Do rheumatic diseases, long-term glucocorticoids, and immunosuppressant treatment, and vaccination impact the COVID-19 severity? Insight from a retrospective cohort study

IF 2 4区医学 Q2 RHEUMATOLOGY International Journal of Rheumatic Diseases Pub Date : 2024-07-09 DOI:10.1111/1756-185X.15251

Yi Ma, Chang Wei, Zixi Yi, Zaiwei Song, Yinchu Cheng, Lin Zeng, Rongsheng Zhao, Rong Mu

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Abstract

Objectives

The impact of rheumatic diseases, long-term medication, and vaccination on COVID-19 severity remain insufficiently understood, hindering effective patient management. This study aims to investigate factors influencing COVID-19 severity in Chinese rheumatic patients and to provide real-world evidence for patient care.

Methods

We conducted a retrospective observational study consisting of two cohorts, followed by a nested case–control analysis. The outpatient cohort included non-severe COVID-19 patients, while the inpatient cohort included consecutive severe COVID-19 inpatients. Additionally, rheumatic patients from both cohorts were included for the nested case–control study. Clinical information was obtained from electronic medical records and surveys.

Results

A total of 749 outpatients and 167 inpatients were enrolled. In the outpatient cohort, rheumatic diseases were identified as a risk factor for the severity of dyspnea (No rheumatic disease: OR = 0.577, 95% CI = 0.396–0.841, p = .004), but not for mortality, length of hospitalization, or hospitalization costs in the inpatient cohort. Long-term glucocorticoids use was identified as an independent risk factor for severity of dyspnea in rheumatic patients (OR = 1.814, 95% CI = 1.235–2.663, p = .002), while vaccination and immunosuppressant treatment showed no association. Vaccination was identified as a protective factor against hospitalization due to COVID-19 in patients with rheumatic diseases (OR = 0.031, 95% CI = 0.007–0.136, p < .001), whereas long-term glucocorticoids and immunosuppressant treatment showed no association.

Conclusions

Rheumatic diseases and long-term glucocorticoids use are significant risk factors for COVID-19 severity in the Chinese population, whereas emphasizing the protective effects of vaccines against COVID-19 severity is crucial. Additionally, the investigation provides preliminary support for the concept that long-term immunosuppressant therapy does not necessarily require additional prescription adjustments.

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风湿病、长期糖皮质激素和免疫抑制剂治疗以及疫苗接种会影响 COVID-19 的严重程度吗？一项回顾性队列研究的启示。

目的：风湿性疾病、长期用药和疫苗接种对 COVID-19 严重程度的影响仍未得到充分了解，从而阻碍了对患者的有效管理。本研究旨在调查影响中国风湿病患者 COVID-19 严重程度的因素，并为患者护理提供实际证据：我们进行了一项回顾性观察研究，包括两个队列，然后进行了嵌套病例对照分析。门诊队列包括非重度 COVID-19 患者，住院队列包括连续重度 COVID-19 住院患者。此外，巢式病例对照研究还包括来自这两个队列的风湿病患者。临床信息来自电子病历和调查：结果：共纳入了 749 名门诊患者和 167 名住院患者。在门诊病人队列中，风湿性疾病被确定为呼吸困难严重程度的危险因素（无风湿性疾病：OR = 0.577，95% CI = 0.396-0.841，p = .004），但在住院病人队列中，风湿性疾病不是死亡率、住院时间或住院费用的危险因素。长期使用糖皮质激素被确定为风湿病患者呼吸困难严重程度的独立危险因素（OR = 1.814，95% CI = 1.235-2.663，p = .002），而接种疫苗和免疫抑制剂治疗则没有相关性。接种疫苗被认为是风湿病患者因 COVID-19 而住院的保护因素（OR = 0.031，95% CI = 0.007-0.136，p 结论：风湿病与长期糖耐量减低有关：在中国人群中，风湿性疾病和长期使用糖皮质激素是导致COVID-19严重程度的重要危险因素，而强调疫苗对COVID-19严重程度的保护作用至关重要。此外，调查还初步支持了长期免疫抑制剂治疗不一定需要额外调整处方的观点。

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来源期刊

International Journal of Rheumatic Diseases RHEUMATOLOGY-

CiteScore

3.70

自引率

4.00%

发文量

362

审稿时长

1 months

期刊介绍： The International Journal of Rheumatic Diseases (formerly APLAR Journal of Rheumatology) is the official journal of the Asia Pacific League of Associations for Rheumatology. The Journal accepts original articles on clinical or experimental research pertinent to the rheumatic diseases, work on connective tissue diseases and other immune and allergic disorders. The acceptance criteria for all papers are the quality and originality of the research and its significance to our readership. Except where otherwise stated, manuscripts are peer reviewed by two anonymous reviewers and the Editor.