Autoimmune disease and COVID-19: a multicentre observational study in the United Kingdom
Deepa J. Arachchillage, Indika Rajakaruna, Charis Pericleous, Phillip L.R. Nicolson, Mike Makris, Mike Laffan, the CA-COVID-19 Study Group, Amanda Dell, Angela Hall, Anna Roynon, Anne Héron, Cheri Price, Claire Price, C. I. Westacott, Debra Barnett, Gail Marshall, Gemma Hodkinson, Georgia Mallison, Grace Okoro, Joshua Gwatkin, Kirstin Davies, Lucy Shipp, Maxine Nash, Rhian Hughes, Rina Mardania, Sarah Lewis Sean Cutler, Caroline Allan, Atiqa Miah, Dide Okaygun, Dan Hart, Faith Dzumbunu, James E. Leveson, Karen Torre, Louise Taylor, Priyanka Raheja, Sara Mamsa, Tasnima Ferdousi, Angharad Everden, Alice Ngumo, Doaa Ahmed, Efstathia Venizelou, James Herdman, Janice Carpenter, Konrad Bartkiewicz, Rebecca E. Cash, Renu Riat, Abigail Downing, Ana Guerrero, Astrid Etherington, Chapa Gamage, D. H. P. S. Gunasekara, Lee M. Morris, Raza Alikhan, Rebecca Cloudsdale, Samya Obaji, Stuart Cunningham, Sylvain Ndjombo, Amanda Cowton, Ami Wilkinson, Andrea Kay, Anne Sebakungu, Anne Thomson, Clare Brady, Dawn Egginton, Ellen Brown, Enid Wright, Gill Rogers, Hannah Plaschkes, Jacqui Jennings, Julie O’Brien, Julie Temple, Kathryn Potts, Kimberly Stamp, Kelly Postlethwaite, Louise Duncan, Margaret Randall, Mark Birt, Melanie Kent, Philip Mounter, Shelly Wood, Nicola Hewitson, Noreen Kingston, Susan Wadd, Sarah McAuliffe, Stefanie Hobson, Susan Riley, Suzanne Naylor, Vicki Atkinson, Alysha Hancock, Bethan Deacon, Carla Pothecary, Caroline Hamilton, Ceri Lynch, C Evenden, Deborah Jones, Ellie Davies, Felicity Page, Gareth Kennard-Holden, John Gavin, Joanne Pugh
Abstract
OBJECTIVE: To establish the demographic characteristics, laboratory findings and clinical outcomes in patients with autoimmune disease (AD) compared with a propensity-matched cohort of patients without AD admitted with COVID-19 to hospitals in the UK. METHODS: This is a multicentre observational study across 26 NHS Trusts. Data were collected both retrospectively and prospectively using a predesigned standardized case record form. Adult patients (≥18 years) admitted between 1 April 2020 and 31 July 2020 were included. RESULTS: Overall, 6288 patients were included to the study. Of these, 394 patients had AD prior to admission with COVID-19. Of 394 patients, 80 patients with SLE, RA or aPL syndrome were classified as severe rheumatologic AD. A higher proportion of those with AD had anaemia [240 (60.91%) vs 206 (52.28%), P = 0.015], elevated LDH [150 (38.08%) vs 43 (10.92%), P < 0.001] and raised creatinine [122 (30.96%) vs 86 (21.83%), P = 0.01], respectively. A significantly higher proportion of patients with severe rheumatologic AD had elevated CRP [77 (96.25%) vs 70 (87.5%), P = 0.044] and LDH [20 (25%) vs 6 (7.5%), P = 0.021]. Patients with severe rheumatologic AD had significantly higher mortality [32/80 (40%)] compared with propensity matched cohort of patients without AD [20/80 (25%), P = 0.043]. However, there was no difference in 180-day mortality between propensity-matched cohorts of patients with or without AD in general (P = 0.47). CONCLUSIONS: Patients with severe rheumatologic AD had significantly higher mortality. Anaemia, renal impairment and elevated LDH were more frequent in patients with any AD while elevated CRP and LDH were more frequent in patients with severe rheumatologic AD both of which have been shown to associate with increased mortality in patients with COVID-19.