High levels of immunosuppression are related to unfavourable outcomes in hospitalised patients with rheumatic diseases and COVID-19: first results of ReumaCoV Brasil registry.

Autor:	Marques CDL; Clinica Medicine, Universidade Federal de Pernambuco, Recife, Brazil., Kakehasi AM; Musculoskeletal System Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil amkakehasi@gmail.com., Pinheiro MM; Rheumatology, Unifesp EPM, Sao Paulo, Brazil., Mota LMH; Hospital Universitário de Brasilia, Universidade de Brasília, Brasilia, Brazil., Albuquerque CP; Hospital Universitário de Brasilia, Universidade de Brasília, Brasilia, Brazil., Silva CR; Hospital Universitário de Brasilia, Universidade de Brasília, Brasilia, Brazil., Santos GPJ; Hospital Universitário de Brasilia, Universidade de Brasília, Brasilia, Brazil., Reis-Neto ET; Medicina, Unifesp EPM, Sao Paulo, Brazil., Matos P; Rheumatology, Unifesp EPM, Sao Paulo, Brazil., Devide G; Rheumatology, Unifesp EPM, Sao Paulo, Brazil., Dantas A; Hospital das Clinicas, Universidade Federal de Pernambuco, Recife, Brazil., Giorgi RD; Rheumatology, Iamspe, Sao Paulo, Brazil., Marinho AO; Rheumatology, Fundação Hospitalar do Acre (Fundhacre), Rio Branco, Brazil., Valadares LDA; Rheumatology, Hospital Getulio Vargas, Recife, Brazil., Melo AKG; Rheumatology, Universidade Federal da Paraiba, Joao Pessoa, Brazil., Ribeiro FM; Rheumatology, UERJ, Rio de Janeiro, Brazil., Ferreira GA; Musculoskeletal System Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil., Santos FPS; Musculoskeletal System Department, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil., Ribeiro SLE; Rheumatology, Universidade Federal do Amazonas, Manaus, Brazil., Andrade NPB; Rheumatology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil., Yazbek MA; Rheumatology, UNICAMP, Campinas, Brazil., Souza VA; Rheumatology, Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil., Paiva ES; Department of Rheumatology, Universidade Federal do Paraná Hospital de Clínicas, Curitiba, Brazil., Azevedo VF; Department of Rheumatology, Universidade Federal do Paraná Hospital de Clínicas, Curitiba, Brazil., Freitas ABSB; Rheumatology, FACISB, Barretos, Brazil., Provenza JR; Rheumatology, Pontifícia Universidade Católica de Campinas, Campinas, Brazil., Toledo RA; Rheumatology, Fundação Faculdade Regional de Medicina de São José do Rio Preto (Hospital de Base), Ribeirão Preto, Brazil., Fontenelle S; Rheumatology, UNIMED Fortaleza - Ceará, Fortaleza, Brazil., Carneiro S; Rheumatology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil., Xavier R; Rheumatology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil., Pileggi GCS; Pediatric immunology and rheumatology, FACISB, Barretos, Brazil., Reis APMG; Hospital Universitário de Brasilia, Universidade de Brasília, Brasilia, Brazil.
Jazyk:	angličtina
Zdroj:	RMD open [RMD Open] 2021 Jan; Vol. 7 (1).
DOI:	10.1136/rmdopen-2020-001461
Abstrakt:	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. Competing Interests: Competing interests: CDLM reports grants from National Council for Scientific and Technological Development (CNPq) and from Brazilian Society of Rheumatology, personal fees from Janssen, Novartis, Abbvie. AMK reports personal fees from Abbvie, Janssen, Pfizer, Lilly and Roche. MMP reports personal fees from Abbvie, Janssen, UCB, Novartis, Pfizer and Lilly. LMHM reports personal fees from Abbvie, Janssen, Pfizer, Roche, Boehringer Ingelheim, GSK, Libbs and Lilly. CRS reports personal fees from Pfizer, Abbvie and Novartis. AD reports personal fees from Boehringer Ingelheim. RDG reports personal fees from Janssen, Eli Lilly, Roche, Boehringer Ingelheim, Amgen Brasil, Pfizer, Sandoz, Novartis Brasil. LDAV personal fees from Janssen, Novartis and UCB. AKGM reports grants from Brazilian Society of Rheumatology, personal fees from Janssen and UCB. MAY reports personal fees from Novartis, Abbvie, Lilly and, UCB. RAdT reports personal fees from ABBVIE, GSK, JANSSEN, NOVARTIS, LILLY, PFIZER, ROCHE and UCB. RX reports grants and personal fees from Abbvie, Eli-Lilly, Pfizer, Janssen and Roche, personal fees from Novartis, UCB. (© 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.)
Databáze:	MEDLINE
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