Clinical features, radiological characteristics, and outcome of coronavirus disease-2019 (COVID-19) infection among hospitalized patients with autoimmune and rheumatic diseases: A multicenter study

Abstract

Background

A general comprehension of coronavirus disease-2019 (COVID-19) characteristics in patients with autoimmune and/or rheumatic diseases (ARDs) is required

Aim of the work

To identify COVID-19 infection characteristics in hospitalized patients with ARDs and identify factors contributing to mortality in this population.

Patients and methods

This study enrolled symptomatic ARD patients with COVID-19 infection and a control group of COVID-19 infected subjects matched in age and gender. Clinical and laboratory data were obtained, and chest computerized tomography images were analyzed for severity using COVID-19 Reporting and Data System (CO-RADS) and CT total severity score (CT-TSS).

Results

The study included 50 ARD patients and 29 controls with COVID-19 infection. The ARD patients mean age was 49.8 ± 16.3 years and demonstrated a significant association with fever (p = 0.004), fatigue (p = 0.007), cough (p < 0.001), higher levels of serum bilirubin (p = 0.003), serum creatinine (p = 0.051) and D-dimer (p = 0.001). ARD patients were more frequently admitted to the intensive care unit (40% vs 10.3%, p = 0.005) and tended to have a higher mortality rate (32% vs 13.8%, p = 0.11). Ground glass opacity was the predominant pattern in ARD patients (74% vs 37.9%), while consolidation was predominant in the control (55.2% vs 20%). The respiratory rate (p = 0.002), oxygen saturation (p = 0.005), ICU admission (<0.001) and pulmonary consolidation (p < 0.001), CO-RADS (p = 0.03) and CT-TSS (p < 0.001) were significant predictors of mortality. CO-RADS predicts at cut off 4.5 (sensitivity 56.3%, specificity 70.6%) and CT-TSS at cut off 7.5 (sensitivity 75%, specificity 82.4%).

Conclusions

In-hospital mortality is high in COVID-19 patients with ARDs and many predictors are determined.