Risk factors for moderate to severe COVID-19 infection in systemic lupus erythematosus

ABSTRACT

Background: People with systemic lupus erythematosus (SLE) are at greater risk of developing infections, including COVID-19. This study describes the characteristics and outcomes of COVID-19 infection among patients with SLE seen in a tertiary hospital in Manila, Philippines. Method(s) This cross-sectional study included patients with diagnosed SLE seen over 24 months from March 2020 to February 2022, who were confirmed with COVID-19 infection. We collected data from patients' electronic records and clinic charts and analyzed underlying SLE characteristics including disease activity and medications, COVID-19 involvement, vaccination status and outcomes including hospitalization and mortality. Result(s) Of the 507 patients with SLE, 53 patients reported positive for COVID-19. Cough, fever, dyspnea, diarrhea, anosmia, ageusia, and sore throat were the common presenting complaints. Three were asymptomatic, 41 had mild symptoms, 2 had moderate, and 7 had severe COVID-19 infection. Sixteen patients (30%) were hospitalized, and 37 (70%) were confined at home or an isolation facility. More than half of patients were unvaccinated during the time of COVID-19 infection (28, 54%), 3 (6%) were partially vaccinated and 21 (40%) were fully vaccinated. Use of methotrexate, mycophenolate mofetil, prednisone <10 mg/day, and hydroxychloroquine did not affect the risk for moderate to severe COVID-19 infection. Patients in low disease activity or remission tended to have asymptomatic to mild COVID-19 infection. Two (4%) died with severe COVID 19 infection a lupus nephritis patient with end-stage renal disease on hemodialysis and a lupus nephritis patient with concomitant double gynecologic malignancy (vulval and cervical) who underwent 35 cycles of radiotherapy prior to COVID-19 infection. Conclusion(s) This study on SLE patients with COVID-19 infection showed that patients with high disease activity, co-morbidity especially ESRD and the use of high dose glucocorticoid had higher risk for moderate to severe COVID-19 infection and hospitalization. Use of immunosuppressants and prednisone <10 mg/day did not appear to contribute to increased severity of COVID-19 infection, hospitalization and mortality.