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
Authors: 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 
Published: November 2020

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.

What is already known about this topic

Patients with autoimmune conditions may be at increased risk of COVID-19 infection andcomplications.

There is a paucity of evidence characterising the outcomes of hospitalised COVID-19 patients with prevalent autoimmune conditions.

What this study adds

Most people with autoimmune diseases who required hospitalisation for COVID-19 were women, aged 50 years or older, and had substantial previous comorbidities.

Patients who were hospitalised with COVID-19 and had prevalent autoimmune diseases had higher prevalence of hypertension, chronic kidney disease, heart disease, and Type 2 diabetes as compared to those with prevalent autoimmune diseases who were diagnosed with COVID-19.

A variable proportion of 6% to 25% across data sources died within one month of hospitalisation with COVID-19 and prevalent autoimmune diseases.

For people with autoimmune diseases, COVID-19 hospitalisation was associated with worse outcomes and 30-day mortality compared to admission with influenza in the 2017-2018 season.