COVID-19 in systemic lupus erythematosus: A pooled analysis and systematic review of case reports and series
Rajalingham Sakthiswary, Hui Yuan Chuah, Ker Shing Chiang, Yee Shan Liew, Noor Azman Muhammad Aizat
Abstract
Objective In the recent months, there have been several case reports and case series on COVID-19 in patients with systemic lupus erythematosus(SLE). We conducted a pooled analysis and systematic review to summarise the findings of these articles. Besides, we aimed to determine the predictors of severe COVID-19 infection in SLE by comparing the mild to moderate cases with the severe to critical ones. Method All case reports and case series pertaining to COVID-19 in SLE were retrieved from Pubmed, Wiley Online Library, Springer Link, Science Direct and Web of Science databases using ‘lupus’, ‘systemic lupus erythematosus’, ‘coronavirus’, ‘SARS-CoV-2’, ‘SLE’ and “Covid-19” as keywords. The following data were extracted from the selected articles: country, age of the patient and the characteristics of SLE such as disease duration, organ or system involved, baseline medications and the severity of the COVID-19 infection. Data extracted from the articles were utilised to perform the pooled analysis. Results A total of 24 articles with 48 patients met the eligibility criteria. The median age at diagnosis of COVID-19 infection was 41 years (IQR: 11–66 years). The median SLE disease duration prior to the diagnosis of COVID-19 was 9 years (IQR: 0–30 years). A total of 22 (45.83%) patients had severe to critical COVID-19. This pooled data did not demonstrate any difference in the baseline medications between the 2 groups. Patients with lupus nephritis were significantly more prone to develop severe to critical disease ( p = 0 .036) with an odds ratio of 5.40 (95% confidence interval of 1.120–26.045). Conclusion We found that lupus nephritis was the only predictor of severe to critical COVID-19 in SLE.