POS1174 HYPERINFLAMMATION AND CLINICAL OUTCOMES FOR PATIENTS WITH SYSTEMIC RHEUMATIC DISEASES HOSPITALIZED FOR COVID-19: A COMPARATIVE COHORT STUDY
Authors: T. Hsu, K. D’silva, N. Serling-Boyd, J. Wang, A. Mueller, X. Fu, L. Prisco, L. Martin, K. Vanni, A. Zaccardelli, C. Cook, H. Choi, Y. Zhang, E. Gravallese, Z. Wallace, J. Sparks
Journal: Annals of the Rheumatic Diseases (2021)

Background: COVID-19 can induce a hyperinflammatory state resulting in cytokine storm, which can lead to poor outcomes. Patients with systemic rheumatic diseases may be at increased risk for respiratory failure with COVID-19. Therefore, we investigated the relationship between rheumatic disease, hyperinflammation, and clinical outcomes among hospitalized COVID-19 patients. Objectives: To compare laboratory values, hyperinflammation, and clinical outcomes of hospitalized COVID-19 rheumatic patients and matched comparators. Methods: We performed a comparative cohort study of patients with polymerase chain reaction (PCR)-confirmed COVID-19 requiring hospitalization between 3/1/20-7/7/20 at a large health care system. We compared each systemic rheumatic disease case to up to 5 matched (by age, sex, and date of +SARS-CoV-2 PCR) comparators without systemic rheumatic disease. We extracted laboratory values from their hospitalization to compare peaks/troughs of individual laboratory results by case status and derived the COVID-19-associated hyperinflammation score (cHIS), a composite of 6 laboratory domains (0-6, ≥2 indicating hyperinflammation), as previously developed 1 . We used multivariable logistic regression to estimate ORs for COVID-19 outcomes by hyperinflammation and case status. Results: We identified 57 hospitalized rheumatic disease cases (mean age 67 years, 67% female) and 232 matched comparators hospitalized with PCR-confirmed COVID-19. Among cases, 26 (46%) had rheumatoid arthritis and 14 (25%) had systemic lupus erythematosus. Most cases (34, 60%) had active rheumatic disease. At baseline, 15 (27%) of cases were treated with biologic DMARDs, and 32 (56%) were using glucocorticoids. We analyzed 39,900 total laboratory results (median 85 per patient). Cases had higher peak neutrophil-to-lymphocyte ratio (9.6 vs 7.8, p =0.02), LDH (421 vs 345 U/L, p =0.04), creatinine (1.2 vs 1.0 mg/dL, p =0.01), and BUN (31 vs 23 mg/dL, p =0.03) than comparators but similar peak CRP (149 vs 116 mg/L, p =0.11, Figure 1). Cases had higher peak median cHIS (3 vs 2, p =0.01). Peak cHIS ≥2 had higher odds of intensive care unit (ICU) admission (OR 3.45, 95%CI 1.98-5.99), mechanical ventilation (OR 66.0, 95%CI 9.0-487.8), and mortality (OR 16.4, 95%CI 4.8-56.4) compared to cHIS &lt;2 (Table 1). Cases had increased risk of ICU admission (OR 2.0, 95%CI 1.1-3.7) and mechanical ventilation (OR 2.7, 95%CI 1.4-5.2) than comparators. Table 1. Associations of peak cHIS and systemic rheumatic disease with COVID-19 hospitalization outcomes Intensive care unit admission Mechanical ventilation Death % Adjusted OR (95%CI) % Adjusted OR (95%CI) % Adjusted OR (95%CI) Hospitalization outcomes by hyperinflammation on cHIS 1 cHIS &lt;2 (n=112) 21% 1.0 (Ref) 1% 1.0 (Ref) 3% 1.0 (Ref) cHIS ≥2 (n=177) 48% 3.5 (2.0-6.0 ) 37% 66.2 (9.0-487.8 ) 27% 16.4 (4.8-56.4 ) Hospitalization outcomes by rheumatic disease status Comparators (n=232) 30% 1.0 (Ref) 19% 1.0 (Ref) 16% 1.0 (Ref) Rheumatic cases (n=57) 51% 1.87 (1.03-3.40 ) 39% 2.46 (1.30-4.67 ) 21% 1.32 (0.61-2.88) Matching factors: age, sex, and date of +PCR. 1 Adjusted for age, sex, and case status. 2 Adjusted for race, smoking, comorbidities, and body mass index. cHIS, COVID-19-associated hyperinflammation score; CI, confidence interval; OR, odds ratio; PCR, polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2. Conclusion: Patients with systemic rheumatic disease hospitalized for COVID-19 had higher risk for hyperinflammation, kidney injury, and mechanical ventilation than non-rheumatic comparators. We validated the cHIS in our cohort, which was strongly associated with poor COVID-19 outcomes. These findings highlight that hospitalized patients with rheumatic diseases may be vulnerable to poor COVID-19 outcomes. References: [1]Webb BJ et al. Clinical criteria for COVID-19-associated hyperinflammatory syndrome. Lancet Rheumatol. 2020 Dec;2(12):e754-e763. Disclosure of Interests: Tiffany Hsu: None declared, Kristin D’Silva: None declared, Naomi Serling-Boyd: None declared, Jiaqi Wang: None declared, Alisa Mueller: None declared, Xiaoqing Fu: None declared, Lauren Prisco: None declared, Lily Martin: None declared, Kathleen Vanni: None declared, Alessandra Zaccardelli: None declared, Claire Cook: None declared, Hyon Choi Consultant of: Dr. Choi reports consultancy fees from Takeda, Selecta, GlaxoSmithKline, and Horizon, Grant/research support from: Dr. Choi reports research support from AstraZeneca., Yuqing Zhang: None declared, Ellen Gravallese: None declared, Zachary Wallace Consultant of: Dr. Wallace reports consulting fees from Viela Bio and MedPace., Grant/research support from: Dr. Wallace reports research support from Bristol-Myers Squibb and Principia., Jeffrey Sparks Consultant of: Dr. Sparks reports consultancy fees from Bristol-Myers Squibb, Gilead, Inova, Janssen, Optum, and Pfizer., Grant/research support from: Dr. Sparks reports research support from Amgen and Bristol-Myers Squibb.