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Title: High levels of immunosuppression are related to unfavourable outcomes in hospitalised patients with rheumatic diseases and COVID-19 : first results of ReumaCoV Brasil registry
Authors: 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
metadata.dc.identifier.orcid: https://orcid.org/0000-0002-3333-2621
Assunto:: Pacientes
Doenças reumáticas
Covid-19
Issue Date: 2021
Publisher: BMJ Journals
Citation: 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.
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
Appears in Collections:FMD - Artigos publicados em periódicos e preprints
UnB - Covid-19

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