PATIENTS with SYSTEMIC LUPUS ERYTHEMATOSUS HAVE AN INCREASED RISK of MORTALITY, MECHANICAL VENTILATION, and HOSPITALIZATION from COVID-19

ABSTRACT

Background: Patients with systemic lupus erythematosus (SLE) may have an increased risk of mortality from COVID-19 due to underlying immuno-suppression, comorbidities, and abnormalities in the innate immune system. Studies have shown that autoimmune diseases and some immunosuppres-sive agents are risk factors for hospitalization, ventilation, and mortality from COVID-19. Objectives: To compare the outcomes of patients with or without SLE who were diagnosed with COVID-19 and to identify the factors associated with 30-day hos-pitalization, mechanical ventilation, and mortality. We hypothesized that patients with SLE had a higher risk of adverse outcomes. Methods: This retrospective cohort study used the deidentifed Optum COVID-19 electronic health record dataset to identify adult patients with COVID-19 diagnosis from 1/1/2020-12/31/2020. The SLE cohort was defned as patients who had two or more international classifcation of diseases (ICD) 9 or 10 diagnosis codes of 710.0 or M32.xx but not M32.0 within one year before COVID-19 diagnosis and were on either antimalarial or immunosuppressive therapy. The general cohort excluded patients with SLE. We matched SLE cases with controls at a ratio of 110 by age, sex, race and ethnicity, and month of COVID-19 diagnosis via a propensity score matching with exact matching for the latter three variables. Outcomes included 30-day mortality, hospitaliza-tion, and mechanical ventilation after COVID-19 diagnosis. We performed multivariable logistic regression models to estimate the odds of 30-day mortality, hospitalization, and mechanical ventilation after adjusting for age, sex, race and ethnicity, COVID-19 diagnosis quarter, insurance, region, severe obesity, smoking status, and comorbidities. Results: We included 687 SLE cases matched with 6,870 controls. After matching, the 30-day mortality for SLE and control was 3.6% and 1.8% (p <0.001), the 30-day mechanical ventilation was 6.0% and 2.5% (p <0.001), and 30-day hospitalization was 31.0% and 17.7% (p <0.001). After multivariable adjustment (Table 1) for age, sex, race, COVID-19 diagnosis quarter, insurance, region, severe obesity, and smoking status, patients with SLE had higher odds of death (Odds Ratio (OR)=2.09;95% CI 1.31-3.32), mechanical ventilation (OR=2.43;95% CI 1.67-3.54) and hospitalization (OR=2.06;95% CI 1.71-2.49). After additionally adjusting for comorbidities, the OR decreased to 1.39 (95%CI 0.79-2.44), 1.81 (95%CI 1.16-2.82), and 1.32 (95%CI 1.05-1.65) for mortality, mechanical ventilation, and hospitalization respectively. Older age, male sex, Hispanic ethnicity or Black race, severe obesity, and smoking had increased risk of adverse outcomes. Conclusion: Patients with SLE have an increased risks of mortality, mechanical ventilation, and hospitalization within 30 days of COVID-19 diagnosis. The risks decreased after adjustment for comorbidities but remained statistically signifcant for mechanical ventilation and hospitalization.