Characterization and Outcomes of SARS-CoV-2 Infection in Patients with Sarcoidosis

Abstract

To analyze the clinical characteristics and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with sarcoidosis from a large multicenter cohort from Southern Europe and to identify the risk factors associated with a more complicated infection. We searched for patients with sarcoidosis presenting with SARS-CoV-2 infection (defined according to the European Centre for Disease Prevention and Control guidelines) among those included in the SarcoGEAS Registry, a nationwide, multicenter registry of patients fulfilling the American Thoracic Society/European Respiratory Society/World Association of Sarcoidosis and Other Granulomatous Disorders 1999 classification criteria for sarcoidosis. A 2:1 age-sex-matched subset of patients with sarcoidosis without SARS-CoV-2 infection was selected as control population. Forty-five patients with SARS-CoV-2 infection were identified (28 women, mean age 55 years). Thirty-six patients presented a symptomatic SARS-CoV-2 infection and 14 were hospitalized (12 required supplemental oxygen, 2 intensive care unit admission and 1 mechanical ventilation). Four patients died due to progressive respiratory failure. Patients who required hospital admission had an older mean age (64.9 vs. 51.0 years, p = 0.006), a higher frequency of baseline comorbidities including cardiovascular disease (64% vs. 23%, p = 0.016), diabetes mellitus (43% vs. 13%, p = 0.049) and chronic liver/kidney diseases (36% vs. 0%, p = 0.002) and presented more frequently fever (79% vs. 35%, p = 0.011) and dyspnea (50% vs. 3%, p = 0.001) in comparison with patients managed at home. Age- and sex-adjusted multivariate analysis identified the age at diagnosis of SARS-Cov-2 infection as the only independent variable associated with hospitalization (adjusted odds ratio 1.18, 95% conficence interval 1.04–1.35). A baseline moderate/severe pulmonary impairment in function tests was associated with a higher rate of hospitalization but the difference was not statistically significant (50% vs. 23%, p = 0.219). A close monitoring of SARS-CoV-2 infection in elderly patients with sarcoidosis, especially in those with baseline cardiopulmonary diseases and chronic liver or renal failure, is recommended. The low frequency of severe pulmonary involvement in patients with sarcoidosis from Southern Europe may explain the weak prognostic role of baseline lung impairment in our study, in contrast to studies from other geographical areas.

Systemic Autoimmune Diseases in Patients Hospitalized with COVID-19 in Spain: A Nation-Wide Registry Study

“…In addition, we confirmed in one of the largest studies exploring COVID-19 outcomes in patients with rheumatic diseases, that neither SLE, SjS, Sarcoidosis, SSc, IIM, MUCTD BD or SV, individually, were associated with a higher mortality risk. Whilst previous reports have analyzed the impact of SLE or Sarcoidosis with similar conclusions, we identified that some of these diseases, less studied due to their lower prevalence, do not relate to worse COVID-19 outcomes [ 35 , 36 , 37 ].…”

Sarcoidosis and COVID-19: At the Cross-Road between Immunopathology and Clinical Manifestation

“…The most frequently reported symptoms are cough (67%), fever (61%), fatigue (42%), and myalgias (28%); conversely, only a minority of patients had dyspnea (22%). Moreover, 31% of patients were hospitalized, and 9% died following COVID-19 infection [ 67 ]. During the first pandemic wave, a similar prevalence was reported in a small case series of African American patients in the US (2.1%), with a mortality of 20% in 5 infected patients [ 68 ].…”

Autophagy and Mitophagy-Related Pathways at the Crossroads of Genetic Pathways Involved in Familial Sarcoidosis and Host-Pathogen Interactions Induced by Coronaviruses

“…Nevertheless, the clinical impact of COVID-19 appears to be more frequent in sarcoidosis patients having a severe pulmonary or neurological involvement [110]. Some sarcoidosis-induced phenotypes are clearly associated with an increased risk of severe outcome and/or death, such as severe basal impaired pulmonary function in three independent studies [111][112][113], and chronic liver and kidney disease [114,115], together with classical unfavorable factors well known in the general population, such as diabetes and obesity. Interestingly, Afro-American patients with chronic sarcoidosis treated with antirheumatic or anti-TNF (Tumor Necrosis Factor) therapies do not appear to be at higher risk of life-threatening complications after SARS-CoV2 infection [116].…”