Laboratory Trends, Hyperinflammation, And Clinical Outcomes For Patients With A Systemic Rheumatic Disease Admitted To Hospital For Covid-19: A Retrospective, Comparative Cohort Study

Background COVID-19 can induce a hyperinflammatory state, which might lead to poor clinical outcomes. We aimed to assess whether patients with a systemic rheumatic disease might be at increased risk for hyperinflammation and respiratory failure from COVID-19. Methods We did a retrospective, comparative cohort study of patients aged 18 years or older admitted to hospital with PCR-confirmed COVID-19 at Mass General Brigham (Boston, USA). We identified patients by a search of electronic health records and matched patients with a systemic rheumatic disease 1:5 to comparators. We compared individual laboratory results by case status and extracted laboratory results and COVID-19 outcomes for each participant. We calculated the COVID-19-associated hyperinflammation score (cHIS), a composite of six domains (a score of >= 2 indicating hyperinflammation) and used logistic regression to estimate odds ratios (ORs) for COVID-19 outcomes by hyperinflammation and case status. Findings We identified 57 patients with a systemic rheumatic disease and 232 matched comparators who were admitted to hospital with COVID-19 between Jan 30 and July 7, 2020; 38 (67%) patients with a rheumatic disease were female compared with 158 (68%) matched comparators. Patients with a systemic rheumatic disease had higher peak median neutrophil-to-lymphocyte ratio (9middot6 [IQR 6middot4-22middot2] vs 7middot8 [4middot5-16middot5]; p=0middot021), lactate dehydrogenase concentration (421 U/L [297-528] vs 345 U/L [254-479]; p=0middot044), creatinine concentration (1middot2 mg/dL [0middot9-2middot0] vs 1middot0 mg/dL [0middot8-1middot4], p=0middot014), and blood urea nitrogen concentration (31 mg/dL [15-61] vs 23 mg/dL [13-37]; p=0middot033) than comparators, but median C-reactive protein concentration (149middot4 mg/L [76middot4-275middot3] vs 116middot3 mg/L [58middot8-225middot9]; p=0middot11) was not significantly different. Patients with a systemic rheumatic disease had higher peak median cHIS than comparators (3 [1-5] vs 2 [1-4]; p=0middot013). All patients with a peak cHIS of 2 or more had higher odds of admission to intensive care (OR 3middot45 [95% CI 1middot98-5middot99]), mechanical ventilation (66middot20 [8middot98-487middot80]), and in-hospital mortality (16middot37 [4middot75-56middot38]) than patients with a peak cHIS of less than 2. In adjusted analyses, patients with a rheumatic disease had higher odds of admission to intensive care (2middot08 [1middot09-3middot96]) and mechanical ventilation (2middot60 [1middot32-5middot12]) than comparators, but not in-hospital mortality (1.78 [0middot79-4middot02]). Among patients who were discharged from hospital, risk of rehospitalisation (1middot08 [0middot37-3middot16]) and mortality within 60 days (1middot20 [0middot58-2middot47]) was similar in patients and comparators. Interpretation Patients with a systemic rheumatic disease who were admitted to hospital for COVID-19 had increased risk for hyperinflammation, kidney injury, admission to intensive care, and mechanical ventilation compared with matched comparators. However, among patients who survived, post-discharge outcomes were not significantly different. The cHIS identified patients with hyperinflammation, which was strongly associated with poor COVID-19 outcomes in both patients with a rheumatic disease and comparators.Clinicians should be aware that patients with systemic rheumatic diseases and COVID-19 could be susceptible to hyperinflammation and poor hospital outcomes. Funding None. Copyright (c) 2021 Elsevier Ltd. All rights reserved.