Título:	High levels of immunosuppression are related to unfavourable outcomes in hospitalised patients with rheumatic diseases and COVID-19 : first results of ReumaCoV Brasil registry
Autor(es):	Marques, Claudia Diniz Lopes Kakehasi, Adriana Maria Pinheiro, Marcelo Medeiros Mota, Licia Maria Henrique Albuquerque, Cleandro Pires Silva, Carolina Rocha Santos, Gabriela Porfirio Jardim Reis Neto, Edgard Torres Matos, Pedro Devide, Guilherme Dantas, Andrea Giorgi, Rina Dalva Omura, Felipe Marinho, Adriana de Oliveira Valadares, Lilian David Azevedo Melo, Ana Karla G. Ribeiro, Francinne Machado Ferreira, Gilda Aparecida Santos, Flavia Patricia de Sena Ribeiro, Sandra Lucia Euzebio Andrade, Nicole Pamplona Bueno Yazbek, Michel Alexandre Souza, Viviane Angelina de Paiva, Eduardo S. Azevedo, Valderilio Feijo Freitas, Ana Beatriz Santos Bacchiega de Provenza, José Roberto Toledo, Ricardo Acayaba de Fontenelle, Sheilla Carneiro, Sueli Xavier, Ricardo Pileggi, Gecilmara Cristina Salviato Reis, Ana Paula Monteiro Gomides
ORCID:	https://orcid.org/0000-0002-3333-2621
Assunto:	Pacientes Reumatismo Covid-19
Data de publicação:	2021
Editora:	BMJ Journals
Referência:	MARQUES, Claudia Diniz Lopes et al. High levels of immunosuppression are related to unfavourable outcomes in hospitalised patients with rheumatic diseases and COVID-19: first results of ReumaCoV Brasil registry. RMD Open, v. 7, n. 1, e001461, 2021. DOI: http://dx.doi.org/10.1136/rmdopen-2020-001461. Disponível em: https://rmdopen.bmj.com/content/7/1/e001461. Acesso em: 31 mar. 2021.
Abstract:	Objectives To evaluate risk factors associated with unfavourable outcomes: emergency care, hospitalisation, admission to intensive care unit (ICU), mechanical ventilation and death in patients with immune-mediated rheumatic disease (IMRD) and COVID-19. Methods Analysis of the first 8 weeks of observational multicentre prospective cohort study (ReumaCoV Brasil register). Patients with IMRD and COVID-19 according to the Ministry of Health criteria were classified as eligible for the study. Results 334 participants were enrolled, a majority of them women, with a median age of 45 years; systemic lupus erythematosus (32.9%) was the most frequent IMRD. Emergency care was required in 160 patients, 33.0% were hospitalised, 15.0% were admitted to the ICU and 10.5% underwent mechanical ventilation; 28 patients (8.4%) died. In the multivariate adjustment model for emergency care, diabetes (prevalence ratio, PR 1.38; 95% CI 1.11 to 1.73; p=0.004), kidney disease (PR 1.36; 95% CI 1.05 to 1.77; p=0.020), oral glucocorticoids (GC) (PR 1.49; 95% CI 1.21 to 1.85; p<0.001) and pulse therapy with methylprednisolone (PR 1.38; 95% CI 1.14 to 1.67; p=0.001) remained significant; for hospitalisation, age >50 years (PR 1.89; 95% CI 1.26 to 2.85; p=0.002), no use of tumour necrosis factor inhibitor (TNFi) (PR 2.51;95% CI 1.16 to 5.45; p=0.004) and methylprednisolone pulse therapy (PR 2.50; 95% CI 1.59 to 3.92; p<0.001); for ICU admission, oral GC (PR 2.24; 95% CI 1.36 to 3.71; p<0.001) and pulse therapy with methylprednisolone (PR 1.65; 95% CI 1.00 to 2.68; p<0.043); the two variables associated with death were pulse therapy with methylprednisolone or cyclophosphamide (PR 2.86; 95% CI 1.59 to 5.14; p<0.018). Conclusions Age >50 years and immunosuppression with GC and cyclophosphamide were associated with unfavourable outcomes of COVID-19. Treatment with TNFi may have been protective, perhaps leading to the COVID-19 inflammatory process.
Unidade Acadêmica:	Faculdade de Medicina (FMD)
Licença:	Open access - This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work noncommercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See http://creativecommons.org/ licenses/by-nc/4.0/. © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
DOI:	http://dx.doi.org/10.1136/rmdopen-2020-001461
Aparece nas coleções:	Artigos publicados em periódicos e afins UnB - Covid-19

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