Characteristics, outcomes, and mortality amongst 133,589 patients with prevalent autoimmune diseases diagnosed with, and 48,418 hospitalised for COVID-19: a multinational distributed network cohort analysis

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; Relcade, Martina; Casajust, Paula; Jonnagaddala, Jitendra; Subbian, Vignesh; Vizcaya, David; Lai, Lana YH; 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. DESIGN: Multinational network cohort study SETTING: Electronic health records data from Columbia University Irving Medical Center (CUIMC) (NYC, 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). PARTICIPANTS: 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. MAIN OUTCOME MEASURES: 30-day complications during hospitalisation and death RESULTS: We studied 133,589 patients diagnosed and 48,418 hospitalised with COVID-19 with prevalent autoimmune diseases. The majority of participants were female (60.5% to 65.9%) and aged ≥50 years. The most prevalent autoimmune conditions were psoriasis (3.5 to 32.5%), rheumatoid arthritis (3.9 to 18.9%), and vasculitis (3.3 to 17.6%). Amongst hospitalised patients, Type 1 diabetes was the most common autoimmune condition (4.8% to 7.5%) in US databases, rheumatoid arthritis in HIRA (18.9%), and psoriasis in SIDIAP-H (26.4%). Compared to 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% versus 6.3% to 24.6%). CONCLUSIONS: Patients with autoimmune diseases had high rates of respiratory complications and 30-day mortality following a hospitalization with COVID-19. Compared to influenza, COVID-19 is a more severe disease, leading to more complications and higher mortality. Future studies should investigate predictors of poor outcomes in COVID-19 patients with autoimmune diseases.