Abstract：
OBJECTIVE: The impact of rheumatic diseases, long-term medication, and vaccination on COVID-19 severity remain insufficiently understood, hindering effective patient management. This study aims to investigate factors influencing COVID-19 severity in Chinese rheumatic patients and to provide real-world evidence for patient care.
METHODS: We conducted a retrospective observational study consisting of two cohorts, followed by a nested case-control analysis. The outpatient cohort included non-severe COVID-19 patients, while the inpatient cohort included consecutive severe COVID-19 inpatients. Additionally, rheumatic patients from both cohorts were included for the nested case-control study. Clinical information was obtained from electronic medical records and surveys.
RESULTS: A total of 749 outpatients and 167 inpatients were enrolled. In the outpatient cohort, rheumatic diseases were identified as a risk factor for the severity of dyspnea (No rheumatic disease: OR = 0.577, 95% CI = 0.396-0.841, p = .004), but not for mortality, length of hospitalization, or hospitalization costs in the inpatient cohort. Long-term glucocorticoids use was identified as an independent risk factor for severity of dyspnea in rheumatic patients (OR = 1.814, 95% CI = 1.235-2.663, p = .002), while vaccination and immunosuppressant treatment showed no association. Vaccination was identified as a protective factor against hospitalization due to COVID-19 in patients with rheumatic diseases (OR = 0.031, 95% CI = 0.007-0.136, p < .001), whereas long-term glucocorticoids and immunosuppressant treatment showed no association.
CONCLUSIONS: Rheumatic diseases and long-term glucocorticoids use are significant risk factors for COVID-19 severity in the Chinese population, whereas emphasizing the protective effects of vaccines against COVID-19 severity is crucial. Additionally, the investigation provides preliminary support for the concept that long-term immunosuppressant therapy does not necessarily require additional prescription adjustments.
METHODS: We conducted a retrospective observational study consisting of two cohorts, followed by a nested case-control analysis. The outpatient cohort included non-severe COVID-19 patients, while the inpatient cohort included consecutive severe COVID-19 inpatients. Additionally, rheumatic patients from both cohorts were included for the nested case-control study. Clinical information was obtained from electronic medical records and surveys.
RESULTS: A total of 749 outpatients and 167 inpatients were enrolled. In the outpatient cohort, rheumatic diseases were identified as a risk factor for the severity of dyspnea (No rheumatic disease: OR = 0.577, 95% CI = 0.396-0.841, p = .004), but not for mortality, length of hospitalization, or hospitalization costs in the inpatient cohort. Long-term glucocorticoids use was identified as an independent risk factor for severity of dyspnea in rheumatic patients (OR = 1.814, 95% CI = 1.235-2.663, p = .002), while vaccination and immunosuppressant treatment showed no association. Vaccination was identified as a protective factor against hospitalization due to COVID-19 in patients with rheumatic diseases (OR = 0.031, 95% CI = 0.007-0.136, p < .001), whereas long-term glucocorticoids and immunosuppressant treatment showed no association.
CONCLUSIONS: Rheumatic diseases and long-term glucocorticoids use are significant risk factors for COVID-19 severity in the Chinese population, whereas emphasizing the protective effects of vaccines against COVID-19 severity is crucial. Additionally, the investigation provides preliminary support for the concept that long-term immunosuppressant therapy does not necessarily require additional prescription adjustments.
摘要：
目的：风湿性疾病的影响，长期用药,疫苗接种对COVID-19的严重程度仍未得到充分理解，阻碍有效的病人管理。本研究旨在调查影响中国风湿性疾病患者COVID-19严重程度的因素，并为患者护理提供现实证据。
方法：我们进行了一项由两个队列组成的回顾性观察研究，然后是嵌套的案例控制分析。门诊队列包括非重症COVID-19患者，而住院队列包括连续的重症COVID-19住院患者。此外,来自两个队列的风湿性疾病患者被纳入巢式病例对照研究.从电子病历和调查中获得临床信息。
结果：共纳入749名门诊患者和167名住院患者。在门诊队列中，风湿性疾病被确定为呼吸困难严重程度的危险因素(无风湿性疾病:OR=0.577,95%CI=0.396-0.841,p=.004),但不是为了死亡率，住院时间,或住院队列中的住院费用。长期使用糖皮质激素被确定为风湿性疾病患者呼吸困难严重程度的独立危险因素(OR=1.814,95%CI=1.235-2.663,p=0.002),而疫苗接种和免疫抑制剂治疗没有相关性。接种疫苗被确定为风湿性疾病患者因COVID-19导致住院的保护因素(OR=0.031,95%CI=0.007-0.136,p<.001),而长期糖皮质激素和免疫抑制剂治疗没有相关性。
结论：风湿性疾病和长期使用糖皮质激素是中国人群COVID-19严重程度的重要危险因素，而强调疫苗对COVID-19严重程度的保护作用是至关重要的。此外,这项研究为长期免疫抑制剂治疗不一定需要额外调整处方这一概念提供了初步支持.
方法：我们进行了一项由两个队列组成的回顾性观察研究，然后是嵌套的案例控制分析。门诊队列包括非重症COVID-19患者，而住院队列包括连续的重症COVID-19住院患者。此外,来自两个队列的风湿性疾病患者被纳入巢式病例对照研究.从电子病历和调查中获得临床信息。
结果：共纳入749名门诊患者和167名住院患者。在门诊队列中，风湿性疾病被确定为呼吸困难严重程度的危险因素(无风湿性疾病:OR=0.577,95%CI=0.396-0.841,p=.004),但不是为了死亡率，住院时间,或住院队列中的住院费用。长期使用糖皮质激素被确定为风湿性疾病患者呼吸困难严重程度的独立危险因素(OR=1.814,95%CI=1.235-2.663,p=0.002),而疫苗接种和免疫抑制剂治疗没有相关性。接种疫苗被确定为风湿性疾病患者因COVID-19导致住院的保护因素(OR=0.031,95%CI=0.007-0.136,p<.001),而长期糖皮质激素和免疫抑制剂治疗没有相关性。
结论：风湿性疾病和长期使用糖皮质激素是中国人群COVID-19严重程度的重要危险因素，而强调疫苗对COVID-19严重程度的保护作用是至关重要的。此外,这项研究为长期免疫抑制剂治疗不一定需要额外调整处方这一概念提供了初步支持.
