Related Experiment Video
Updated: Nov 26, 2025
Single-cell Analysis of Immunophenotype and Cytokine Production in Peripheral Whole Blood via Mass Cytometry
Published on: June 26, 2018
COVID-19 Outcomes in Patients With Systemic Autoimmune Rheumatic Diseases Compared to the General Population: A US
Kristin M D'Silva1, April Jorge1, Andrew Cohen2
1Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts.
Insights
Patients with autoimmune rheumatic diseases (ARDs) face higher risks of severe COVID-19 outcomes, including hospitalization and acute renal failure. These risks are primarily linked to comorbidities, except for venous thromboembolism.
Area of Science:
- Rheumatology
- Infectious Diseases
- Critical Care Medicine
Background:
- Patients with systemic autoimmune rheumatic diseases (ARDs) have concerns regarding severe outcomes from coronavirus disease 2019 (COVID-19).
- Understanding these risks is crucial for managing patients with both ARDs and COVID-19.
Purpose of the Study:
- To evaluate the risks of severe COVID-19 outcomes in patients with systemic ARDs compared to those without ARDs.
Main Methods:
- A comparative cohort study using a large multicenter electronic health record network.
- COVID-19 patients with and without systemic ARDs were matched based on demographics, comorbidities, and healthcare utilization.
- Thirty-day outcomes including hospitalization, ICU admission, mechanical ventilation, acute renal failure, venous thromboembolism, and death were assessed.
Main Results:
- In the primary matched model, patients with systemic ARDs had higher risks of hospitalization (RR 1.14), ICU admission (RR 1.32), acute renal failure (RR 1.81), and venous thromboembolism (RR 1.74).
- No significantly higher risk was observed for mechanical ventilation or death in the primary model.
- In the extended model, risks were attenuated, except for venous thromboembolism (RR 1.60), suggesting comorbidities mediate some risks.
Conclusions:
- COVID-19 patients with systemic ARDs face elevated risks for hospitalization, ICU admission, acute renal failure, and venous thromboembolism.
- Comorbidities appear to largely mediate these risks, with the exception of venous thromboembolism.
Objective:
Patients with systemic autoimmune rheumatic diseases (ARDs) continue to be concerned about risks of severe coronavirus disease 2019 (COVID-19) outcomes. This study was undertaken to evaluate the risks of severe outcomes in COVID-19 patients with systemic ARDs compared to COVID-19 patients without systemic ARDs.
Methods:
Using a large multicenter electronic health record network, we conducted a comparative cohort study of patients with systemic ARDs diagnosed as having COVID-19 (identified by diagnostic code or positive molecular test result) compared to patients with COVID-19 who did not have systemic ARDs, matched for age, sex, race/ethnicity, and body mass index (primary matched model) and additionally matched for comorbidities and health care utilization (extended matched model). Thirty-day outcomes were assessed, including hospitalization, intensive care unit (ICU) admission, mechanical ventilation, acute renal failure requiring renal replacement therapy, ischemic stroke, venous thromboembolism, and death.
Results:
We initially identified 2,379 COVID-19 patients with systemic ARDs (mean age 58 years; 79% female) and 142,750 comparators (mean age 47 years; 54% female). In the primary matched model (2,379 patients with systemic ARDs and 2,379 matched comparators with COVID-19 without systemic ARDs), patients with systemic ARDs had a significantly higher risk of hospitalization (relative risk [RR] 1.14 [95% confidence interval (95% CI) 1.03-1.26]), ICU admission (RR 1.32 [95% CI 1.03-1.68]), acute renal failure (RR 1.81 [95% CI 1.07-3.07]), and venous thromboembolism (RR 1.74 [95% CI 1.23-2.45]) versus comparators but did not have a significantly higher risk of mechanical ventilation or death. In the extended model, all risks were largely attenuated, except for the risk of venous thromboembolism (RR 1.60 [95% CI 1.14-2.25]).
Conclusion:
Our findings indicate that COVID-19 patients with systemic ARDs may be at a higher risk of hospitalization, ICU admission, acute renal failure, and venous thromboembolism when compared to COVID-19 patients without systemic ARDs. These risks may be largely mediated by comorbidities, except for the risk of venous thromboembolism.
Related Concept Videos
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
01:29Autoimmune Disorders
Concept and Mechanism of Autoimmune Diseases
The immune...
01:23Rheumatic Heart Disease I: Introduction
01:11Genome-wide Association Studies-GWAS
GWAS does not require the identification of the target gene involved in...
01:21Rheumatic Heart Disease III: Medical Management
01:27Psychoneuroimmunology: Cardiovascular Disease
A key area of focus in PNI is the relationship between stress and coronary...