Identifying Characteristics and Outcomes of COVID-19 in Patients With Systemic Lupus Erythematosus

Patients with systemic lupus erythematosus (SLE) may be at similar risk for coronavirus disease 2019 (COVID-19) as the general population, according to study results published in Arthritis & Rheumatology.

Using data from patients in the New York University hospital system and Bellevue Hospital Center, New York, investigators aimed to characterize the presentation and progression of COVID-19 in patients with SLE.

A total of 226 patients with SLE (92.9% women) were identified, including 41 patients with confirmed COVID-19, 19 patients with a negative reverse transcription polymerase chain reaction (RT-PCR) test despite COVID-19-like symptoms or known exposure, 42 patients with COVID-19-like symptoms with no test, and 124 patients without any symptoms who were not tested for COVID-19.

Patients with confirmed COVID-19 were predominantly women (92.7%) and Black (41.5%) or Hispanic (36.6%). The most commonly observed symptoms of COVID-19 were cough (78.4%), fever (64.9%), and shortness of breath (64.9%). The majority of patients were receiving hydroxychloroquine (78%); 43.9% were receiving systemic steroids and 58.5% were receiving ≥1 immunosuppressants. The most common immunosuppressant was mycophenolate mofetil (24.4%), followed by tacrolimus (12.2%).

Hospitalization was required for 24 (58.5%) patients with confirmed COVID-19, of whom 52.7% required supplemental oxygen, 16.7% required admission to the intensive care unit, and 13% required intubation and mechanical ventilation. Four patients died of respiratory failure, a majority of whom (75%) were non-White, women, and experiencing ≥1 comorbidity. All patients who died were receiving hydroxychloroquine. Compared with patients with COVID-19 who did not require hospitalization, those who were treated in the hospital setting were older, less likely to be White, and more likely to have a history of ≥1 comorbid condition. In multivariable analyses, the non-White race (odds ratio [OR], 7.78; 95% CI, 1.13-53.58; P =.037), the presence of ≥1 comorbidities (OR, 4.66; 95% CI, 1.02-21.20; P =.047), and body mass index (OR, 1.08 per kg/m² increase; 95% CI, 0.99-1.18; P =.096) were independent predictors of hospitalization.

Among patients with COVID-19-like symptoms with no test, cough (52.4%), fever (45.2%), and sore throat (38.1%) were the most common symptoms. Sex and racial/ethnic demographics were similar to those of patients with confirmed COVID-19; however, patients with COVID-19-like symptoms vs confirmed COVID-19 were slightly younger (41 vs 47 years, respectively) and lesser frequent lupus nephritis (7.1% vs 34.1%, respectively). Other comorbidities were also less common. Use of hydroxychloroquine and immunosuppressants were similar between groups, but the use of systemic steroids was lower in the group with suspected COVID-19 (11.9% vs 43.9%, respectively).

Cough (36.8%), fever (36.8%), shortness of breath (31.6%), and sore throat (31.6%) were also the most common symptoms in patients who tested negative for COVID-19. Because of a high index of suspicion, 6 patients were tested multiple times, among whom 2 were hospitalized (1 for severe thrombocytopenia [with an incidental finding of lung infiltrates] and 1 for end-stage kidney disease).

Investigators noted that the availability and accuracy of testing represented limitations of the study.

“[O]ur data suggest that patients with SLE and COVID-19 have a high rate of hospitalization but a similar mortality rate to the general population in [New York City],” they concluded. “There is insufficient evidence to conclude with our data that SLE-specific factors additionally contribute to the risk of hospitalization.”

Disclosures: Several authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.

Reference

Fernandez-Ruiz R, Masson M, Kim MY, et al. Leveraging the United States epicenter to provide insights on COVID-19 in patients with systemic lupus erythematosus. Arthritis Rheumatol. Published online July 26, 2020. doi:10.1002/art.41450