Frontiers in Immunology (Apr 2021)

COVID-19 Among Patients With Inflammatory Rheumatic Diseases

  • Sinem Nihal Esatoglu,
  • Koray Tascilar,
  • Hakan Babaoğlu,
  • Cemal Bes,
  • Berna Yurttas,
  • Servet Akar,
  • Ozlem Pehlivan,
  • Cansu Akleylek,
  • Duygu Tecer,
  • Emire Seyahi,
  • Tuba Yuce-Inel,
  • Nilufer Alpay-Kanitez,
  • Erdal Bodakci,
  • Emre Tekgoz,
  • Seda Colak,
  • Ertugrul Cagri Bolek,
  • Suleyman Serdar Koca,
  • Umut Kalyoncu,
  • Ozan Cemal Icacan,
  • Serdal Ugurlu,
  • Hande Ece Oz,
  • Vedat Hamuryudan,
  • Gulen Hatemi,
  • the Turkish Society for Rheumatology COVID-19 Registry Investigators,
  • Ayse Cefle,
  • Ali Karakas,
  • Derya Kaskari,
  • Samet Karahan,
  • Dilek Tezcan,
  • Abdurrahman Tufan,
  • Ayse Ayan,
  • Levent Kılıc,
  • Salim Donmez,
  • Mustafa Erdogan,
  • Veli Yazisiz,
  • Edip Gokalp Gok,
  • Ahmet Eftal Yucel,
  • Elif Dincses Nas,
  • Gezmiş Kimyon,
  • Gunay Sahin Dalgic,
  • Hakan Erdem,
  • Kerem Yigit Abacar,
  • Ridvan Mercan,
  • Omer Karadag,
  • Onay Gercik,
  • Suleyman Ozbek,
  • Sebnem Gider,
  • Semih Gulle,
  • Sibel Osken,
  • Sedat Kiraz,
  • Timucin Kasifoglu,
  • Fatma Alibaz-Oner,
  • Izzet Fresko,
  • Ali Akdogan,
  • Neslihan Yilmaz

DOI
https://doi.org/10.3389/fimmu.2021.651715
Journal volume & issue
Vol. 12

Abstract

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BackgroundThe course of novel coronavirus disease 2019 (COVID-19) has been of special concern in patients with inflammatory rheumatic diseases (IRDs) due to the immune dysregulation that may be associated with these diseases and the medications used for IRDs, that may affect innate immune responses.ObjectiveIn this cohort study, we aimed to report the disease characteristics and variables associated with COVID-19 outcome among Turkish patients with IRDs.MethodsBetween April and June, 2020, 167 adult IRD patients with COVID-19 were registered from 31 centers in 14 cities in Turkey. Disease outcome was classified in 4 categories; (i) outpatient management, (ii) hospitalization without oxygen requirement, (iii) hospitalization with oxygen requirement, and (iv) intensive care unit (ICU) admission or death. Multivariable ordinal logistic regression analysis was conducted to determine variables associated with a worse outcome.Results165 patients (mean age: 50 ± 15.6 years, 58.2% female) were included. Twenty-four patients (14.5%) recovered under outpatient management, 141 (85.5%) were hospitalized, 49 (30%) required inpatient oxygen support, 22 (13%) were treated in the ICU (17 received invasive mechanic ventilation) and 16 (10%) died. Glucocorticoid use (OR: 4.53, 95%CI 1.65-12.76), chronic kidney disease (OR: 12.8, 95%CI 2.25-103.5), pulmonary disease (OR: 2.66, 95%CI 1.08-6.61) and obesity (OR: 3.7, 95%CI 1.01-13.87) were associated with a worse outcome. Biologic disease-modifying antirheumatic drugs (DMARDs) do not seem to affect COVID-19 outcome while conventional synthetic DMARDs may have a protective effect (OR: 0.36, 95%CI 0.17-0.75). Estimates for the associations between IRD diagnoses and outcome were inconclusive.ConclusionsAmong IRD patients with COVID-19, comorbidities and glucocorticoid use were associated with a worse outcome, while biologic DMARDs do not seem to be associated with a worse outcome.

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