背景SARS-CoV-2(COVID-19)是冠状病毒家族的正链核糖核酸(RNA)病毒,这导致了最严重的流行病之一,全球确诊病例超过1400万例。估计类风湿性关节炎(RA)在0.5-1%的美国人口中流行。到目前为止,几乎没有证据表明COVID-19感染及其导致RA患者死亡率或住院时间增加的倾向.为了对这一文学做出贡献,本研究将评估COVID-19与RA患者死亡率和住院时间增加相关的程度,同时考虑这些患者的合并症.方法我们的回顾性研究包括14,180例患者(年龄>18,中位数58,范围18-90),这些患者从1月1日起检测出COVID-19阳性或被认为感染了COVID-19,2020年7月31日,2020年。根据RA和COVID-19感染的诊断将患者与没有RA的患者进行分组。被诊断为系统性红斑狼疮(SLE)的患者,慢性阻塞性肺疾病,排除高血压。协变量包括年龄,体重指数(BMI),种族,性别,最大C反应蛋白值,最大D-二聚体值,合并糖尿病。结果指标是住院时间(LOS),住院死亡率,重症监护病房(ICU)入院,ICULOS,机械通气,机械通气时间,出院到临终关怀医院.Logistic回归模型用于估计住院死亡率的概率,入住ICU,放置在机械通气上,出院到临终关怀,当比较RA和COVID-19感染的患者与COVID-19感染的非RA患者时,院内死亡率与家庭抗炎使用相关。结果14180例患者中(男性57.1%,女性42.9%),159名患者(1.1%),诊断为RA。RA和医院LOS之间没有显著关联,入住ICU,ICULOS,机械通气的LOS,或在感染COVID-19的人中出院到临终关怀。然而,在感染COVID-19的患者中,RA与较高的死亡率(OR:1.65;95%CI:1.07-2.53;p=0.02)和机械通气(OR:1.82;95%CI:1.22-2.71;p<0.01)相关。结论这项研究表明,RA和COVID-19患者院内死亡率和机械通气的可能性显着增加。虽然在大流行的情况下很难意识到,有必要在全国范围内开展大型研究,以提高我们对诊断为RA的患者中COVID-19感染的认识.
Background SARS-CoV-2 (COVID-19) is a positive-stranded ribonucleic acid (RNA) virus of the coronavirus family, which has resulted in one of the most serious pandemics, with more than 14 million cases confirmed globally. Rheumatoid arthritis (RA) is estimated to be prevalent in 0.5-1% of the U.S. population. So far, there has been little evidence of COVID-19 infection and its propensity to result in increased mortality or length of hospital stay in patients with RA. To contribute to this body of literature, this study will assess the degree to which COVID-19 is associated with increased mortality and length of hospital stay in patients with RA while also taking into account these patients\' comorbidities. Methods Our retrospective study included 14,180 patients (age >18, median 58, range 18-90) who tested positive for COVID-19 or were assumed to have COVID-19 infection from January 1st, 2020, through July 31st, 2020. Patients were grouped based on the diagnosis of RA and COVID-19 infection versus those without RA. Patients who were diagnosed with systemic lupus erythematosus (SLE), chronic obstructive pulmonary disease, and hypertension were excluded. Covariates included age, body mass index (BMI), race, sex, maximum C-reactive protein value, maximum D-dimer value, and comorbid diabetes mellitus. Outcome measures were length of hospital stay (LOS), in-hospital mortality, intensive care unit (ICU) admission, ICU LOS, mechanical ventilation, time on mechanical ventilation, and discharge to hospice. The logistic regression model was used to estimate the probability of in-hospital mortality, ICU admission, placement on mechanical ventilation, discharge to hospice, and in-hospital mortality related to home anti-inflammatory use when comparing patients with RA and COVID-19 infection to COVID-19 infected patients without RA. Results Of the total 14,180 patients (males 57.1%, females 42.9%), 159 patients (1.1%), had a diagnosis of RA. There was no significant association between RA and hospital LOS, ICU admission, ICU LOS, LOS on mechanical ventilation, or discharge to hospice among those infected with COVID-19. Yet, RA was associated with higher mortality (OR: 1.65; 95% CI: 1.07-2.53; p=0.02) and placement on mechanical ventilation (OR: 1.82; 95% CI: 1.22-2.71; p<0.01) amidst patients infected with COVID-19. Conclusion This study suggests that patients with RA and COVID-19 have a significantly increased likelihood of in-hospital mortality and placement on mechanical ventilation. While challenging to realize in a pandemic situation, large studies nationwide are necessary to improve our understanding of COVID-19 infection in patients diagnosed with RA.