Abstract
Objective: Autoimmune systemic diseases (ASD) represent a predisposing condition to COVID-19. Our prospective, observational multicenter telephone survey study aimed to investigate the prevalence, prognostic factors, and outcomes of COVID-19 in Italian ASD patients.
Methods: The study included 3,918 ASD pts (815 M, 3103 F; mean age 59±12SD years) consecutively recruited between March 2020 and May 2021 at the 36 referral centers of COVID-19 and ASD Italian Study Group. The possible development of COVID-19 was recorded by means of a telephone survey using a standardized symptom assessment questionnaire.
Results: ASD patients showed a significantly higher prevalence of COVID-19 (8.37% vs. 6.49%; p<0.0001) but a death rate statistically comparable to the Italian general population (3.65% vs. 2.95%). Among the 328 ASD patients developing COVID-19, 17% needed hospitalization, while mild-moderate manifestations were observed in 83% of cases. Moreover, 12/57 hospitalized patients died due to severe interstitial pneumonia and/or cardiovascular events; systemic sclerosis (SSc) patients showed a significantly higher COVID-19-related death rate compared to the general population (6.29% vs. 2.95%; p=0.018). Major adverse prognostic factors to develop COVID-19 were: older age, male gender, SSc, pre-existing ASD-related interstitial lung involvement, and long-term steroid treatment. Of note, patients treated with conventional synthetic disease-modifying antirheumatic drugs (csDMARDs) showed a significantly lower prevalence of COVID-19 compared to those without (3.58% vs. 46.99%; p=0.000), as well as the SSc patients treated with low dose aspirin (with 5.57% vs. without 27.84%; p=0.000).
Conclusion: During the first three pandemic waves, ASD patients showed a death rate comparable to the general population despite the significantly higher prevalence of COVID-19. A significantly increased COVID-19- related mortality was recorded in only SSc patients’ subgroup, possibly favored by preexisting lung fibrosis. Moreover, ongoing long-term treatment with csDMARDs in ASD might usefully contribute to the generally positive outcomes of this frail patients’ population.
Keywords: COVID-19, autoimmune systemic diseases, systemic sclerosis, vasculitis, interstitial lung involvement, steroids, DMARD, aspirin.
[http://dx.doi.org/10.1016/S2665-9913(21)00247-2] [PMID: 34485930]
[http://dx.doi.org/10.1136/annrheumdis-2020-217717] [PMID: 32398281]
[http://dx.doi.org/10.1007/s10067-020-05334-7] [PMID: 32852623]
[http://dx.doi.org/10.1136/annrheumdis-2020-217424] [PMID: 32241793]
[http://dx.doi.org/10.1136/annrheumdis-2020-217615] [PMID: 32321723]
[http://dx.doi.org/10.1136/annrheumdis-2020-217681] [PMID: 32414804]
[http://dx.doi.org/10.1056/NEJMc2009567] [PMID: 32348641]
[http://dx.doi.org/10.1542/hpeds.2020-0123] [PMID: 32265235]
[http://dx.doi.org/10.1016/S0140-6736(20)31103-X] [PMID: 32410760]
[http://dx.doi.org/10.7861/clinmed.2019-coron] [PMID: 32139372]
[http://dx.doi.org/10.1016/S2665-9913(21)00243-5] [PMID: 34316725]
[http://dx.doi.org/10.1038/s41467-021-24832-z] [PMID: 34315899]
[http://dx.doi.org/10.1002/art.41301] [PMID: 32349183]
[http://dx.doi.org/10.1016/S2665-9913(21)00007-2] [PMID: 33521657]
[http://dx.doi.org/10.2174/1381612827666210903103935] [PMID: 34477509]
[http://dx.doi.org/10.1016/S2665-9913(21)00151-X] [PMID: 34179832]
[http://dx.doi.org/10.1038/s41586-020-2521-4] [PMID: 32640463]
[http://dx.doi.org/10.1136/annrheumdis-2020-217984] [PMID: 32769150]
[http://dx.doi.org/10.1136/annrheumdis-2020-217871] [PMID: 32471903]
[http://dx.doi.org/10.1136/rmdopen-2020-001461] [PMID: 33510041]
[http://dx.doi.org/10.1016/S2665-9913(21)00059-X] [PMID: 33786454]
[http://dx.doi.org/10.3390/life11090979] [PMID: 34575128]
[http://dx.doi.org/10.1016/j.jaut.2020.102442] [PMID: 32253068]
[http://dx.doi.org/10.3390/jcm10040783] [PMID: 33669218]
[http://dx.doi.org/10.2147/JIR.S322831] [PMID: 34321903]
[http://dx.doi.org/10.1136/annrheumdis-2021-220647] [PMID: 34127481]
[http://dx.doi.org/10.1016/j.jaut.2021.102744] [PMID: 34781162]