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High levels of immunosuppression are related to unfavourable outcomes in hospitalised patients with rheumatic diseases and COVID-19: first results of ReumaCoV Brasil registry

Authors
  • Marques, Claudia Diniz Lopes1
  • Kakehasi, Adriana Maria2
  • Pinheiro, Marcelo Medeiros3
  • Mota, Licia Maria Henrique4
  • Albuquerque, Cleandro Pires4
  • Silva, Carolina Rocha4
  • Santos, Gabriela Porfirio Jardim4
  • Reis-Neto, Edgard Torres3
  • Matos, Pedro3
  • Devide, Guilherme3
  • Dantas, Andrea1
  • Giorgi, Rina Dalva5
  • Omura, Felipe6
  • Marinho, Adriana de Oliveira7
  • Valadares, Lilian David Azevedo8
  • Melo, Ana Karla G9
  • Ribeiro, Francinne Machado10
  • Ferreira, Gilda Aparecida2
  • Santos, Flavia Patricia de Sena2
  • Ribeiro, Sandra Lucia Euzebio11
  • And 13 more
  • 1 Universidade Federal de Pernambuco, Recife, Brazil , Recife (Brazil)
  • 2 Universidade Federal de Minas Gerais, Belo Horizonte, Brazil , Belo Horizonte (Brazil)
  • 3 Unifesp EPM, Sao Paulo, Brazil , Sao Paulo (Brazil)
  • 4 Universidade de Brasília, Brasilia, Brazil , Brasilia (Brazil)
  • 5 Iamspe, Sao Paulo, Brazil , Sao Paulo (Brazil)
  • 6 Clinica Omura Diagnostic Medicine, Sao Paulo, Brazil , Sao Paulo (Brazil)
  • 7 Fundação Hospitalar do Acre (Fundhacre), Rio Branco, Brazil , Rio Branco (Brazil)
  • 8 Hospital Getulio Vargas, Recife, Brazil , Recife (Brazil)
  • 9 Universidade Federal da Paraiba, Joao Pessoa, Brazil , Joao Pessoa (Brazil)
  • 10 UERJ, Rio de Janeiro, Brazil , Rio de Janeiro (Brazil)
  • 11 Universidade Federal do Amazonas, Manaus, Brazil , Manaus (Brazil)
  • 12 Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil , Porto Alegre (Brazil)
  • 13 UNICAMP, Campinas, Brazil , Campinas (Brazil)
  • 14 Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil , Juiz de Fora (Brazil)
  • 15 Universidade Federal do Paraná Hospital de Clínicas, Curitiba, Brazil , Curitiba (Brazil)
  • 16 FACISB, Barretos, Brazil , Barretos (Brazil)
  • 17 Pontifícia Universidade Católica de Campinas, Campinas, Brazil , Campinas (Brazil)
  • 18 Fundação Faculdade Regional de Medicina de São José do Rio Preto (Hospital de Base), Ribeirão Preto, Brazil , Ribeirão Preto (Brazil)
  • 19 UNIMED Fortaleza – Ceará, Fortaleza, Brazil , Fortaleza (Brazil)
  • 20 Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil , Rio de Janeiro (Brazil)
Type
Published Article
Journal
RMD Open
Publisher
BMJ
Publication Date
Jan 28, 2021
Volume
7
Issue
1
Identifiers
DOI: 10.1136/rmdopen-2020-001461
PMID: 33510041
PMCID: PMC7844930
Source
PubMed Central
Keywords
License
Green

Abstract

Objectives To evaluate risk factors associated with unfavourable outcomes: emergency care, hospitalisation, admission to intensive care unit (ICU), mechanical ventilation and death in patients with immune-mediated rheumatic disease (IMRD) and COVID-19. Methods Analysis of the first 8 weeks of observational multicentre prospective cohort study (ReumaCoV Brasil register). Patients with IMRD and COVID-19 according to the Ministry of Health criteria were classified as eligible for the study. Results 334 participants were enrolled, a majority of them women, with a median age of 45 years; systemic lupus erythematosus (32.9%) was the most frequent IMRD. Emergency care was required in 160 patients, 33.0% were hospitalised, 15.0% were admitted to the ICU and 10.5% underwent mechanical ventilation; 28 patients (8.4%) died. In the multivariate adjustment model for emergency care, diabetes (prevalence ratio, PR 1.38; 95% CI 1.11 to 1.73; p=0.004), kidney disease (PR 1.36; 95% CI 1.05 to 1.77; p=0.020), oral glucocorticoids (GC) (PR 1.49; 95% CI 1.21 to 1.85; p<0.001) and pulse therapy with methylprednisolone (PR 1.38; 95% CI 1.14 to 1.67; p=0.001) remained significant; for hospitalisation, age >50 years (PR 1.89; 95% CI 1.26 to 2.85; p=0.002), no use of tumour necrosis factor inhibitor (TNFi) (PR 2.51;95% CI 1.16 to 5.45; p=0.004) and methylprednisolone pulse therapy (PR 2.50; 95% CI 1.59 to 3.92; p<0.001); for ICU admission, oral GC (PR 2.24; 95% CI 1.36 to 3.71; p<0.001) and pulse therapy with methylprednisolone (PR 1.65; 95% CI 1.00 to 2.68; p<0.043); the two variables associated with death were pulse therapy with methylprednisolone or cyclophosphamide (PR 2.86; 95% CI 1.59 to 5.14; p<0.018). Conclusions Age >50 years and immunosuppression with GC and cyclophosphamide were associated with unfavourable outcomes of COVID-19. Treatment with TNFi may have been protective, perhaps leading to the COVID-19 inflammatory process.

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