were extracted electronically from EMR and stratified into six-time intervals defined in table 1. Day 0 was defined as the date of positive nasopharyngeal polymerase chain reaction swab test. 2 Independent Samples test (Mann-Whitney U) was used to compare the median (25th - 75th interquartile range [IQR]) level of D-dimer and fibrinogen between both study groups at the defined intervals.ResultsThe study included 203 cases and 551 controls with a mean (SD) age of 45.3 (11.7) and 44 (12.5) years, females were (122 [60.1%] vs. 297 [53.9%], p = 0.129), respectively.Distribution of ARDs was rheumatoid arthritis 86 (42.4%), spondyloarthropathy 33 (16.1%) and systemic lupus erythematosus 31 (15.7%) cases. 67% were on conventional synthetic disease modifying anti-rheumatic drugs (Cs-DMARDs), 15.8% on biological DMARDs and 4.9% on rituximab. About 83% of the ARDs group were in remission or low disease activity and 13% were in moderate or high disease activity.The median (25th - 75th IQR) level of D-dimer and fibrinogen were comparable between study groups in all defined intervals with insignificant p values except at interval 4, fibrinogen was significantly higher in the cases, p 0.006. Table 1ConclusionThere was no significant difference in the trend of D-dimer and fibrinogen levels during SARS-CoV2 infection between patients with ARDs and those without ARDs. Additional studies are needed to quantify the actual risk of VTE in patients with ARDs during SARS-CoV2 in correlation with serum markers of VTE.References[1]Eljilany I, Elzouki AN. D-Dimer, Fibrinogen, and IL-6 in COVID-19 Patients with Suspected Venous Thromboembolism: A Narrative Review. Vasc Health Risk Manag. 2020;16:455-62.[2]Li JY, Wang HF, Yin P, Li D, Wang DL, Peng P, et al. Clinical characteristics and risk factors for symptomatic venous thromboembolism in hospitalized COVID-19 patients: A multicenter retrospective study. J Thromb Haemost. 2021;19(4):1038-48.[3]Zhan H, Chen H, Liu C, Cheng L, Yan S, Li H, et al. Diagnostic Value of D-Dimer in COVID-19: A Meta-Analysis and Meta-Regression. Clin Appl Thromb Hemost. 2021;27:10760296211010976.[4]Lee JJ, Pope JE. A meta-analysis of the risk of venous thromboembolism in inflammatory rheumatic diseases. Arthritis Res Ther. 2014;16(5):435.Table 1.Differences in D-dimer and fibrinogen during SARS-CoV2 infection between patients with ARDs and those without at the defined intervals.Case N = 203Control N = 551P valueMedian (25th - 75th IQR), D-dimer (mg/L)(0 to < 3 days)0.56 (0.34 – 1.31)0.86 (0.54 – 1.41)0.096(≤ 3 to < 6 days)0.67 (0.35 – 2.58)1.11 (0.44 – 1.11)0.340(≤ 6 to < 9 days)0.81 (0.33 – 5.12)1.12 (0.56 – 3.28)0.299(≤ 9 to 12 days)0.94 (0.72 – 5.44)5.20 (1.0 – 15.05)0.058(≤ 12 to < 15 days)2.88 (0.72 – 5.53)4.96 (0.57 – 9.98)0.681(≤ 15 to 18 days)1.81 (0.89 – 2.55)5.56 (2.60 – 15.1)0.086Median (25th – 75th IQR), fibrinogen (mg/L)(0 to < 3 days)6.53 (2.0 - 6.53)5.65 (3.75 – 7.17)1.000(≤ 3 to < 6 days)6.25 (3.72 – 8.3)4.6 (4.1 – 5.6)0.385(≤ 6 to < 9 days)3.53 (3.29 – 4.62)3.4 (3.2 – 3.92)0.328(≤ 9 to 12 days)4.3 (2.82 – 4.78)2.2 (1.65 – 3.05)0.006(≤ 12 to < 15 days)4.4 (2.37 – 5.13)3.1 (1.7 – 4.45)0.170(≤ 15 to 18 days)3.6 ( – 5.7)3.7 (2.0 – 4.88)0.524Acknowledgements:NIL.Disclosure of InterestsNone Declared.
RESUMEN
Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viral load and its impact on disease outcome in patients with autoimmune rheumatic disease (ARD) are lacking. Also, whether patients with ARD receiving immunomodulators have different viral loads compared to the general population is unknown. Objectives: To compare the viral load of SARS-CoV-2 and its trending between patients without and with ARD. Methods: Retrospectively, patients with ARD infected with SARS-CoV-2 were matched by age and sex at a ratio of 1:2 to patients without ARD and not receiving immunosuppression or immunomodulator drugs. Viral load was determined by the cycle threshold (CT) value measured by a number of platforms: (a) Automated Platforms-the Roche Cobas 6800 system using the Cobas SARS-CoV-2 Test targeting the E and orf1a/b genes (Roche, Switzerland) and the Xpert Xpress SARS-CoV-2 targeting the E and N genes (Cepheid, USA);(b) Manual platforms-EZ1 (QIAGEN, USA), QIAsymphony (QIAGEN, USA), and Bioneer ExiPrepTM 96 Virus DNA/RNA kits Catalogue No K4614 (Bioneer, South Korea) extraction with thermal cycling using TaqPath™ PCR COVID-19 Combo Kit targeting the N, S and orf1a/b genes (Thermo Fisher Scientific, USA) on ABI 7500 thermal cyclers. Independent samples t-test was used to compare the mean CT values of the study groups at baseline and at 5 subsequent intervals (1-5.9, 6-11.9, 12-17.9, 18-23.9 and 24-30 days). Results: Mean age (SD) of 197 cases and 420 controls were 45.2 (11.8) and 44.1 (12.3) years, respectively. Females were predominant in both groups 60% vs. 52%, P=0.053. The most common ARD was rheumatoid arthritis in 82 cases (41.6%), followed by spondyloarthropathy in 33 (16.8%) and systemic lupus ery-thematosus in 31 (15.7%). Of the cases, 67% were on conventional synthetic disease modifying anti-rheumatic drugs (DMARDs), 15.2% on biological DMARDs and 4.6% patients were on rituximab. The mean CT values was signifcantly lower in the ARD group at baseline and persisted till day 24. Conclusion: Compared to patients without ARD, the viral load of SARS-CoV-2 in patients with ARD is signifcantly higher at baseline testing and persists till day 24. This fnding may indicate that patients with ARD are at higher risk of severe SARS-CoV-2 infection and prolonged potential transmission. Clinical outcome correlation is needed.