Preexisting Autoimmunity Is Associated With Increased Severity of Coronavirus Disease 2019: A Retrospective Cohort Study Using Data From the National COVID Cohort Collaborative (N3C)

Abstract

Background Identifying individuals with a higher risk of developing severe COVID-19 outcomes will inform targeted or more intensive clinical monitoring and management. To date, there is mixed evidence regarding the impact of pre-existing autoimmune disease (AID) diagnosis and/or immunosuppressant (IS) exposure on developing severe COVID-19 outcomes. Methods A retrospective cohort of adults diagnosed with COVID-19 was created in the National COVID Cohort Collaborative enclave. Two outcomes, life-threatening disease, and hospitalization were evaluated by using logistic regression models with and without adjustment for demographics and comorbidities. Results Of the 2,453,799 adults diagnosed with COVID-19, 191,520 (7.81%) had a pre-existing AID diagnosis and 278,095 (11.33%) had a pre-existing IS exposure. Logistic regression models adjusted for demographics and comorbidities demonstrated that individuals with a pre-existing AID (OR = 1.13, 95% CI 1.09 - 1.17; P< 0.001), IS (OR= 1.27, 95% CI 1.24 - 1.30; P< 0.001), or both (OR = 1.35, 95% CI 1.29 - 1.40; P< 0.001) were more likely to have a life-threatening COVID-19 disease. These results were consistent when evaluating hospitalization. A sensitivity analysis evaluating specific IS revealed that TNF inhibitors were protective against life-threatening disease (OR = 0.80, 95% CI 0.66- 0.96; P=0.017) and hospitalization (OR = 0.80, 95% CI 0.73 - 0.89; P< 0.001). Conclusions Patients with pre-existing AID, exposure to IS, or both are more likely to have a life-threatening disease or hospitalization. These patients may thus require tailored monitoring and preventative measures to minimize negative consequences of COVID-19.

The risk of COVID-19 in IBD patients is increased by urban living and is not influenced by disease activity or intravenous biologics

“…• Rural area 13 18 (28.9) 26 19 Recent data suggest that pre-existing auto-immune disease is associated with increased severity of COVID-19, but IBD was not the most frequent auto-immune disease in the dataset and the same study showed a protective effect of anti-TNF therapy, which is the most frequently used in patients with IBD (38). Conversely, the BELCOMID study described a benign course of COVID-19 infection in a cohort of more than 2000 patients with immune mediated inflammatory diseases (IMID) of whom more than 60% had IBD (39).…”

Early immune factors associated with the development of post-acute sequelae of SARS-CoV-2 infection in hospitalized and non-hospitalized individuals

“…Previous studies have found increased autoantibodies to be associated with COVID-19 and PASC ( 6 , 54 – 60 ), though the findings associating PASC and autoantibodies have been inconsistent ( 61 ). Additionally, prior autoimmunity and antibody cross-reactivity between tissue proteins and SARS-CoV-2 antigens could also be contributing to the pathophysiology of COVID-19, and hence, PASC ( 62 , 63 ). We did not observe any significant differences in antibodies against SARS-CoV-2 or other common viral pathogens between hospitalized PASC and non-PASC participants, indicating that hospitalized PASC participants likely have a functional acute immune response against the SARS-CoV-2 virus, similar to that of hospitalized non-PASC participants.…”