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Abstract

Background Coronavirus-19, primarily a respiratory virus, affects multiple organs and can lead to exacerbation of autoimmune or systemic conditions. Patients with autoimmune diseases, rheumatoid arthritis particularly, are susceptible to infection and complications from COVID-19. RA has become well-associated with COVID-19 infections, but large-scale studies evaluating outcomes among this vulnerable group are limited. Methods For the retrospective analysis, we used the National Inpatient Sample database to compare COVID-19 patients with and without RA. A total of 1,050,040 adult hospitalizations were included in the study between January 1 to December 31, 2020: COVID-19 with RA (n = 21,545; 2.1%) and COVID-19 without RA (n = 1,028,495; 97.9%). The primary outcome was in-hospital mortality. Secondary outcomes included mechanical ventilation requirement, vasopressor use, cardiac arrest, cardiogenic shock, acute kidney injury, acute kidney injury requiring hemodialysis, gastrostomy, tracheostomy, length of stay, health care utilization costs, and disposition. A secondary analysis evaluating in-hospital mortality and mechanical ventilation with respect to age was conducted. Results COVID-19 patients with RA had significantly increased in-hospital mortality compared to COVID-19 patients without RA (12.9% vs 11.1%, adjusted OR [aOR]: 1.2 [95% CI 1.1-1.3], p < 0.001). This cohort also had significantly increased rates of mechanical ventilation, pressor use, and cardiogenic shock. Conclusions Given limited large evidence regarding COVID-19 with respect to RA, future research should be focused on this topic to improve outcomes for this subset of patients.

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