Risk factors and outcomes of autoimmune/inflammatory diseases during covid-19 infection: A comparative study

ABSTRACT

Objectives: To determine the risk factors, impact and outcomes of COVID-19 in autoimmune / inflammatory diseases (AID). Methods: Case (patients with AID) and controls (patients without AID) study. Both groups with SARS-CoV-2 by PCR. Clinical, biochemical, treatment and outcome characteristics were determined. Spearman correlation, X2 and multivariate analysis were performed. Results: AID, 90 (49.49 ± 14.2 years) vs controls, 90 (52.58 ± 13.5 years). AID systemic lupus erythematosus (SLE) (n = 20, 22.2%), systemic sclerosis (n = 16, 17.8%), rheumatoid arthritis (n = 14, 15.6%), primary antiphospholipid syndrome (n = 12, 13.3%), autoimmune encephalitis (AIE) (n = 6, 6.7%), granulomatosis with polyangiitis (GPA) (n = 5, 5.6%) and multiple sclerosis (n = 3, 3.3%) were the most frequent. Treatment anticoagulant 73.3%, glucocorticoid 53.3% and antimalarials 35.6%. The AID patients had less invasive mechanical ventilation (IMV) (p = 0.004), lower death (p = 0.006) and lower discharge with O2 (p = 0.001) (Table 1). AID creatinine correlate positively with days with IMV (rho = 539, p 0.024). In AID, AIE and O2 saturation ≤ 88% provided risk for IMV (OR 88.42, CI 3.9-196.7, p = 0.005 and OR 10.05, CI 1.2-83.7, p = 0.033, respectively) while antimalarials were protective for IMV (OR 0.08, CI 0.0-0.9, p = 0.042). Regarding death in AID, oxygen saturation ≤ 88% and CO-RADS ≥4 were risk factors (OR 5.12, CI 1.5-16.4, p = 0.006 and OR 8.84, CI 1.2-64.0, p = 0.031, respectively) and anticoagulant use was protective (OR 0.26, CI 0.0-0.8, p = 0.019) (Table 2). Conclusion: Our study suggests that patients with AID have a better outcome than the control group. Multiple factors are involved in this outcome such as surveillance, chronic use of antimalarials, steroid and anticoagulation.We propose that at the molecular level high levels of IFN may be a protective factor for complications from SARS-CoV-2 infection. New longitudinal and molecular level studies in patients with mild/moderate, severe and critical COVID-19 will be necessary to know the impact of COVID-19 in AID.