Abstract：
BACKGROUND: To systematically describe clinical characteristics and investigate factors associated with COVID-19-related infection, hospital admission, and IgG4-related disease relapse in IgG4-RD patients.
METHODS: Physician-reported IgG4-RD patients were included in this retrospective study. Using multivariable logistic regression analysis to determine factors for primary outcome (COVID-19-related IgG4-RD relapse) and secondary outcome (COVID-19-related infection and hospital admission). Covariates included age, sex, body mass index, smoking status, comorbidities, IgG4-RD clinical features, and treatment strategies.
RESULTS: Among 649 patients, 530 had a diagnosis of COVID-19, 25 had COVID-19-related hospital admission, and 69 had COVID-19-related IgG4-RD relapse. Independent factors associated with COVID-19 infection were age (OR, 0.98; 95% CI, 0.96-1.00), body mass index (1.10, 1.03-1.18), and tofacitinib (0.34, 0.14-0.79). Further analysis indicated that age (1.10, 1.03-1.16), coronary heart disease (24.38, 3.33-178.33), COVID-19-related dyspnea (7.11, 1.85-27.34), pulmonary infection (73.63, 16.22-4615.34), and methotrexate (17.15, 1.93-157.79) were associated with a higher risk of COVID-19-related hospital admission. Importantly, age (0.93, 0.89-0.98), male sex (0.16, 0.03-0.80), ever/current smoking (19.23, 3.78-97.80), COVID-19-related headache (2.98, 1.09-8.17) and psychiatric symptoms (3.12, 1.07-9.10), disease activity before COVID-19 (1.89, 1.02-3.51), number of involved organs (1.38, 1.08-1.76), glucocorticoid dosage (1.08, 1.03-1.13), and methotrexate (5.56, 1.40-22.08) were strong factors for COVID-19-related IgG4-RD relapse.
CONCLUSIONS: Our data add to evidence that smoking and disease-specific factors (disease activity, number of involved organs, and specific medications) were risk factors of COVID-19-related IgG4-RD relapse. The results highlight the importance of adequate disease control with b/tsDMARDs, preferably without using methotrexate and increasing glucocorticoid dosages in the COVID-19 era. Key Points • COVID-19-related infection or hospital admission were associated with known general factors (age, body mass index, specific comorbidities and methotrexate) among IgG4-RD patients. • Smoking and disease-specific factors (disease activity, number of involved organs and specific medications) were associated with higher odds of COVID-19-related IgG4-RD relapse. • The results highlight the importance of adequate disease control with b/tsDMARDs, preferably without using methotrexate or increasing glucocorticoid dosages.
METHODS: Physician-reported IgG4-RD patients were included in this retrospective study. Using multivariable logistic regression analysis to determine factors for primary outcome (COVID-19-related IgG4-RD relapse) and secondary outcome (COVID-19-related infection and hospital admission). Covariates included age, sex, body mass index, smoking status, comorbidities, IgG4-RD clinical features, and treatment strategies.
RESULTS: Among 649 patients, 530 had a diagnosis of COVID-19, 25 had COVID-19-related hospital admission, and 69 had COVID-19-related IgG4-RD relapse. Independent factors associated with COVID-19 infection were age (OR, 0.98; 95% CI, 0.96-1.00), body mass index (1.10, 1.03-1.18), and tofacitinib (0.34, 0.14-0.79). Further analysis indicated that age (1.10, 1.03-1.16), coronary heart disease (24.38, 3.33-178.33), COVID-19-related dyspnea (7.11, 1.85-27.34), pulmonary infection (73.63, 16.22-4615.34), and methotrexate (17.15, 1.93-157.79) were associated with a higher risk of COVID-19-related hospital admission. Importantly, age (0.93, 0.89-0.98), male sex (0.16, 0.03-0.80), ever/current smoking (19.23, 3.78-97.80), COVID-19-related headache (2.98, 1.09-8.17) and psychiatric symptoms (3.12, 1.07-9.10), disease activity before COVID-19 (1.89, 1.02-3.51), number of involved organs (1.38, 1.08-1.76), glucocorticoid dosage (1.08, 1.03-1.13), and methotrexate (5.56, 1.40-22.08) were strong factors for COVID-19-related IgG4-RD relapse.
CONCLUSIONS: Our data add to evidence that smoking and disease-specific factors (disease activity, number of involved organs, and specific medications) were risk factors of COVID-19-related IgG4-RD relapse. The results highlight the importance of adequate disease control with b/tsDMARDs, preferably without using methotrexate and increasing glucocorticoid dosages in the COVID-19 era. Key Points • COVID-19-related infection or hospital admission were associated with known general factors (age, body mass index, specific comorbidities and methotrexate) among IgG4-RD patients. • Smoking and disease-specific factors (disease activity, number of involved organs and specific medications) were associated with higher odds of COVID-19-related IgG4-RD relapse. • The results highlight the importance of adequate disease control with b/tsDMARDs, preferably without using methotrexate or increasing glucocorticoid dosages.
摘要：
背景：为了系统地描述临床特征并调查与COVID-19相关感染相关的因素，入院,IgG4-RD患者的IgG4相关疾病复发。
方法：这项回顾性研究包括医生报告的IgG4-RD患者。使用多变量逻辑回归分析确定主要结局（COVID-19相关IgG4-RD复发）和次要结局（COVID-19相关感染和住院）的因素。协变量包括年龄，性别,身体质量指数,吸烟状况,合并症,IgG4-RD临床特征，和治疗策略。
结果：在649名患者中，530名诊断为COVID-19，25名诊断为COVID-19相关住院，69人患有COVID-19相关IgG4-RD复发。与COVID-19感染相关的独立因素是年龄(OR，0.98；95%CI，0.96-1.00），身体质量指数（1.10，1.03-1.18），和托法替尼（0.34，0.14-0.79）。进一步的分析表明，年龄(1.10，1.03-1.16)，冠心病（24.38，3.33-178.33），COVID-19相关呼吸困难（7.11，1.85-27.34），肺部感染（73.63，16.22-4615.34），甲氨蝶呤（17.15，1.93-157.79）与COVID-19相关住院风险较高相关。重要的是,年龄（0.93，0.89-0.98），男性（0.16，0.03-0.80），曾经/当前吸烟（19.23，3.78-97.80），COVID-19相关头痛（2.98，1.09-8.17）和精神症状（3.12，1.07-9.10），COVID-19之前的疾病活动（1.89，1.02-3.51），涉及的器官数量（1.38，1.08-1.76），糖皮质激素剂量（1.08，1.03-1.13），甲氨蝶呤（5.56，1.40-22.08）是COVID-19相关IgG4-RD复发的重要因素。
结论：我们的数据增加了吸烟和疾病特异性因素(疾病活动，涉及的器官数量，和特定药物）是COVID-19相关IgG4-RD复发的危险因素。结果强调了使用b/tsDMARDs进行充分疾病控制的重要性，在COVID-19时代，优选不使用甲氨蝶呤和增加糖皮质激素剂量。关键点•COVID-19相关感染或入院与已知的一般因素(年龄，身体质量指数,IgG4-RD患者中的特定合并症和甲氨蝶呤）。•吸烟和疾病特异性因素（疾病活动，受累器官数量和特定药物）与COVID-19相关IgG4-RD复发的几率更高。•结果强调了使用b/tsDMARDs进行适当疾病控制的重要性，优选不使用甲氨蝶呤或增加糖皮质激素剂量。
方法：这项回顾性研究包括医生报告的IgG4-RD患者。使用多变量逻辑回归分析确定主要结局（COVID-19相关IgG4-RD复发）和次要结局（COVID-19相关感染和住院）的因素。协变量包括年龄，性别,身体质量指数,吸烟状况,合并症,IgG4-RD临床特征，和治疗策略。
结果：在649名患者中，530名诊断为COVID-19，25名诊断为COVID-19相关住院，69人患有COVID-19相关IgG4-RD复发。与COVID-19感染相关的独立因素是年龄(OR，0.98；95%CI，0.96-1.00），身体质量指数（1.10，1.03-1.18），和托法替尼（0.34，0.14-0.79）。进一步的分析表明，年龄(1.10，1.03-1.16)，冠心病（24.38，3.33-178.33），COVID-19相关呼吸困难（7.11，1.85-27.34），肺部感染（73.63，16.22-4615.34），甲氨蝶呤（17.15，1.93-157.79）与COVID-19相关住院风险较高相关。重要的是,年龄（0.93，0.89-0.98），男性（0.16，0.03-0.80），曾经/当前吸烟（19.23，3.78-97.80），COVID-19相关头痛（2.98，1.09-8.17）和精神症状（3.12，1.07-9.10），COVID-19之前的疾病活动（1.89，1.02-3.51），涉及的器官数量（1.38，1.08-1.76），糖皮质激素剂量（1.08，1.03-1.13），甲氨蝶呤（5.56，1.40-22.08）是COVID-19相关IgG4-RD复发的重要因素。
结论：我们的数据增加了吸烟和疾病特异性因素(疾病活动，涉及的器官数量，和特定药物）是COVID-19相关IgG4-RD复发的危险因素。结果强调了使用b/tsDMARDs进行充分疾病控制的重要性，在COVID-19时代，优选不使用甲氨蝶呤和增加糖皮质激素剂量。关键点•COVID-19相关感染或入院与已知的一般因素(年龄，身体质量指数,IgG4-RD患者中的特定合并症和甲氨蝶呤）。•吸烟和疾病特异性因素（疾病活动，受累器官数量和特定药物）与COVID-19相关IgG4-RD复发的几率更高。•结果强调了使用b/tsDMARDs进行适当疾病控制的重要性，优选不使用甲氨蝶呤或增加糖皮质激素剂量。
