Risk factors for severe outcomes in patients with systemic vasculitis & COVID‐19: a bi‐national registry‐based cohort study

Rutherford, Matthew A; Scott, Jennifer; Karabayas, Maira; Antonelou, Marilina; Gopaluni, Seerapani; Gray, David; Barrett, Joe; Brix, Silke R; Dhaun, Neeraj; McAdoo, Stephen P; Smith, Rona M; Geddes, Colin; Jayne, David; Luqmani, Raashid; Salama, Alan D; Little, Mark; Basu, Neil

OBJECTIVE: COVID‐19 is a novel infectious disease with a broad spectrum of clinical severity. Patients with systemic vasculitis have an increased risk of serious infections and so may be at risk of severe outcomes following COVID‐19. It is important to establish the risk factors for severe COVID‐19 outcomes in these patients, including the impact of immunosuppressive therapies. METHODS: A multi‐centre cohort was developed through the participation of centres affiliated with national UK and Ireland vasculitis registries. Clinical characteristics and outcomes were described. Logistic regression was used to evaluate associations between potential risk factors and severe COVID‐19 outcome, defined as a requirement for advanced oxygen therapy, invasive ventilation, or death. RESULTS: Sixty‐five cases of patients with systemic vasculitis who developed COVID‐19 were reported (median age 70 years, 49% female) of whom 25 (38%) experienced a severe outcome. Most cases (55/65, 85%) had ANCA‐associated vasculitis (AAV). Almost all patients required hospitalization (59/65, 91%), 7 patients (11%) were admitted to intensive care and 18 patients (28%) died. Background glucocorticoid therapy was associated with severe outcome (adjusted odds ratio [aOR] 3.7 (1.1‐14.9, p=0.047)) as was comorbid respiratory disease (aOR 7.5 (1.9‐38.2, p=0.006)). Vasculitis disease activity and non‐glucocorticoid immunosuppression were not associated with severe outcome. CONCLUSION: In patients with systemic vasculitis, glucocorticoid use at presentation and comorbid respiratory disease were associated with severe outcomes in COVID‐19. These data can inform clinical decision making relating to risk of severe COVID‐19 in this vulnerable patient group.