scholarly journals Clinical outcomes of hospitalised patients with COVID-19 and chronic inflammatory and autoimmune rheumatic diseases: a multicentric matched cohort study

2020 ◽  
Vol 79 (12) ◽  
pp. 1544-1549 ◽  
Author(s):  
Jose L Pablos ◽  
María Galindo ◽  
Loreto Carmona ◽  
Ana Lledó ◽  
Miriam Retuerto ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Rheumatic Diseases ◽  
Connective Tissue Diseases ◽  
Severe Illness ◽  
Inflammatory Rheumatic Diseases ◽  
Hospitalised Patients ◽  
Male Sex ◽  
The Impact ◽  
Rheumatic Patients

ObjectivesThe impact of inflammatory rheumatic diseases on COVID-19 severity is poorly known. Here, we compare the outcomes of a cohort of patients with rheumatic diseases with a matched control cohort to identify potential risk factors for severe illness.MethodsIn this comparative cohort study, we identified hospital PCR+COVID-19 rheumatic patients with chronic inflammatory arthritis (IA) or connective tissue diseases (CTDs). Non-rheumatic controls were randomly sampled 1:1 and matched by age, sex and PCR date. The main outcome was severe COVID-19, defined as death, invasive ventilation, intensive care unit admission or serious complications. We assessed the association between the outcome and the potential prognostic variables, adjusted by COVID-19 treatment, using logistic regression.ResultsThe cohorts were composed of 456 rheumatic and non-rheumatic patients, in equal numbers. Mean age was 63 (IQR 53–78) years and male sex 41% in both cohorts. Rheumatic diseases were IA (60%) and CTD (40%). Most patients (74%) had been hospitalised, and the risk of severe COVID-19 was 31.6% in the rheumatic and 28.1% in the non-rheumatic cohort. Ageing, male sex and previous comorbidity (obesity, diabetes, hypertension, cardiovascular or lung disease) increased the risk in the rheumatic cohort by bivariate analysis. In logistic regression analysis, independent factors associated with severe COVID-19 were increased age (OR 4.83; 95% CI 2.78 to 8.36), male sex (1.93; CI 1.21 to 3.07) and having a CTD (OR 1.82; CI 1.00 to 3.30).ConclusionIn hospitalised patients with chronic inflammatory rheumatic diseases, having a CTD but not IA nor previous immunosuppressive therapies was associated with severe COVID-19.

scholarly journals Clinical Outcomes of Patients with COVID-19 and Chronic Inflammatory and Autoimmune Rheumatic Diseases: A Multicentric Matched-Cohort Study

2020 ◽  
Author(s):  
José L. Pablos ◽  
María Galindo ◽  
Loreto Carmona ◽  
Miriam Retuerto ◽  
Ana Lledó ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Rheumatic Diseases ◽  
Bivariate Analysis ◽  
Severe Illness ◽  
Inflammatory Rheumatic Diseases ◽  
Potential Risk Factors ◽  
Male Sex ◽  
The Impact ◽  
Rheumatic Patients

ABSTRACTBackgroundThe impact of inflammatory rheumatic diseases on COVID-19 severity is poorly known. Here we compare the outcomes of a cohort of rheumatic patients with a matched control cohort to identify potential risk factors for severe illness.MethodsIn this comparative cohort study, we identified hospital PCR+ COVID-19 rheumatic patients with chronic inflammatory arthritis (IA) or autoimmune/immunomediated diseases (AI/IMID). Non-rheumatic controls were randomly sampled 1:1, and matched by age, sex, and PCR date. The main outcome was severe COVID-19, defined as death, invasive ventilation, ICU admission, or serious complications. We assessed the association between the outcome and potential prognostic variables, adjusted by COVID treatment, using logistic regression.ResultsThe cohorts were composed of 456 rheumatic and non-rheumatic patients, in equal numbers. Mean age was 63 [IQR 53-78] and male sex 41% in both cohorts. Rheumatic diseases were IA (60%) and AI/IMID (40%). Most patients (74%) had been hospitalised, and the risk of severe COVID was 31.6% in the rheumatic and 28.1% in the non-rheumatic cohort. Ageing, male sex and previous comorbidity (obesity, diabetes, hypertension, cardiovascular, or lung disease) increased the risk in the rheumatic cohort by bivariate analysis. In logistic regression analysis, independent factors associated with severe COVID were increased age (OR 5.31; CI 3.14-8.95), male sex (2.13; CI 1.35-3.36) and having an AI/IMID (OR 1.98; CI 1.15-3.41).ConclusionIn patients with chronic inflammatory rheumatic diseases aging, sex and having an AI/IMID but not IA nor previous immunosuppressive therapies were associated with severe COVID-19.

scholarly journals POS1260 FACTORS ASSOCIATED WITH SEVERE SARS-COV-2 INFECTION IN PATIENTS WITH INFLAMMATORY RHEUMATIC DISEASES IN MADRID: RESULTS FROM REUMA-COVID SORCOM REGISTRY

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 914-914
Author(s):  
A. Boteanu ◽  
A. García Fernández ◽  
N. De la Torre ◽  
M. Pavia Pascual ◽  
O. Sanchez Pernaute ◽  
...  
Keyword(s):  
High Risk ◽  
Rheumatic Diseases ◽  
Connective Tissue Diseases ◽  
Severe Infection ◽  
Pulmonary Involvement ◽  
Inflammatory Rheumatic Diseases ◽  
Factors Associated ◽  
Risk Of Death ◽  
Cardiovascular Comorbidities ◽  
Male Sex

Background:Patients with inflammatory rheumatic diseases (IRD) infected with SARS-CoV-2 may be at risk to develop a severe course of COVID-19 due to the immune dysregulation or the influence of immunomodulating drugs on the course of the infection. For a better understanding of SARS-CoV-2 infections in patients with IRD and due to the high incidence of COVID-19 in Madrid from the beginning of this pandemic infection in Spain, the Society of Rheumatology from Madrid (SORCOM) established a registry (REUMA-COVID SORCOM) shortly after the beginning of the pandemic in Spain.Objectives:To determine factors associated with severity of infection with SARS-CoV-2 in patients with inflammatory rheumatic diseases in MadridMethods:The REUMA-COVID SORCOM registry is a multicenter, retrospective, observational cohort study conducted in Madrid, a SORCOM initiative. All rheumatology departments from Madrid were invited to participate. The study includes patients with IRD presenting with a confirmed or highly suspected diagnosis of COVID-19 between March 1, 2020, and November 10, 2020. We consider severe infection death or need of hospitalization. Inclusion criteria was having an IRD and at least 1 of the following 4 criteria: (1) a biologically confirmed COVID-19 diagnosis based on a positive result of a SARS-CoV-2 polymerase chain reaction (PCR) test on a nasopharyngeal swab; (2) Detection of IgM or IgG anti SARS-CoV2 in a symptomatic or asymptomatic patients (3)typical thoracic computed tomography (CT) abnormalities (ground-glass opacities) in epidemic areas; (4) COVID19–typical symptoms in an epidemic zone of COVID-19.Results:As of November 10, 2020, 417 patients with IRD were included in the REUMA-COVID SORCOM registry. 5 patients were discharged for incomplete data. Of 412 patients (mean age 57 years, 87.4% Caucasian race, 66.3% female) 174 need hospitalization (42.2%) and 33 patients died (18.4% mortality in hospitalized patients). 82.3% had comorbidities. 234 (56.8%) patients were classified as inflammatory arthropathy, 133 (32.3%) had connective tissue diseases (CTD). 41.1% of the patients had a large history of IRD (> 10 years). 10.4% of patients had previously pulmonary involvement. The study includes 143 patients taking Methotrexate, 89 patients taking anti-TNFα therapy and 27 Rituximab. In the univariant analysis, no differences were seen in the severity of COVID-19 infection in patients taking methotrexate. 63% of the all patients taking Rituximab included in the registry need hospitalization and 22% of them died. Hypertension, COPD or cardiovascular disease was associated with hospitalization.Independent factors associated with COVID-19 hospitalization in the multivariate analysis was: age (>62 years), male sex, IMC >30, previous cardiovascular comorbidities and the IRD disease duration (> 10 years). Independent factors associated with COVID-19 related death was: age (> 62 years), having a CTD diagnose, pulmonary involvement before infection and chronical GC treatment.Conclusion:Patients with IRD represent a population of particular interest in the pandemic context because the baseline immunological alteration and the treated with immunosuppressants agents they receive, comorbidities and the well-known risk of severe infection. Older age, male sex, cardiovascular comorbidities were factors associated with high risk of hospitalization in IRD patients. CTD diseases, previously pulmonary involvement and chronical GC treatment with more than 10mg/day were associated with high risk of death. Neither anti TNF-α treatment nor Methotrexate were risk factor for hospitalization or death COVID-19 related in IRD patients.Disclosure of Interests:None declared

scholarly journals Incidence of Tuberculosis in Inflammatory Rheumatic Diseases: Results from a Lithuanian Retrospective Cohort Study

Medicina ◽  
2020 ◽  
Vol 56 (8) ◽  
pp. 392
Author(s):  
Dalia Miltinienė ◽  
Giedrė Deresevičienė ◽  
Birutė Nakčerienė ◽  
Valerija Edita Davidavičienė ◽  
Edvardas Danila ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cohort Study ◽  
Incidence Rate ◽  
Rheumatic Diseases ◽  
Retrospective Cohort ◽  
Significant Risk ◽  
Inflammatory Rheumatic Diseases ◽  
The Mean ◽  
Rheumatic Patients

Background and objective: With an increase in survival rates among rheumatic patients, comorbidities and infections, in particular, have gained more importance, especially after the introduction of biologicals to the treatment algorithms. Tuberculosis (TB) infection has always been given a special attention in patients with rheumatic diseases (RD). Although Lithuanian population has one of the highest TB incidence rates among European countries, the incidence of TB in the rheumatic patients’ population is still unknown. The aim of this study was to assess the incidence rate of TB in an inflammatory RD retrospective cohort and to compare that rate with a rate in a general population. Material and Methods: Patients with the first-time diagnosis of inflammatory RD during the period between 1 January 2012 and 31 December 2017 were identified from the Lithuanian Compulsory Health Insurance Information System database SVEIDRA. All cases were cross-checked with Health Information center at the Institute of Hygiene, for the vital status of these patients and date of death if the fact of death was documented, and with Tuberculosis Register operated by Vilnius University Hospital Santaros Klinikos, for the confirmation of TB cases. Sex and age standardized incidence ratios (SIR) were calculated by dividing the observed numbers of TB among rheumatic patients by the expected number of cases, calculated using national rates from Lithuanian Department of Statistics Official Statistics website. Results: Overall, 8779 patients with newly diagnosed RD were identified during the 2013–2017 period, these included 458 patients who used biological disease modifying drugs (bDMARDs). The mean duration of the follow-up period was 2.71 years. The cohort consisted mainly of women (70%) and a half of the cohort were rheumatoid arthritis (RA) patients (53%). Mean age of patients at the time of RD diagnosis was 56 years (range = 18–97 years). There were 9 TB cases identified during 23,800 person years of follow-up: 2 cases among them were treated with bDMARDs. The mean calculated annual TB incidence in RD cohort was 37.81 per 100,000 person years, which is consistent with the incidence rate predicted by national estimates, with a resultant SIR of 0.90 (0.41–1.70). The unadjusted hazard ratio for bDMARD use versus no bDMARD use was 4.54 (0.94; 21.87) in a total cohort and very similar in rheumatoid arthritis cohort; in both cohorts, it was not a statistically significant risk. Conclusions: Here, we present the first nationwide cohort study to assess the incidence of TB in a broad spectrum of inflammatory RD. Although limited by short follow-up period, this study shows that TB incidence in RD cohort does not exceed TB incidence in the general Lithuanian population.

scholarly journals Impairment in activities of daily living and readmission in older patients with heart failure: a cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e044416
Author(s):  
Tan Van Nguyen ◽  
Huyen Thanh Dang ◽  
Mason Jenner Burns ◽  
Hiep HH Dao ◽  
Tu Ngoc Nguyen
Keyword(s):  
Heart Failure ◽  
Cohort Study ◽  
Activities Of Daily Living ◽  
Daily Living ◽  
Older Patients ◽  
Tertiary Hospital ◽  
Logistic Regression Models ◽  
Hospitalised Patients ◽  
Patients With Heart Failure ◽  
The Impact

ObjectivesThis study aims to investigate the prevalence of impairment of activities of daily living (ADLs) in older patients with heart failure (HF), and to examine the impact of ADL impairment on readmission after discharge.Design and settingsA prospective cohort study was conducted in patients aged ≥65 years with HF admitted to a tertiary hospital in Vietnam from August 2016 to June 2017. Difficulties with six ADLs were assessed by a questionnaire. Participants were classified into two categories (with and without ADL impairment). The associations of ADL impairment with 3-month readmission were examined using logistic regression models.ResultsThere were 180 participants (mean age 80.6±8.2, 50% female) and 26.1% were classified as having ADL impairment. The most common impaired activity was bathing (21.1%), followed by transferring (20.0%), toileting (12.2%), dressing (8.9%), eating (3.3%), and continence (2.8%). During 3-month follow-up, 32.8% of the participants were readmitted to hospitals (55.3% in participants with ADL impairment, 24.8% in those without ADL impairment, p<0.001). ADL impairment significantly increased the risk of 3-month readmission (adjusted OR 2.75, 95% CI 1.25 to 6.05, p=0.01).ConclusionsIn summary, ADL impairment was common in older hospitalised patients with HF and was associated with increased readmission. These findings suggest further studies on ADL assessment and intervention during transition care for older patients with HF after discharge to prevent readmission.

scholarly journals Relation between body composition and severe diarrhea in patients treated with preoperative chemoradiation with capecitabine for rectal cancer: a single-centre cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
J. M. van Rees ◽  
W. Hartman ◽  
J. J. M. E. Nuyttens ◽  
E. Oomen-de Hoop ◽  
J. L. A. van Vugt ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Body Composition ◽  
Logistic Regression ◽  
Cohort Study ◽  
Preoperative Chemoradiation ◽  
Regression Analyses ◽  
Single Centre ◽  
Severe Diarrhea ◽  
The Impact

Abstract Background Chemoradiation with capecitabine followed by surgery is standard care for locally advanced rectal cancer (LARC). Severe diarrhea is considered a dose-limiting toxicity of adding capecitabine to radiation therapy. The aim of this study was to describe the risk factors and the impact of body composition on severe diarrhea in patients with LARC during preoperative chemoradiation with capecitabine. Methods A single centre retrospective cohort study was conducted in a tertiary referral centre. All patients treated with preoperative chemoradiation with capecitabine for LARC from 2009 to 2015 were included. Patients with locally recurrent rectal cancer who received chemoradiation for the first time were included as well. Logistic regression analyses were performed to identify risk factors for severe diarrhea. Results A total of 746 patients were included. Median age was 64 years (interquartile range 57–71) and 477 patients (64%) were male. All patients received a radiation dosage of 25 × 2 Gy during a period of five weeks with either concomitant capecitabine administered on radiation days or continuously during radiotherapy. In this cohort 70 patients (9%) developed severe diarrhea. In multivariable logistic regression analyses female sex (OR: 4.42, 95% CI 2.54–7.91) and age ≥ 65 (OR: 3.25, 95% CI 1.85–5.87) were the only risk factors for severe diarrhea. Conclusions Female patients and patients aged sixty-five or older had an increased risk of developing severe diarrhea during preoperative chemoradiation therapy with capecitabine. No relation was found between body composition and severe diarrhea.

P2744Age distribution of valvular heart disease in China: from a national multicenter prospective cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
B Zhang ◽  
H T Zhang ◽  
H Y Xu ◽  
Y J Wu
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Heart Disease ◽  
Mitral Valve ◽  
Valvular Heart Disease ◽  
Mitral Valve Disease ◽  
Multimodality Imaging ◽  
Valve Disease ◽  
Multivariate Logistic Regression ◽  
The Impact

Abstract Background Valvular heart disease (VHD) has been caught in two important cross-currents in recent decades: aging demography and the rise of multimodality imaging and transcatheter valve therapy. In this setting, we aim to identify the distribution, characteristics, and management of Chinese VHD patients according to age. Methods China Valvular Heart Disease Cohort Study (China-VHD) was conducted from March to September 2019 in 46 centers over China. It included prospectively 12331 adults with native moderate or severe VHD, of which we described the distribution, management, and in-hospital events according to age (18–44, 45–54, 55–64, 65–74, ≥75). Multivariate Logistic regression was employed to investigate the impact of age on in-hospital events composed of in-hospital mortality, acute heart failure, and stoke. Results In Chinese VHD population, overall percentage peaked in 55–64 year olds. The frequency of multivalvular heart disease (MVHD) saw an increasing trend with age (p for trend <0.001). Of single valvular heart disease, mitral regurgitation (MR) was the most frequent left-sided VHD followed by aortic regurgitation (AR), aortic stenosis (AS), and mitral stenosis (MS). AS frequency significantly grew with age (p for trend = 0.02) while AR peaked in 18–44 year olds and fluctuated at a lower level in the older population. In contrast, mitral valve disease (MS, MR, and mixed mitral valve disease) was most frequent in 45–54 year olds and dropped with age (p for trend all <0.001). Noteworthily, all aortic valve disease was notably frequent in men whereas mitral valve disease and MVHD more common in women. Similar to developed countries, degenerative etiology rose steeply while rheumatic and congenital origin fell with age. Regarding management, surgical valve replacement rate was similar in age groups lower than 75 years old with increasing frequency of concomitant CABG. No matter aortic or mitral, the percentage of bio-prosthesis rocketed after 65 years (aortic: 74.7%, mitral: 70.6%). In multivariate logistic regression, covariables included age, sex, BMI, hypertension, diabetes, coronary heart disease, aortic disease, cardiomyopathy, COPD, NYHA class and valvular intervention. Compared to patients younger than 45, in-hospital events significantly higher in patients over 75 only (OR: 1.69 [95% CI: 1.07–2.66], p<0.02). Moreover, women showed a lower risk of in-hospital events (OR: 0.78 [95% CI: 0.63–0.96], p<0.01). Age distribution of VHD Conclusion Age plays a crucial role in valvular heart disease, best illustrated in AS. Unlike the western world, AR and MR are more frequent than AS but show a slightly decreasing trend with age. As expected, degenerative etiology is becoming more prevalent whereas rheumatism decreases. Age over 75 and male are associated with growing in-hospital events. Degenerative VHD thus present an important public-health burden. Acknowledgement/Funding Innovation project of Chinese academy of medical science

Comorbidities of rheumatic disease

2013 ◽  
Author(s):  
Tuulikki Sokka ◽  
Kari Puolakka ◽  
Carl Turesson
Keyword(s):  
Rheumatic Disease ◽  
Rheumatic Diseases ◽  
Health Professionals ◽  
Physical Inactivity ◽  
Organ Damage ◽  
Inflammatory Rheumatic Diseases ◽  
Rheumatology Clinic ◽  
Cholesterol Levels ◽  
Lifestyle Choices ◽  
The Impact

All other diseases that coexist with a disease of interest are called comorbidities. Comorbidities in inflammatory rheumatic diseases may be associated with persistent inflammatory activity or disease-related organ damage, or may be related to medications. Lifestyle choices such as smoking or physical inactivity contribute to comorbidity. Patients with rheumatic diseases meet health professionals regularly and are more often tested for osteoporosis or cholesterol levels than individuals without rheumatic disease, which may contribute to a higher prevalence of some comorbidities. Comorbidities can also be unrelated to rheumatic diseases or their treatments. In this chapter, we discuss the impact of comorbidities to the patient. We emphasize the importance to review and manage comorbidities in usual daily rheumatology clinic, to improve outcomes of patients with rheumatic diseases.

scholarly journals Fluoroquinolones and isoniazid-resistant tuberculosis: implications for the 2018 WHO guidance

2019 ◽  
Vol 54 (4) ◽  
pp. 1900982 ◽  
Author(s):  
Helen R. Stagg ◽  
Graham H. Bothamley ◽  
Jennifer A. Davidson ◽  
Heinke Kunst ◽  
Maeve K. Lalor ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Cohort Study ◽  
Odds Ratio ◽  
Treatment Effectiveness ◽  
Drug Regimen ◽  
Disease Recurrence ◽  
World Health ◽  
Phenotypic Resistance ◽  
Health Organization ◽  
The Impact

Introduction2018 World Health Organization (WHO) guidelines for the treatment of isoniazid (H)-resistant (Hr) tuberculosis recommend a four-drug regimen: rifampicin (R), ethambutol (E), pyrazinamide (Z) and levofloxacin (Lfx), with or without H ([H]RZE-Lfx). This is used once Hr is known, such that patients complete 6 months of Lfx (≥6[H]RZE-6Lfx). This cohort study assessed the impact of fluoroquinolones (Fq) on treatment effectiveness, accounting for Hr mutations and degree of phenotypic resistance.MethodsThis was a retrospective cohort study of 626 Hr tuberculosis patients notified in London, 2009–2013. Regimens were described and logistic regression undertaken of the association between regimen and negative regimen-specific outcomes (broadly, death due to tuberculosis, treatment failure or disease recurrence).ResultsOf 594 individuals with regimen information, 330 (55.6%) were treated with (H)RfZE (Rf=rifamycins) and 211 (35.5%) with (H)RfZE-Fq. The median overall treatment period was 11.9 months and median Z duration 2.1 months. In a univariable logistic regression model comparing (H)RfZE with and without Fqs, there was no difference in the odds of a negative regimen-specific outcome (baseline (H)RfZE, cluster-specific odds ratio 1.05 (95% CI 0.60–1.82), p=0.87; cluster NHS trust). Results varied minimally in a multivariable model. This odds ratio dropped (0.57, 95% CI 0.14–2.28) when Hr genotype was included, but this analysis lacked power (p=0.42).ConclusionsIn a high-income setting, we found a 12-month (H)RfZE regimen with a short Z duration to be similarly effective for Hr tuberculosis with or without a Fq. This regimen may result in fewer adverse events than the WHO recommendations.

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