Age-Stratified COVID-19 Hospitalization Rates for People With Autoimmune Inflammatory Rheumatic Disease

Rheumatologists are understandably concerned regarding immune suppressed patients amid the coronavirus (COVID-19) pandemic. What are the risk factors for hospitalization? And do drugs which act against inflammation complicate matters?

A new study published in BMJ’s Annals of the Rheumatic Diseases has found that, in a real-world setting, 44% of patients with Autoimmune Inflammatory Rheumatic Disease (AIRD) and COVID-19 required hospital admission.

“These were mainly elderly patients, with more comorbidities and systemic autoimmune conditions,” according to study authors.

The data also show that patients exposed to “disease-modifying agents” do not seem to be at higher risk of hospital admission related to COVID-19. The disease-modifying agents in the study included the controversial hydroxychloroquine as well as tocilizumab.

Out of 123 patients with COVID-19 and AIRD studied, 54 (slightly less than half) needed to be hospitalized.

The admitted patients had a median age of about 70 years, which was more than 15 years older than patients who were not admitted.

Patients who were admitted frequently had more baseline comorbidities and systemic autoimmune conditions.

Interestingly, for therapy, “admitted patients were less frequently exposed to antimalarial and anti-TNF-alpha agents.”

According to authors, the median time from onset of symptoms to hospitalization was 5 days. Nearly 90% of patients needing hospitalization had pneumonia on arrival.

Lab results for admitted patients were characterized by lymphopenia and elevated acute-phase reactants.

“In fact, 75% of the patients had elevated D-dimers (normal, <500) and elevated IL-6 (normal, <7 pg/mL),” authors noted.

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“Treatment during admission varied widely as the disease proved challenging for specialists, who prescribed various combinations of drugs based on little published evidence,” authors explained.

The patients who eventually died during the study had a median age of greater than 80 years. The finding is consistent with general population data in which over 95% of deaths occurred in persons >60 years and great than 50% of all deaths were in people aged ≥80 years.

“The key strength of our study is that it was performed in real-life conditions during then pandemic peak, with access to complete sociodemographic and clinical data from our rheumatology electronic clinical history,” authors continue.

The investigators did clarify that, despite these strengths, the information provided by the study is preliminary and ought to be considered alongside other real-life studies. Still, the findings may prove useful in the management or risk assessment of patients with AIRD and COVID-19.