Risk Factors for Severe Outcomes in Patients With Systemic Vasculitis and COVID-19: A Binational, Registry-Based Cohort Study

Matthew A Rutherford; Jennifer Scott; Maira Karabayas; Marilina Antonelou; Seerapani Gopaluni; David Gray; Joe Barrett; Silke R Brix; Neeraj Dhaun; Stephen P McAdoo; Rona M Smith; Colin C Geddes; David Jayne; Raashid Luqmani; Alan D Salama; Mark A Little; Neil Basu; UK and Ireland Vasculitis Rare Disease Group (UKIVAS)

doi:10.1002/art.41728

Risk Factors for Severe Outcomes in Patients With Systemic Vasculitis and COVID-19: A Binational, Registry-Based Cohort Study

Matthew A Rutherford^* (Corresponding Author), Jennifer Scott, Maira Karabayas, Marilina Antonelou, Seerapani Gopaluni, David Gray, Joe Barrett, Silke R Brix, Neeraj Dhaun, Stephen P McAdoo, Rona M Smith, Colin C Geddes, David Jayne, Raashid Luqmani, Alan D Salama, Mark A Little, Neil Basu, UK and Ireland Vasculitis Rare Disease Group (UKIVAS)

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

OBJECTIVE: COVID-19 is a novel infectious disease with a broad spectrum of clinical severity. Patients with systemic vasculitis have an increased risk of serious infections and may be at risk of severe outcomes following COVID-19. We undertook this study to establish the risk factors for severe COVID-19 outcomes in these patients, including the impact of immunosuppressive therapies.

METHODS: A multicenter cohort was developed through the participation of centers affiliated with national UK and Ireland vasculitis registries. Clinical characteristics and outcomes are described. Logistic regression was used to evaluate associations between potential risk factors and a severe COVID-19 outcome, defined as a requirement for advanced oxygen therapy, a requirement for invasive ventilation, or death.

RESULTS: The cohort included 65 patients with systemic vasculitis who developed COVID-19 (median age 70 years, 49% women), of whom 25 patients (38%) experienced a severe outcome. Most patients (55 of 65 [85%]) had antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Almost all patients required hospitalization (59 of 65 [91%]), 7 patients (11%) were admitted to intensive care, and 18 patients (28%) died. Background glucocorticoid therapy was associated with severe outcomes (adjusted odds ratio [OR] 3.7 [95% confidence interval 1.1-14.9]; P = 0.047), as was comorbid respiratory disease (adjusted OR 7.5 [95% confidence interval 1.9-38.2]; P = 0.006). Vasculitis disease activity and nonglucocorticoid immunosuppressive therapy were not associated with severe outcomes.

CONCLUSION: In patients with systemic vasculitis, glucocorticoid use at presentation and comorbid respiratory disease were associated with severe outcomes in COVID-19. These data can inform clinical decision-making relating to the risk of severe COVID-19 in this vulnerable patient group.

Original language	English
Pages (from-to)	1713-1719
Number of pages	7
Journal	Arthritis & Rheumatology
Volume	73
Issue number	9
Early online date	27 Jul 2021
DOIs	https://doi.org/10.1002/art.41728
Publication status	Published - 1 Sept 2021

Keywords

Aged
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/drug therapy
COVID-19/mortality
Comorbidity
Female
Glucocorticoids/therapeutic use
Hospitalization
Humans
Immunosuppressive Agents/therapeutic use
Intensive Care Units
Male
Middle Aged
Odds Ratio
Oxygen Inhalation Therapy/statistics & numerical data
Registries
Respiration, Artificial/statistics & numerical data
Respiratory Tract Diseases/epidemiology
Risk Factors
SARS-CoV-2
Severity of Illness Index
Systemic Vasculitis/drug therapy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Rutherford, M. A., Scott, J., Karabayas, M., Antonelou, M., Gopaluni, S., Gray, D., Barrett, J., Brix, S. R., Dhaun, N., McAdoo, S. P., Smith, R. M., Geddes, C. C., Jayne, D., Luqmani, R., Salama, A. D., Little, M. A., Basu, N., & UK and Ireland Vasculitis Rare Disease Group (UKIVAS) (2021). Risk Factors for Severe Outcomes in Patients With Systemic Vasculitis and COVID-19: A Binational, Registry-Based Cohort Study. Arthritis & Rheumatology, 73(9), 1713-1719. https://doi.org/10.1002/art.41728

Rutherford, MA, Scott, J, Karabayas, M, Antonelou, M, Gopaluni, S, Gray, D, Barrett, J, Brix, SR, Dhaun, N, McAdoo, SP, Smith, RM, Geddes, CC, Jayne, D, Luqmani, R, Salama, AD, Little, MA, Basu, N & UK and Ireland Vasculitis Rare Disease Group (UKIVAS) 2021, 'Risk Factors for Severe Outcomes in Patients With Systemic Vasculitis and COVID-19: A Binational, Registry-Based Cohort Study', Arthritis & Rheumatology, vol. 73, no. 9, pp. 1713-1719. https://doi.org/10.1002/art.41728

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title = "Risk Factors for Severe Outcomes in Patients With Systemic Vasculitis and COVID-19: A Binational, Registry-Based Cohort Study",

abstract = "OBJECTIVE: COVID-19 is a novel infectious disease with a broad spectrum of clinical severity. Patients with systemic vasculitis have an increased risk of serious infections and may be at risk of severe outcomes following COVID-19. We undertook this study to establish the risk factors for severe COVID-19 outcomes in these patients, including the impact of immunosuppressive therapies.METHODS: A multicenter cohort was developed through the participation of centers affiliated with national UK and Ireland vasculitis registries. Clinical characteristics and outcomes are described. Logistic regression was used to evaluate associations between potential risk factors and a severe COVID-19 outcome, defined as a requirement for advanced oxygen therapy, a requirement for invasive ventilation, or death.RESULTS: The cohort included 65 patients with systemic vasculitis who developed COVID-19 (median age 70 years, 49% women), of whom 25 patients (38%) experienced a severe outcome. Most patients (55 of 65 [85%]) had antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Almost all patients required hospitalization (59 of 65 [91%]), 7 patients (11%) were admitted to intensive care, and 18 patients (28%) died. Background glucocorticoid therapy was associated with severe outcomes (adjusted odds ratio [OR] 3.7 [95% confidence interval 1.1-14.9]; P = 0.047), as was comorbid respiratory disease (adjusted OR 7.5 [95% confidence interval 1.9-38.2]; P = 0.006). Vasculitis disease activity and nonglucocorticoid immunosuppressive therapy were not associated with severe outcomes.CONCLUSION: In patients with systemic vasculitis, glucocorticoid use at presentation and comorbid respiratory disease were associated with severe outcomes in COVID-19. These data can inform clinical decision-making relating to the risk of severe COVID-19 in this vulnerable patient group.",

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author = "Rutherford, {Matthew A} and Jennifer Scott and Maira Karabayas and Marilina Antonelou and Seerapani Gopaluni and David Gray and Joe Barrett and Brix, {Silke R} and Neeraj Dhaun and McAdoo, {Stephen P} and Smith, {Rona M} and Geddes, {Colin C} and David Jayne and Raashid Luqmani and Salama, {Alan D} and Little, {Mark A} and Neil Basu and {UK and Ireland Vasculitis Rare Disease Group (UKIVAS)}",

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doi = "10.1002/art.41728",

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journal = "Arthritis & Rheumatology",

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TY - JOUR

T1 - Risk Factors for Severe Outcomes in Patients With Systemic Vasculitis and COVID-19

T2 - A Binational, Registry-Based Cohort Study

AU - Rutherford, Matthew A

AU - Scott, Jennifer

AU - Karabayas, Maira

AU - Antonelou, Marilina

AU - Gopaluni, Seerapani

AU - Gray, David

AU - Barrett, Joe

AU - Brix, Silke R

AU - Dhaun, Neeraj

AU - McAdoo, Stephen P

AU - Smith, Rona M

AU - Geddes, Colin C

AU - Jayne, David

AU - Luqmani, Raashid

AU - Salama, Alan D

AU - Little, Mark A

AU - Basu, Neil

AU - UK and Ireland Vasculitis Rare Disease Group (UKIVAS)

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N2 - OBJECTIVE: COVID-19 is a novel infectious disease with a broad spectrum of clinical severity. Patients with systemic vasculitis have an increased risk of serious infections and may be at risk of severe outcomes following COVID-19. We undertook this study to establish the risk factors for severe COVID-19 outcomes in these patients, including the impact of immunosuppressive therapies.METHODS: A multicenter cohort was developed through the participation of centers affiliated with national UK and Ireland vasculitis registries. Clinical characteristics and outcomes are described. Logistic regression was used to evaluate associations between potential risk factors and a severe COVID-19 outcome, defined as a requirement for advanced oxygen therapy, a requirement for invasive ventilation, or death.RESULTS: The cohort included 65 patients with systemic vasculitis who developed COVID-19 (median age 70 years, 49% women), of whom 25 patients (38%) experienced a severe outcome. Most patients (55 of 65 [85%]) had antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Almost all patients required hospitalization (59 of 65 [91%]), 7 patients (11%) were admitted to intensive care, and 18 patients (28%) died. Background glucocorticoid therapy was associated with severe outcomes (adjusted odds ratio [OR] 3.7 [95% confidence interval 1.1-14.9]; P = 0.047), as was comorbid respiratory disease (adjusted OR 7.5 [95% confidence interval 1.9-38.2]; P = 0.006). Vasculitis disease activity and nonglucocorticoid immunosuppressive therapy were not associated with severe outcomes.CONCLUSION: In patients with systemic vasculitis, glucocorticoid use at presentation and comorbid respiratory disease were associated with severe outcomes in COVID-19. These data can inform clinical decision-making relating to the risk of severe COVID-19 in this vulnerable patient group.

AB - OBJECTIVE: COVID-19 is a novel infectious disease with a broad spectrum of clinical severity. Patients with systemic vasculitis have an increased risk of serious infections and may be at risk of severe outcomes following COVID-19. We undertook this study to establish the risk factors for severe COVID-19 outcomes in these patients, including the impact of immunosuppressive therapies.METHODS: A multicenter cohort was developed through the participation of centers affiliated with national UK and Ireland vasculitis registries. Clinical characteristics and outcomes are described. Logistic regression was used to evaluate associations between potential risk factors and a severe COVID-19 outcome, defined as a requirement for advanced oxygen therapy, a requirement for invasive ventilation, or death.RESULTS: The cohort included 65 patients with systemic vasculitis who developed COVID-19 (median age 70 years, 49% women), of whom 25 patients (38%) experienced a severe outcome. Most patients (55 of 65 [85%]) had antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Almost all patients required hospitalization (59 of 65 [91%]), 7 patients (11%) were admitted to intensive care, and 18 patients (28%) died. Background glucocorticoid therapy was associated with severe outcomes (adjusted odds ratio [OR] 3.7 [95% confidence interval 1.1-14.9]; P = 0.047), as was comorbid respiratory disease (adjusted OR 7.5 [95% confidence interval 1.9-38.2]; P = 0.006). Vasculitis disease activity and nonglucocorticoid immunosuppressive therapy were not associated with severe outcomes.CONCLUSION: In patients with systemic vasculitis, glucocorticoid use at presentation and comorbid respiratory disease were associated with severe outcomes in COVID-19. These data can inform clinical decision-making relating to the risk of severe COVID-19 in this vulnerable patient group.

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KW - Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis/drug therapy

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KW - Oxygen Inhalation Therapy/statistics & numerical data

KW - Registries

KW - Respiration, Artificial/statistics & numerical data

KW - Respiratory Tract Diseases/epidemiology

KW - Risk Factors

KW - SARS-CoV-2

KW - Severity of Illness Index

KW - Systemic Vasculitis/drug therapy

U2 - 10.1002/art.41728

DO - 10.1002/art.41728

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ER -

Risk Factors for Severe Outcomes in Patients With Systemic Vasculitis and COVID-19: A Binational, Registry-Based Cohort Study

Abstract

Keywords

UN SDGs

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