COVID-19 in patients with autoimmune diseases: characteristics and outcomes in a multinational network of cohorts across three countries

Tan, Eng Hooi; Sena, Anthony G; Prats-Uribe, Albert; You, Seng Chan; Ahmed, Waheed-Ul-Rahman; Kostka, Kristin; Reich, Christian; Duvall, Scott L; Lynch, Kristine E; Matheny, Michael E; Duarte-Salles, Talita; Bertolin, Sergio Fernandez; Hripcsak, George; Natarajan, Karthik; Falconer, Thomas; Spotnitz, Matthew; Ostropolets, Anna; Blacketer, Clair; Alshammari, Thamir M; Alghoul, Heba; Alser, Osaid; Lane, Jennifer C E; Dawoud, Dalia M; Shah, Karishma; Yang, Yue; Zhang, Lin; Areia, Carlos; Golozar, Asieh; Recalde, Martina; Casajust, Paula; Jonnagaddala, Jitendra; Subbian, Vignesh; Vizcaya, David; Lai, Lana Y H; Nyberg, Fredrik; Morales, Daniel R; Posada, Jose D; Shah, Nigam H; Gong, Mengchun; Vivekanantham, Arani; Abend, Aaron; Minty, Evan P; Suchard, Marc; Rijnbeek, Peter; Ryan, Patrick B; Prieto-Alhambra, Daniel

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.