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Preexisting Autoimmunity Is Associated With Increased Severity of Coronavirus Disease 2019: A Retrospective Cohort
Arjun S Yadaw1, David K Sahner1, Hythem Sidky1
1National Center for Advancing Translational Sciences, National Institutes of Health, Rockville, Maryland, USA.
Insights
Individuals with autoimmune diseases or on immunosuppressants face higher risks for severe COVID-19 outcomes, including life-threatening illness and hospitalization. Tumor necrosis factor inhibitors may offer protection against severe disease.
Area of Science:
- Immunology
- Infectious Diseases
- Public Health
Background:
- Identifying individuals at high risk for severe COVID-19 is crucial for targeted clinical management.
- Evidence on the impact of autoimmune diseases (AID) and immunosuppressant (IS) exposure on severe COVID-19 outcomes remains mixed.
Purpose of the Study:
- To investigate the association between preexisting autoimmune disease (AID) diagnosis and/or immunosuppressant (IS) exposure and severe COVID-19 outcomes.
- To evaluate the risk of life-threatening disease and hospitalization in adults with COVID-19 based on AID and IS status.
Main Methods:
- A retrospective cohort study was conducted using data from the National COVID Cohort Collaborative.
- Logistic regression models were employed to assess the association between AID/IS and severe COVID-19 outcomes, adjusting for demographics and comorbidities.
Main Results:
- Adults with preexisting AID, IS exposure, or both had significantly higher odds of life-threatening COVID-19 disease and hospitalization.
- Individuals with AID had an odds ratio (OR) of 1.13, IS exposure an OR of 1.27, and both an OR of 1.35 for life-threatening disease.
- Tumor necrosis factor inhibitors were found to be protective against both life-threatening disease (OR: 0.80) and hospitalization (OR: 0.80).
Conclusions:
- Preexisting autoimmune disease and immunosuppressant exposure increase the likelihood of severe COVID-19 outcomes, including hospitalization.
- Patients with AID or IS exposure may require tailored monitoring and preventative strategies to mitigate COVID-19 risks.
- Specific immunosuppressants, such as tumor necrosis factor inhibitors, may confer a protective effect against severe COVID-19.
Background:
Identifying individuals with a higher risk of developing severe coronavirus disease 2019 (COVID-19) outcomes will inform targeted and more intensive clinical monitoring and management. To date, there is mixed evidence regarding the impact of preexisting autoimmune disease (AID) diagnosis and/or immunosuppressant (IS) exposure on developing severe COVID-19 outcomes.
Methods:
A retrospective cohort of adults diagnosed with COVID-19 was created in the National COVID Cohort Collaborative enclave. Two outcomes, life-threatening disease and hospitalization, were evaluated by using logistic regression models with and without adjustment for demographics and comorbidities.
Results:
Of the 2 453 799 adults diagnosed with COVID-19, 191 520 (7.81%) had a preexisting AID diagnosis and 278 095 (11.33%) had a preexisting IS exposure. Logistic regression models adjusted for demographics and comorbidities demonstrated that individuals with a preexisting AID (odds ratio [OR], 1.13; 95% confidence interval [CI]: 1.09-1.17; P < .001), IS exposure (OR, 1.27; 95% CI: 1.24-1.30; P < .001), or both (OR, 1.35; 95% CI: 1.29-1.40; P < .001) were more likely to have a life-threatening disease. These results were consistent when hospitalization was evaluated. A sensitivity analysis evaluating specific IS revealed that tumor necrosis factor inhibitors were protective against life-threatening disease (OR, 0.80; 95% CI: .66-.96; P = .017) and hospitalization (OR, 0.80; 95% CI: .73-.89; P < .001).
Conclusions:
Patients with preexisting AID, IS exposure, or both are more likely to have a life-threatening disease or hospitalization. These patients may thus require tailored monitoring and preventative measures to minimize negative consequences of COVID-19.
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