Frontiers in Medicine (Mar 2023)

CovAID: Identification of factors associated with severe COVID-19 in patients with inflammatory rheumatism or autoimmune diseases

  • Kevin Chevalier,
  • Michaël Genin,
  • Thomas Petit Jean,
  • Jerôme Avouac,
  • Rene-Marc Flipo,
  • Sophie Georgin-Lavialle,
  • Soumaya El Mahou,
  • Edouard Pertuiset,
  • Thao Pham,
  • Amelie Servettaz,
  • Hubert Marotte,
  • Fanny Domont,
  • Pascal Chazerain,
  • Mathilde Devaux,
  • Arsene Mekinian,
  • Jérémie Sellam,
  • Bruno Fautrel,
  • Diane Rouzaud,
  • Esther Ebstein,
  • Nathalie Costedoat-Chalumeau,
  • Christophe Richez,
  • Eric Hachulla,
  • Xavier Mariette,
  • Raphaèle Seror

DOI
https://doi.org/10.3389/fmed.2023.1152587
Journal volume & issue
Vol. 10

Abstract

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IntroductionAutoimmune/inflammatory rheumatic diseases (AIRDs) patients might be at-risk of severe COVID-19. However, whether this is linked to the disease or to its treatment is difficult to determine. This study aimed to identify factors associated with occurrence of severe COVID-19 in AIRD patients and to evaluate whether having an AIRD was associated with increased risk of severe COVID-19 or death.Materials and methodsTwo databases were analyzed: the EDS (Entrepôt des Données de Santé, Clinical Data Warehouse), including all patients followed in Paris university hospitals and the French multi-center COVID-19 cohort [French rheumatic and musculoskeletal diseases (RMD)]. First, in a combined analysis we compared patients with severe and non-severe COVID-19 to identify factors associated with severity. Then, we performed a propensity matched score case–control study within the EDS database to compare AIRD cases and non-AIRD controls.ResultsAmong 1,213 patients, 195 (16.1%) experienced severe COVID-19. In multivariate analysis, older age, interstitial lung disease (ILD), arterial hypertension, obesity, sarcoidosis, vasculitis, auto-inflammatory diseases, and treatment with corticosteroids or rituximab were associated with increased risk of severe COVID-19. Among 35,741 COVID-19 patients in EDS, 316 having AIRDs were compared to 1,264 Propensity score-matched controls. AIRD patients had a higher risk of severe COVID-19 [aOR = 1.43 (1.08–1.87), p = 0.01] but analysis restricted to rheumatoid arthritis and spondyloarthritis found no increased risk of severe COVID-19 [aOR = 1.11 (0.68–1.81)].ConclusionIn this multicenter study, we confirmed that AIRD patients treated with rituximab or corticosteroids and/or having vasculitis, auto-inflammatory disease, and sarcoidosis had increased risk of severe COVID-19. Also, AIRD patients had, overall, an increased risk of severe COVID-19 compares general population.

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