Link between RMDs and poor COVID-19 outcomes ‘mediated largely by comorbidities’
medwireNews: Patients with rheumatic and musculoskeletal diseases (RMDs) have a higher risk for some severe COVID-19 outcomes than those without, and this association is mostly explained by the presence of comorbidities, study findings suggest.
As outlined at the ACR Convergence 2020 virtual meeting, Kristin D'Silva (Massachusetts General Hospital, Boston, USA) and colleagues used electronic medical records to analyze data from 716 COVID-19 patients with RMDs, most commonly rheumatoid arthritis (45%) or systemic lupus erythematosus (18%), and the same number of COVID-19 patients without RMDs who were matched based on age, sex, and race/ethnicity.
The most frequently used drug among the RMD patients was prednisone (40%), followed by hydroxychloroquine (20%), methotrexate (14%), and tumor necrosis factor (TNF) inhibitors.
Over the first 4 months of the pandemic, people with RMDs had a significantly higher risk for hospitalization within 3 months of COVID-19 infection than those without, at a risk ratio (RR) of 1.23. RMD patients also had a significantly higher risk for intensive care unit (ICU) admission, mechanical ventilation, and acute kidney injury (AKI) than those without, at RRs of 1.75, 1.77, and 1.83, respectively.
D'Silva and team then evaluated 30-day outcomes reported over the first 6 months of the pandemic, finding that 2379 patients with RMDs and COVID-19 had significantly higher rates of hospitalization (RR=1.14), ICU admission (RR=1.32), AKI (RR=1.81), renal replacement therapy (RR=1.81), and venous thromboembolism (VTE; RR=1.74), but not mechanical ventilation, than 2379 COVID-19 patients without RMDs matched on age, sex, and race/ethnicity.
After further adjustment for comorbidities and healthcare utilization, the presence of RMDs was no longer significantly associated with hospitalization, ICU admission, and renal replacement therapy, suggesting that the associations are “likely mediated largely by comorbidities,” said D'Silva.
However, she stressed that there was a “persistently higher risk for VTE” among RMD patients even after adjustment for comorbidities and healthcare utilization, with a significant RR of 1.60 relative to those without RMDs in the fully adjusted analysis.
Therefore, “rheumatic diseases may contribute to risk of VTE even beyond the mediating effects of comorbidities,” said the presenter.
“Patients with rheumatic disease should be monitored closely for VTE during COVID-19 infection,” she concluded.
medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2020 Springer Healthcare Ltd, part of the Springer Nature Group
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