Patients with a systemic rheumatic disease hospitalized with COVID-19 may be at increased risk for severe outcomes, including hyperinflammation, kidney injury, admission to the intensive care unit (ICU), and mechanical ventilation, according to study results published in the Lancet Rheumatology.

Previous studies have shown that excessive inflammation may be associated with risk for poor outcomes in patients with COVID-19. However, data are mixed on the risk for severe COVID-19 in patients with systemic rheumatic diseases.

The objective of the current study was to determine whether a systemic rheumatic disease is a risk factor for hyperinflammation and respiratory failure from COVID-19.

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The retrospective study included patients with a systemic rheumatic disease aged 18 years and older and admitted to Mass General Brigham for COVID-19. For every patient, up to 5 comparator participants who were hospitalized with COVID-19 were matched based on age, sex, and date of initial positive polymerase chain reaction (PCR) test.

Laboratory results were compared by case status and COVID-19-associated hyperinflammation score (cHIS), a composite score that integrates laboratory results measuring 6 domains routinely and repeatedly collected during COVID-19 hospital admission. The associations between diagnosis of a systemic rheumatic disease, cHIS score, and in-hospital COVID-19 clinical outcomes, including ICU admission, mechanical ventilation, and mortality, were determined.

The study sample included 57 patients (mean age, 66.8 years; 67% women) with a systemic rheumatic disease and 232 (mean age, 67.5 years; 68% women) matched comparator participants. Interstitial lung disease and chronic kidney disease were more common among patients with a systemic rheumatic disease than among the comparator participants (12% vs 2%; P =.0014 and 18% vs 8%; P =.035, respectively), but no significant differences were noted for other individual comorbidities.

Patients with a systemic rheumatic disease vs comparator participants had higher peak median neutrophil-to-lymphocyte ratio (9.6 vs 7.8; P =.021), lactate dehydrogenase (421 vs 345 U/L; P =.044), creatinine concentration (1.2 vs 1.0 mg/dL; P =.014), and blood urea nitrogen concentration (31 vs 23 mg/dL, respectively; P =.033).

Although compared with the control participants the patients with a systemic rheumatic disease had numerically higher median C-reactive protein (CRP) concentrations on each hospital day, there was no significant difference between the 2 groups in median CRP concentration (P =.30). The other laboratory results were not significantly different between the groups during the first 14 days of hospitalization.

Peak median cHIS was significantly higher among patients with a systemic rheumatic disease vs comparator participants (3 vs 2, respectively; P =.013). After adjustment for age, sex, and history of a systemic rheumatic disease, peak cHIS of 2 or more vs less than 2 was associated with a significantly increased risk for ICU admission (odds ratio [OR], 3.45; 95% CI, 1.98-5.99), mechanical ventilation (OR, 66.20; 95% CI, 8.98-487.80), and in-hospital mortality (OR, 16.37; 95% CI, 4.75-56.38).

A total of 22 patients with a systemic rheumatic disease and 44 (98%) comparator participants who required mechanical ventilation had peak cHIS of 2 or more.

Risk of being admitted to the ICU (adjusted OR, 2.08; 95% CI, 1.09-3.96) or requiring mechanical ventilation (adjusted OR, 2.60; 95% CI, 1.32-5.12) was significantly higher among patients with a systemic rheumatic disease than among comparator participants. Risk for in-hospital mortality was not different between the 2 groups. However, postdischarge outcomes were not significantly different among participants who survived the initial hospital stay.

The small sample size and potential selection bias were important limitations of the study. The study was conducted early during the COVID-19 pandemic and outcomes have since improved. The multivariable analyses did not include adjustment for postbaseline factors, for characteristics of the underlying rheumatic disease, and for treatment during the hospital stay.

“These results suggest that patients with a rheumatic disease might be vulnerable to poor outcomes during the initial hospital stay for COVID-19,” the researchers concluded.

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Hsu TYT, D’Silva KM, Patel NJ, et al. Laboratory trends, hyperinflammation, and clinical outcomes for patients with a systemic rheumatic disease admitted to hospital for COVID-19: a retrospective, comparative cohort study. Lancet Rheumatol. Published online May 28, 2021. doi:10.1016/S2665-9913(21)00140-5