Cargando…
High levels of immunosuppression are related to unfavourable outcomes in hospitalised patients with rheumatic diseases and COVID-19: first results of ReumaCoV Brasil registry
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 obse...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844930/ https://www.ncbi.nlm.nih.gov/pubmed/33510041 http://dx.doi.org/10.1136/rmdopen-2020-001461 |
_version_ | 1783644454974914560 |
---|---|
author | Marques, Claudia Diniz Lopes Kakehasi, Adriana Maria Pinheiro, Marcelo Medeiros Mota, Licia Maria Henrique Albuquerque, Cleandro Pires Silva, Carolina Rocha Santos, Gabriela Porfirio Jardim Reis-Neto, Edgard Torres Matos, Pedro Devide, Guilherme Dantas, Andrea Giorgi, Rina Dalva Omura, Felipe Marinho, Adriana de Oliveira Valadares, Lilian David Azevedo Melo, Ana Karla G Ribeiro, Francinne Machado Ferreira, Gilda Aparecida Santos, Flavia Patricia de Sena Ribeiro, Sandra Lucia Euzebio Andrade, Nicole Pamplona Bueno Yazbek, Michel Alexandre de Souza, Viviane Angelina Paiva, Eduardo S Azevedo, Valderilio Feijo de Freitas, Ana Beatriz Santos Bacchiega Provenza, José Roberto de Toledo, Ricardo Acayaba Fontenelle, Sheilla Carneiro, Sueli Xavier, Ricardo Pileggi, Gecilmara Cristina Salviato Reis, Ana Paula Monteiro Gomides |
author_facet | Marques, Claudia Diniz Lopes Kakehasi, Adriana Maria Pinheiro, Marcelo Medeiros Mota, Licia Maria Henrique Albuquerque, Cleandro Pires Silva, Carolina Rocha Santos, Gabriela Porfirio Jardim Reis-Neto, Edgard Torres Matos, Pedro Devide, Guilherme Dantas, Andrea Giorgi, Rina Dalva Omura, Felipe Marinho, Adriana de Oliveira Valadares, Lilian David Azevedo Melo, Ana Karla G Ribeiro, Francinne Machado Ferreira, Gilda Aparecida Santos, Flavia Patricia de Sena Ribeiro, Sandra Lucia Euzebio Andrade, Nicole Pamplona Bueno Yazbek, Michel Alexandre de Souza, Viviane Angelina Paiva, Eduardo S Azevedo, Valderilio Feijo de Freitas, Ana Beatriz Santos Bacchiega Provenza, José Roberto de Toledo, Ricardo Acayaba Fontenelle, Sheilla Carneiro, Sueli Xavier, Ricardo Pileggi, Gecilmara Cristina Salviato Reis, Ana Paula Monteiro Gomides |
author_sort | Marques, Claudia Diniz Lopes |
collection | PubMed |
description | 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. |
format | Online Article Text |
id | pubmed-7844930 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-78449302021-01-29 High levels of immunosuppression are related to unfavourable outcomes in hospitalised patients with rheumatic diseases and COVID-19: first results of ReumaCoV Brasil registry Marques, Claudia Diniz Lopes Kakehasi, Adriana Maria Pinheiro, Marcelo Medeiros Mota, Licia Maria Henrique Albuquerque, Cleandro Pires Silva, Carolina Rocha Santos, Gabriela Porfirio Jardim Reis-Neto, Edgard Torres Matos, Pedro Devide, Guilherme Dantas, Andrea Giorgi, Rina Dalva Omura, Felipe Marinho, Adriana de Oliveira Valadares, Lilian David Azevedo Melo, Ana Karla G Ribeiro, Francinne Machado Ferreira, Gilda Aparecida Santos, Flavia Patricia de Sena Ribeiro, Sandra Lucia Euzebio Andrade, Nicole Pamplona Bueno Yazbek, Michel Alexandre de Souza, Viviane Angelina Paiva, Eduardo S Azevedo, Valderilio Feijo de Freitas, Ana Beatriz Santos Bacchiega Provenza, José Roberto de Toledo, Ricardo Acayaba Fontenelle, Sheilla Carneiro, Sueli Xavier, Ricardo Pileggi, Gecilmara Cristina Salviato Reis, Ana Paula Monteiro Gomides RMD Open Infections 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. BMJ Publishing Group 2021-01-28 /pmc/articles/PMC7844930/ /pubmed/33510041 http://dx.doi.org/10.1136/rmdopen-2020-001461 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/ http://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Infections Marques, Claudia Diniz Lopes Kakehasi, Adriana Maria Pinheiro, Marcelo Medeiros Mota, Licia Maria Henrique Albuquerque, Cleandro Pires Silva, Carolina Rocha Santos, Gabriela Porfirio Jardim Reis-Neto, Edgard Torres Matos, Pedro Devide, Guilherme Dantas, Andrea Giorgi, Rina Dalva Omura, Felipe Marinho, Adriana de Oliveira Valadares, Lilian David Azevedo Melo, Ana Karla G Ribeiro, Francinne Machado Ferreira, Gilda Aparecida Santos, Flavia Patricia de Sena Ribeiro, Sandra Lucia Euzebio Andrade, Nicole Pamplona Bueno Yazbek, Michel Alexandre de Souza, Viviane Angelina Paiva, Eduardo S Azevedo, Valderilio Feijo de Freitas, Ana Beatriz Santos Bacchiega Provenza, José Roberto de Toledo, Ricardo Acayaba Fontenelle, Sheilla Carneiro, Sueli Xavier, Ricardo Pileggi, Gecilmara Cristina Salviato Reis, Ana Paula Monteiro Gomides High levels of immunosuppression are related to unfavourable outcomes in hospitalised patients with rheumatic diseases and COVID-19: first results of ReumaCoV Brasil registry |
title | High levels of immunosuppression are related to unfavourable outcomes in hospitalised patients with rheumatic diseases and COVID-19: first results of ReumaCoV Brasil registry |
title_full | High levels of immunosuppression are related to unfavourable outcomes in hospitalised patients with rheumatic diseases and COVID-19: first results of ReumaCoV Brasil registry |
title_fullStr | High levels of immunosuppression are related to unfavourable outcomes in hospitalised patients with rheumatic diseases and COVID-19: first results of ReumaCoV Brasil registry |
title_full_unstemmed | High levels of immunosuppression are related to unfavourable outcomes in hospitalised patients with rheumatic diseases and COVID-19: first results of ReumaCoV Brasil registry |
title_short | High levels of immunosuppression are related to unfavourable outcomes in hospitalised patients with rheumatic diseases and COVID-19: first results of ReumaCoV Brasil registry |
title_sort | high levels of immunosuppression are related to unfavourable outcomes in hospitalised patients with rheumatic diseases and covid-19: first results of reumacov brasil registry |
topic | Infections |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7844930/ https://www.ncbi.nlm.nih.gov/pubmed/33510041 http://dx.doi.org/10.1136/rmdopen-2020-001461 |
work_keys_str_mv | AT marquesclaudiadinizlopes highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT kakehasiadrianamaria highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT pinheiromarcelomedeiros highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT motaliciamariahenrique highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT albuquerquecleandropires highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT silvacarolinarocha highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT santosgabrielaporfiriojardim highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT reisnetoedgardtorres highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT matospedro highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT devideguilherme highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT dantasandrea highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT giorgirinadalva highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT omurafelipe highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT marinhoadrianadeoliveira highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT valadaresliliandavidazevedo highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT meloanakarlag highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT ribeirofrancinnemachado highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT ferreiragildaaparecida highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT santosflaviapatriciadesena highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT ribeirosandraluciaeuzebio highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT andradenicolepamplonabueno highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT yazbekmichelalexandre highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT desouzavivianeangelina highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT paivaeduardos highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT azevedovalderiliofeijo highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT defreitasanabeatrizsantosbacchiega highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT provenzajoseroberto highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT detoledoricardoacayaba highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT fontenellesheilla highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT carneirosueli highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT xavierricardo highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT pileggigecilmaracristinasalviato highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry AT reisanapaulamonteirogomides highlevelsofimmunosuppressionarerelatedtounfavourableoutcomesinhospitalisedpatientswithrheumaticdiseasesandcovid19firstresultsofreumacovbrasilregistry |