Higher Risk for Mortality and Poor Outcomes Among Patients With SLE Hospitalized With COVID-19-Associated ARDS

nurse checking on hospitalized patient, ventilator, COVID19
Nurse is checking a covid patient’s drip needle at the ICU
Researchers assessed the risk for mortality and poor outcomes in patients with systemic lupus erythematosus hospitalized with COVID-19 acute respiratory distress syndrome.

Compared with individuals without SLE and other comorbidities, those with systemic lupus erythematosus (SLE) hospitalized due to COVID-19-associated acute respiratory distress syndrome (ARDS) have a significantly higher risk for mortality and poor outcomes, according to study findings published in ACR Open Rheumatology.

Researchers sought to evaluate the risk for mortality and combined poor outcomes (ie, death, admission to an intensive care unit [ICU], and/or use of mechanical ventilation) among hospitalized patients with SLE and COVID-19-associated ARDS compared with those without SLE hospitalized with COVID-19.

A first-of-its-kind, nationwide, cross-sectional study was conducted among patients with SARS-CoV-2 infection enrolled in the national Influenza Epidemiological Surveillance Information System (Sistema de Informação de Vigilância Epidemiológica da Gripe [SIVEP-gripe]) in Brazil.

Researchers assessed mortality rates, frequency of ICU admissions, and use of mechanical among 319 patients with SLE and 251,800 individuals without SLE.

Between January and August 2020, a total of 607,326 cases of ARDS were reported in Brazil, among which 51.4% (n=312,419) were due to COVID-19. A total of 80.7% of these cases were reverse transcription polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 infection.

According to the positive RT-PCR cohort analysis, participants with vs without SLE were significantly younger (45.5±16.5 vs 58.7±18.9 years, respectively; P <.0001), with a significantly greater prevalence of women (85.9% vs 43.8%, respectively; P <.001).

Participants with vs without SLE had a significantly increased risk for mortality and combined poor outcomes (relative risk [RR], 1.738; 95% CI, 1.557-1.914 and RR, 1.391; 95% CI, 1.282-1.492, respectively). Among all comorbidities, SLE was associated with a higher risk for death and combined poor outcomes (RR, 2.205; 95% CI, 1.780-2.633 and RR, 1.654; 95% CI, 1.410-1.881, respectively).

Limitations of the analysis included the study design and lack of data regarding SLE classification criteria, disease activity, and damage indexes.

The researchers concluded, “This is an important alert to those caring for patients with SLE, and it is an additional reinforcement of the importance of preventive measures, such as vaccines, during a pandemic for this population.”


Bertoglio IM, Valim JML, Daffre D, et al. Poor prognosis of COVID-19 acute respiratory distress syndrome in lupus erythematosus: nationwide cross-sectional population study of 252 119 patients. ACR Open Rheumatol. Published online August 23, 2021. doi:10.1002/acr2.11329