Mechanical Ventilation More Likely in Patients With Rheumatic Disease & COVID-19
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Patients with vs without rheumatic disease and coronavirus disease 2019 (COVID-19) infection were more likely to require intensive care admission and mechanical ventilation, according to study results published in the Annals of the Rheumatic Disease.
Researchers conducted a comparative cohort study of adult patients seen at the Partners HealthCare System, Boston area, Massachusetts, who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by a polymerase chain reaction clinical assay between January 30, 2020 and April 8, 2020. Rheumatic diseases were identified with consultation from a rheumatologist and assessment of patients’ electronic health records, which included data on demographics, rheumatic disease characteristics, comorbidities, COVID-19 symptoms, pharmacologic treatment, and clinical outcomes. The main outcomes of the study were hospitalization, intensive care admission, mechanical ventilation, and mortality.
Results showed that 2154 patients had a positive test result for SARS-CoV-2, among whom 52 had rheumatic disease (2.2%; mean age, 63 years; 69% women), which included rheumatoid arthritis, systemic lupus erythematosus, polymyalgia rheumatic, spondyloarthritis, myositis, vasculitis, and sarcoidosis. Patients with rheumatic disease and COVID-19 were age- and sex-matched a 1:2 ratio with 104 patients with nonrheumatic disease.
Results indicated that COVID-19 symptoms and laboratory findings were similar between the 2 groups; COVID-19 symptoms included cough, fever, shortness of breath, and myalgia. A majority of patients with rheumatic disease (75%) were receiving immunosuppressive therapy.
Researchers noted that a similar percentage of patients with and without rheumatic disease were hospitalized because of COVID-19 (44% vs 40%; OR, 1.26 (95% CI, 0.64-2.48; P =.50). They also observed that among hospitalized patients with and without rheumatic disease, there were a similar percentage of patients in the 2 groups requiring supplemental oxygen (P =.55); however, there were significantly more patients with rheumatic disease who required intensive care admission and mechanical ventilation (48% vs 18%; OR, 3.11 [95% CI, 1.07-9.05]; P =.01). When adjusting for age, hypertension, coronary artery disease, and lung disease, odds of mechanical ventilation remained higher in patients with rheumatic disease (OR, 2.92; 95% CI, 1.002-8.490 P =.049) vs those without rheumatic disease. Researchers noted that 13% vs 4% of patients with and without rheumatic disease, respectively, remained hospitalized despite having a similar length of stay (P =.93). Mortality was similar between the 2 groups (P =.69)
“Our findings are important benchmarks in the care of patients with rheumatic disease as the COVID-19 pandemic continues to unfold and highlight the need for close monitoring when patients with rheumatic disease are diagnosed with COVID-19,” the researchers concluded.