Assessment of risk factors for hospitalization of autoimmune and rheumatic disease patients with COVID-19-a single centre observational study

Mn, J.; Dekate, P.; Vontari, S.; Dudam, R.

Background: Most of the patients suffering from autoimmune and rheumatic diseases (AIRD) are on immunomodulator or immunosuppressive therapies and they are susceptible to infections including COVID19. Objectives: To assess the risk factors for hospitalization with COVID-19 in patients with AIRD Methods: A single centre retrospective observational study including patients with AIRD who had contracted COVID-19. Data was collected from all patients attending our clinic from September 2020 to January 2021. Patients with COVID-19 were divided into hospitalized and non-hospitalized groups. Clinical, demographic, ongoing medications, comorbidities and post COVID flare data were collected and analysed using crosstabs-chi square and Mann-Whitney U test. Results: 520 patients with AIRD were screened over the study duration, of which 52 patients who had contracted COVID-19 were included in the study. Amongst them, 19 patients (36.5%) required hospitalization. The common symptoms in the hospitalized patients over non-hospitalized were fever (63.2% vs 57.6), fatigue (42.1% vs 21.2%), headache (36.8% vs 18.2%), abdominal pain (26.3% vs 6.1%), myalgias (36.8 vs 18.2%) and dyspnea (31.6% vs 18.2%). The most common rheumatic conditions seen in both the groups were RA (42.1% vs 30.3%), SPA (26.3% vs 36.4%), and SLE with other CTD's (15.8% vs 24.2%). 6 patients (11.5%) required ICU stay, 3 patients (5.7%) were ventilated, and 2 (3.8%) patients died. Patients requiring hospitalization were aged ≥50 years (p=0.018), had DM type II (p=0.003), HTN (p=0.035), multimorbidity (p=0.021), and a higher CORAD score (p<0.001). Usage of CsDMARDS, bDMARDS, TsDMARDS, corticosteroids did not show a significant difference between both the groups. Patients with ≥2 years of disease duration required hospitalization in comparison to <2 years of duration but this was not statistically significant. 84.2% of hospitalized and 69.7% of non-hospitalized patients stopped anti-rheumatic treatment and disease flare was seen in 47.4% and 39.4% patients respectively. Conclusion: The rheumatic disease and their medications did not increase the risk of COVID-19 hospitalization in this study. However, higher age, DM II, HTN, and high CORAD score were found to be associated with hospitalization in AIRD patients. The findings of this study are limited by a small sample size.