AB0090 PRESENTATION RISK FACTORS ASSOCIATED WITH PROGRESSION TO CRITICAL ILLNESS IN COVID-19 PATIENTS UNDERGOING INDEX HOSPITALIZATION WITH RHEUMATIC DISEASE
Authors: K. Cai Zhen, G. Garcia, P. Kotlarz, B. Long, G. Ramos, I. Vargas, M. Rosario, K. Hamad, W. Wiese-Rometsch
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> SARS-CoV-2 infection manifests a spectrum from mild to critical illness. The prognosis of COVID-19 patients with underlying rheumatologic disease remains unclear. [1] <h3>Objectives:</h3> The purpose of this study was to characterize presentation risk factors associated with progression to critical illness (PCI) defined as a composite outcome (ICU admission, mortality, or discharge to hospice). <h3>Methods:</h3> This retrospective study was declared exempt by IRB. Clinicodemographic and administrative data including ICD-10-based Elixhauser comorbidity categories were extracted from electronic medical records between March 14, 2020, through October 31, 2022. Discrete data summarized as proportions were compared with the Chi-squared test. Continuous data summarized with mean ["±" SD] were compared using an ANOVA test adjusting P- value for parametric vs. non-parametric distribution. A two-tailed p&lt;0.05 was considered significant. <h3>Results:</h3> Among 6,402 COVID-19 patients consecutively discharged, 239 were divided into PCI (n=68) vs. non-PCI (n=171). Rheumatologic disease was distributed across rheumatoid arthritis (n= 134, 56%), systemic lupus erythematosus (n=29, 12%), polymyalgia rheumatica (n= 19, 8%), Sjogren's syndrome (n=11, 5%), psoriatic arthritis (n=10, 4%), others (n=36, 15%). Narrative results respectively are sequenced PCI vs. non-PCI. Mean age was 73±14 and 71±14 years distributed among females (56% vs. 66%), distributed iso-morphically thus averaged across Whites (84%), Blacks (6%), and other races (12%). Intergroup contrasts were equivocal for hypertension (76% vs. 75%, P=0.505), iron deficiency anemia (37 vs. 20%, P=0.006), but differed with obesity (43% vs. 29%, P=0.03), diabetes (38% vs. 23%, p=0.01), coagulopathy (35% vs. 10%, p&lt;0.001), and heart failure (28% vs. 14%, P=0.02). Laboratory medicine revealed ANC (7,452±4,725 Vs. 5,706±3,597 cells/µL, P=0.004), WBC (9,826±5,632 vs. 7,981±3,595 cells/µL, P=0.04), LDH (414±212 vs. 309±106 U/L, p=0.001), ferritin (1,008±801 vs. 613±888, ng/mL, P=0.005), CRP (13.1±7.6 vs. 6.8±5.6 mg/dL, P&lt;0.0001), D-dimer (3.23±6.04 vs. 2.14±4.66 µg/mL, P=0.11), procalcitonin (0.94±2.52 vs. 0.51±1.41 ng/mL, P=0.18). The length of stay (days) for PCI patients was 16.3±11.9 vs. 6.3±7.4 for non-PCI patients (P &lt;0.0001). <h3>Conclusion:</h3> Progression to critical illness amongst rheumatologic patients with COVID-19 occurred more frequently in advanced aged Caucasian females with multiple comorbidities and elevated ANC, WBC, LDH, ferritin, and CRP. These inflammatory markers warrant serial monitoring as they may identify those at risk of progressing to critical illness. Length of stay also was significantly higher, which was understandable given nature of protracted illness progressing to require ICU care, hospice discharge decision, or hospital death. In contrast to a meta-analysis [2], we did not observe sex or hypertension to be independently associated with death. However, extant obesity, diabetes, heart failure, and coagulopathy independently were associated with mortality risk. Interpretation of our findings should be tempered due to sample dominance of Caucasians and no control for pre-hospitalization rheumatologic medications which conceivable could have impacted immune response. Clinical relevance is characterization of presentation features enabling risk stratification in the emergency department to complement level of care decisions. <h3>REFERENCES:</h3> [1] Oku, K., Kimoto, Y., Horiuchi, T., et al. Risk factors for hospitalization or mortality for COVID-19 in patients with rheumatic diseases: Results of a nationwide JCR covid-19 registry in Japan. Modern Rheumatology. 2022. Accessed January 12, 2024 at https://doi.org/10.1093/mr/roac104. [2] Wang, F., Ma, Y., Xu, S et al. "Prevalence and Risk of COVID-19 in Patients with Rheumatic Diseases: A Systematic Review and Meta-Analysis." Clinical Rheumatology, U.S. National Library of Medicine, 1 July 2022.. Accessed January 12, 2024 at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8964246/. <h3>Acknowledgements:</h3> No conflict of interest. This Abstract was presented at Clinical Congress of Rheumatology-September 7th-10th, 2023. Also it was presented at Florida Society of Rheumatology in July 21-23th, 2023 (Within the window period required by EULAR). <h3>Disclosure of Interests:</h3> <b>None declared.</b>