Incidence of COVID-19 Hospitalisation in Patients with Systemic Lupus Erythematosus: A Nationwide Cohort Study from Denmark

Cordtz, René; Kristensen, Salome; Dalgaard, Louise Plank Holm; Westermann, Rasmus; Duch, Kirsten; Lindhardsen, Jesper; Torp‐Pedersen, Christian; Dreyer, Lene

doi:10.3390/jcm10173842

Cited by 30 publications

(32 citation statements)

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“…We found a relatively low number of patients with SLE among the French population with COVID-19-AOF (196 of 113 371, 0.2%) between March and November 2020, whereas Cordtz et al 21 recently reported an increased risk of hospitalisation for SLE patients with COVID-19 in Denmark compared with the general population. It might be due to a lack of precision in coding SLE procedures; however, our results fit well with the prevalence of SLE in France, estimated at 5 for 10 000 22.…”

Section: Discussioncontrasting

confidence: 64%

Survival after COVID-19-associated organ failure among inpatients with systemic lupus erythematosus in France: a nationwide study

et al. 2021

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ObjectiveWe analysed the incidence of, the specific outcomes and factors associated with COVID-19-associated organ failure (AOF) in patients with systemic lupus erythematosus (SLE) in France.MethodsWe performed a cohort study using the French national medical/administrative hospital database for the January 2011–November 2020 period. Each patient with SLE diagnosed in a French hospital with a COVID-19-AOF until November 2020 was randomly matched with five non-SLE patients with COVID-19-AOF. We performed an exact matching procedure taking age ±2 years, gender and comorbidities as matching variables. COVID-19-AOF was defined as the combination of at least one code of COVID-19 diagnosis with one code referring to an organ failure diagnosis.ResultsFrom March to November 2020, 127 380 hospital stays in France matched the definition of COVID-19-AOF, out of which 196 corresponded with patients diagnosed with SLE. Based on the presence of comorbidities, we matched 908 non-SLE patients with COVID-19-AOF with 190 SLE patients with COVID-19-AOF. On day 30, 43 in-hospital deaths (22.6%) occurred in SLE patients with COVID-19-AOF vs 198 (21.8%) in matched non-SLE patients with COVID-19-AOF: HR 0.98 (0.71–1.34). Seventy-five patients in the SLE COVID-19-AOF group and 299 in the matched control group were followed up from day 30 to day 90. During this period, 19 in-hospital deaths occurred in the SLE group (25.3%) vs 46 (15.4%) in the matched control group; the HR associated with death occurring after COVID-19-AOF among patients with SLE was 1.83 (1.05–3.20).ConclusionsCOVID-19-AOF is associated with a poor late-onset prognosis among patients with SLE.

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Section: Discussioncontrasting

confidence: 64%

Survival after COVID-19-associated organ failure among inpatients with systemic lupus erythematosus in France: a nationwide study

et al. 2021

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“…4 Several case series or single-centre/country studies suggest that some individuals with SLE can have a severe disease course, but the small size of these studies has precluded a comprehensive analysis of risk factors for poor COVID-19 outcomes. [5][6][7][8][9][10] We used the C19-GRA registry to identify sociodemographic and clinical factors associated with more severe COVID-19 outcomes in individuals with SLE.…”

Section: Systemic Lupus Erythematosusmentioning

confidence: 99%

“…OpenSAFELY, a large analysis of primary care records of >17 million adults linked to 10 926 COVID-19-related deaths reported that after adjustment for a wide variety of factors such as demographic characteristics and comorbidities, those with autoimmune disease (SLE, RA or psoriasis as a group) had a higher risk of mortality, but this study did not adjust for medication use, nor did it evaluate SLE as a discrete or separate disease 4. Several case series or single-centre/country studies suggest that some individuals with SLE can have a severe disease course, but the small size of these studies has precluded a comprehensive analysis of risk factors for poor COVID-19 outcomes 5–10…”

Section: Introductionmentioning

confidence: 96%

Characteristics associated with poor COVID-19 outcomes in individuals with systemic lupus erythematosus: data from the COVID-19 Global Rheumatology Alliance

et al. 2022

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AimTo determine characteristics associated with more severe outcomes in a global registry of people with systemic lupus erythematosus (SLE) and COVID-19.MethodsPeople with SLE and COVID-19 reported in the COVID-19 Global Rheumatology Alliance registry from March 2020 to June 2021 were included. The ordinal outcome was defined as: (1) not hospitalised, (2) hospitalised with no oxygenation, (3) hospitalised with any ventilation or oxygenation and (4) death. A multivariable ordinal logistic regression model was constructed to assess the relationship between COVID-19 severity and demographic characteristics, comorbidities, medications and disease activity.ResultsA total of 1606 people with SLE were included. In the multivariable model, older age (OR 1.03, 95% CI 1.02 to 1.04), male sex (1.50, 1.01 to 2.23), prednisone dose (1–5 mg/day 1.86, 1.20 to 2.66, 6–9 mg/day 2.47, 1.24 to 4.86 and ≥10 mg/day 1.95, 1.27 to 2.99), no current treatment (1.80, 1.17 to 2.75), comorbidities (eg, kidney disease 3.51, 2.42 to 5.09, cardiovascular disease/hypertension 1.69, 1.25 to 2.29) and moderate or high SLE disease activity (vs remission; 1.61, 1.02 to 2.54 and 3.94, 2.11 to 7.34, respectively) were associated with more severe outcomes. In age-adjusted and sex-adjusted models, mycophenolate, rituximab and cyclophosphamide were associated with worse outcomes compared with hydroxychloroquine; outcomes were more favourable with methotrexate and belimumab.ConclusionsMore severe COVID-19 outcomes in individuals with SLE are largely driven by demographic factors, comorbidities and untreated or active SLE. Patients using glucocorticoids also experienced more severe outcomes.

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“…The risk for hospitalization was three-fold higher than the general population as per a nationwide study in Denmark [ 23 ]. There was an increased risk associated with race (odds ratio [OR] 7.78 for non-Whites versus Whites, 95% CI 1.13–53.58), presence of comorbidities (OR 4.66, 95% CI 1.02–21.20), and body mass index (BMI) (1.08 per increase in kg/m 2 , 95% CI 0.99–1.18) as per results from the New York University (NYU) Lupus Cohort [ 24 ].…”

Section: Features Of Covid-19 In Patients With Sle and Effects Of Drugsmentioning

confidence: 99%

Systemic lupus erythematosus in the light of the COVID-19 pandemic: infection, vaccination, and impact on disease management

et al. 2022

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Patients with systemic lupus erythematosus (SLE) form a vulnerable group in terms of the impact of the COVID-19 pandemic on disease management. We conducted this overview by searches through Medline/PubMed, Scopus, and the Directory of Open Access Journals (DOAJ). The prevalence and severity of COVID-19, efficacy of COVID-19 vaccination, impact on the management of SLE, and the attitudes of SLE patients to COVID-19 and vaccination were explored. After screening and due exclusions, 198 studies were included for the final review. Patients with SLE have a greater risk of acquiring COVID-19 (0.6–22%) and related hospitalization (30%), severe disease (13.5%), and death (6.5%) than the general population. Older age, male gender, comorbidities, moderate or high disease activity, and glucocorticoid, rituximab, and cyclophosphamide use are associated with unfavorable outcomes, whereas methotrexate and belimumab use showed no association with outcomes. COVID-19 vaccines are safe in SLE with minimal risk of severe flares (< 2%). Vaccine efficacy is negatively associated with glucocorticoids. The overall attitude of patients towards vaccination is positive (54–90%). The pandemic has negatively affected access to medical care, hospitalizations, procurement of drugs, employment, and the mental health of patients which need to be addressed as part of holistic care in SLE. Key Points • Lupus patients are at a greater risk of acquiring COVID-19, related hospitalization, severe disease, and death than the general population. • COVID-19 vaccines are relatively safe for lupus patients with minimal risk of severe flares. • Lupus patients’ attitude towards COVID-19 vaccination is predominantly positive.

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Incidence of COVID-19 Hospitalisation in Patients with Systemic Lupus Erythematosus: A Nationwide Cohort Study from Denmark

Cited by 30 publications

References 28 publications

Survival after COVID-19-associated organ failure among inpatients with systemic lupus erythematosus in France: a nationwide study

Survival after COVID-19-associated organ failure among inpatients with systemic lupus erythematosus in France: a nationwide study

Characteristics associated with poor COVID-19 outcomes in individuals with systemic lupus erythematosus: data from the COVID-19 Global Rheumatology Alliance

Systemic lupus erythematosus in the light of the COVID-19 pandemic: infection, vaccination, and impact on disease management

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