Introduction Increased mortality has been demonstrated in older adults with COVID-19, but the effect of frailty has been unclear. Methods This multi-centre cohort study involved patients aged 18 years and older hospitalised with COVID-19, using routinely collected data. We used Cox regression analysis to assess the impact of age, frailty, and delirium on the risk of inpatient mortality, adjusting for sex, illness severity, inflammation, and co-morbidities. We used ordinal logistic regression analysis to assess the impact of age, Clinical Frailty Scale (CFS), and delirium on risk of increased care requirements on discharge, adjusting for the same variables. Results Data from 5,711 patients from 55 hospitals in 12 countries were included (median age 74, IQR 54–83; 55.2% male). The risk of death increased independently with increasing age (>80 vs 18–49: HR 3.57, CI 2.54–5.02), frailty (CFS 8 vs 1–3: HR 3.03, CI 2.29–4.00) inflammation, renal disease, cardiovascular disease, and cancer, but not delirium. Age, frailty (CFS 7 vs 1–3: OR 7.00, CI 5.27–9.32), delirium, dementia, and mental health diagnoses were all associated with increased risk of higher care needs on discharge. The likelihood of adverse outcomes increased across all grades of CFS from 4 to 9. Conclusions Age and frailty are independently associated with adverse outcomes in COVID-19. Risk of increased care needs was also increased in survivors of COVID-19 with frailty or older age.

OBJECTIVES To evaluate risk factors for severe Coronavirus Disease 2019 (COVID-19) in patients with immune-mediated rheumatic diseases, stratified by systemic autoimmune conditions and chronic inflammatory arthritis. METHODS An observational, cross-sectional multicenter study was performed. Patients from 10 Rheumatology departments in Madrid who presented with SARS-CoV-2 infection between Feb 2020 and May 2021 were included. The main outcome was COVID-19 severity (hospital admission or mortality). Risk factors for severity were estimated, adjusting for covariates (sociodemographic, clinical and treatments), using logistic regression analyses. RESULTS 523 patients with COVID-19 were included, among whom 192 (35.6%) patients required hospital admission and 38 (7.3%) died. Male gender, older age and comorbidities such as diabetes mellitus, hypertension and obesity were associated with severe COVID-19. Corticosteroid doses over 10 mg/day, rituximab, sulfasalazine and mycophenolate use, were independently associated with worse outcomes. COVID-19 severity decreased over the different pandemic waves. Mortality was higher in the systemic autoimmune conditions (univariate analysis, p<0.001), although there were no differences in overall severity in the multivariate analysis. CONCLUSIONS This study confirms and provides new insights regarding the harmful effects of corticosteroids, rituximab and other therapies (mycophenolate and sulfasalazine) in COVID-19. Methotrexate and anti-TNF therapy were not associated with worse outcomes.

Background:The pathological class of lupus nephritis (LN) may change to a different class during the course of the disease. Renal biopsy is repeated is repeated in many patients during a flare but there is there is no agreement about systematically recommending them because proliferative lesions on their original biopsy rarely switch to a pure nonproliferative nephritis during a flare. However, renal rebiopsy may be useful in some cases to make appropriate adjustments or changes of treatment.Objectives:To analyze the impact of renal rebiopsy on the therapeutic approach in patients with previous histological diagnosis of LN who experience a worsening in the clinical parameters of renal involvement.Methods:Retrospective study of patients with histological diagnosis of NL subjected to at least one renal biopsy. We studied the demographic, clinical, histopathological variables of the first and subsequent renal biopsies, received treatment and the therapeutic modifications in relation to the result of the rebiopsies.Results:We analyzed 35 patients diagnosed with LN between 1978 and 2017. 9 of them had been rebiopsied at least on one occasion and made a total of 11 rebiopsies (7 patients with a rebiopsy and 2 patients with 2 rebiopsies). All patients were female and Caucasian, except for a Hispanic woman, with a mean age at the time of the rebiopsy of 31 ± 12 years (14-55). The mean serum creatinine at the time of the first re-biopsy was 0.8 ± 0.17 mg/dl (0.5-1.06) and in the second, 1.18 ± 0.05 mg/dl (1.15-1.23). The fundamental indication for the rebiopsy was the increase in proteinuria, up to non-nephrotic range in 64% of the patients and within the nephrotic range in 36%. In comparison with the previous biopsy, 3 of the rebiopsies (27%) showed evolution from a non-proliferative to a proliferative form (from II to III, from II to IV and from V to V + IV). 4 of the rebiopsies (36%) started from a proliferative class and changed class but within these forms (3 from IV to III and and 1 from III to IV). The remaining 4 rebiopsies (27%) showed no change in the histological type. Regarding the baseline biopsy, we observed a decrease in the index of activity of the rebiopsies (5.4 ± 2.2 vs 3.4 ± 2.5, p = 0.017) and an increase in the chronicity index (0.8 ± 0.7 vs 2.9 ± 3.2, p = 0.027). In all cases, therapeutic modifications were carried out. In 9 cases (82%) the immunosuppression was increased and in two of them (18%) it was decreased.Conclusion:The repetition of renal biopsy in cases of LN with clinical data of renal deterioration is relevant. The change of histological class and the evolution of activity and chronicity indexes support the decision to increase immunosuppression and are fundamental to diminish it.References[1] Narváez J, et al. The value of repeat biopsy in lupus nephritis flares. Medicine (Baltimore). 2017;96:e7099.Disclosure of Interests:None declared

Background:Juvenile Idiopathic Arthritis (JIA) is a heterogeneous group of pediatric diseases. Different response to biological treatment (BT) has been reported according to disease subtype.Objectives:To analyze the prescription and withdrawal of BT in JIA patients with focus on JIA category.Methods:A retrospective observational study was conducted on JIA patients followed in a referal hospital and who had received at least one BT between 1999 and 2019.Results:130 JIA patients were analyzed: 29 (22,4%) were Oligoarticular Persistent (OligP), 22 (16,9%) Enthesitis related Arthritis (ERA), 20 (15,4%) Systemic (sJIA), 19 (14,6%) Polyarticular RF- (PolyRF-), 14 (10,8%) Polyarticular RF+(PolyRF+), 13 (10%) Oligoarticular-Extended (OligE), 11 (8,4%) Psoriatic Arthritis (APso) and 2 (1,5%) Undifferentiated (Und).The main characteristics are summarized in table 1.The first line BT most frequently indicated was Etanercept up to 40% in all the categories except for ERA, where the most frequent BT was Adalimumab and sJIA, where the most frequent BT was Anakinra. The time between diagnosis and start of BT was different among the categories (p=0,007). In the Und category, the time until BT was the shortest (median: 1 month), since both patients had coxitis, followed by APso [median: 9 months IQR(1-57)] and sJIA [median: 17,5 months IQR(0,3-146,8)].The survival of the first BT was different among the categories (p=0,006): 94,7% of the ERA continue receiving the first BT, followed by 76,2% of OligP and 50% of PolyRF+ and APso. Only 42% of sJIA continue on the first BT prescribed [up to 53,3% were TNF inhibitors (TNFi)]. The categories with less retention of the first BT were: OligE (25%); PolyRF- (27,3%) and Und (0%). The most frequent cause of discontinuation, among these categories, was secondary failure.In the survival analysis between categories, there were differences on OligP (p=0,004), OligE (p=0,042) and PolyRF- (p=0,017). Tocilizumab and Adalimumab were the BT with highest survival with regards to Infliximab, Etanercept, Rituximab (OligE, PolyRF-), Abatacept (OligE, PolyRF-) and Certolizumab (OligP). The survival rate of IL1 inhibitiors and IL6 inhibitiors was higher regarding to TNFi in sJIA patients (p=0,013).Conclusion:Taking into account JIA category is mandatory to choose BT and to understand the response and discontinuation of BT. OligE and PolyRF - showed a high rate of change of the first BT related to secondary failure of Etanercept and Infliximab when compared to Adalimumab and Tocilizumab, as described in the survival analysis. The category with the highest retention of the first BT was ERA. UND patients started sooner BT due to the presence of coxitis. In sJIA, IL1 inhibitors and IL6 inhibitors were superior to TNFi in the survival analysis, as reported in existing literature.Table:Disclosure of Interests:None declared