COVID-19 in patients with autoimmune diseases: characteristics and outcomes in a multinational network of cohorts across three countries.
Tan EH., Sena AG., Prats-Uribe A., You SC., Ahmed W-U-R., Kostka K., Reich C., Duvall SL., Lynch KE., Matheny ME., Duarte-Salles T., Bertolin SF., Hripcsak G., Natarajan K., Falconer T., Spotnitz M., Ostropolets A., Blacketer C., Alshammari TM., Alghoul H., Alser O., Lane JCE., Dawoud DM., Shah K., Yang Y., Zhang L., Areia C., Golozar A., Recalde M., Casajust P., Jonnagaddala J., Subbian V., Vizcaya D., Lai LYH., Nyberg F., Morales DR., Posada JD., Shah NH., Gong M., Vivekanantham A., Abend A., Minty EP., Suchard M., Rijnbeek P., Ryan PB., Prieto-Alhambra D.
OBJECTIVE: Patients with autoimmune diseases were advised to shield to avoid COVID-19, but information on their prognosis is lacking. We characterised 30-day outcomes and mortality after hospitalisation with COVID-19 among patients with prevalent autoimmune diseases, and compared outcomes after hospital admissions among similar patients with seasonal influenza. METHODS: A multinational network cohort study was conducted using electronic health records data from Columbia University Irving Medical Center (CUIMC) (United States [US]), Optum [US], Department of Veterans Affairs (VA) (US), Information System for Research in Primary Care-Hospitalisation Linked Data (SIDIAP-H) (Spain), and claims data from IQVIA Open Claims (US) and Health Insurance and Review Assessment (HIRA) (South Korea). All patients with prevalent autoimmune diseases, diagnosed and/or hospitalised between January and June 2020 with COVID-19, and similar patients hospitalised with influenza in 2017-2018 were included. Outcomes were death and complications within 30 days of hospitalisation. RESULTS: We studied 133 589 patients diagnosed and 48 418 hospitalised with COVID-19 with prevalent autoimmune diseases. Most patients were female, aged ≥50 years with previous comorbidities. The prevalence of hypertension (45.5-93.2%), chronic kidney disease (14.0-52.7%) and heart disease (29.0-83.8%) was higher in hospitalised vs diagnosed patients with COVID-19. Compared with 70 660 hospitalised with influenza, those admitted with COVID-19 had more respiratory complications including pneumonia and acute respiratory distress syndrome, and higher 30-day mortality (2.2% to 4.3% vs 6.3% to 24.6%). CONCLUSIONS: Compared with influenza, COVID-19 is a more severe disease, leading to more complications and higher mortality.