Abstract
To analyze the clinical characteristics and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with sarcoidosis from a large multicenter cohort from Southern Europe and to identify the risk factors associated with a more complicated infection. We searched for patients with sarcoidosis presenting with SARS-CoV-2 infection (defined according to the European Centre for Disease Prevention and Control guidelines) among those included in the SarcoGEAS Registry, a nationwide, multicenter registry of patients fulfilling the American Thoracic Society/European Respiratory Society/World Association of Sarcoidosis and Other Granulomatous Disorders 1999 classification criteria for sarcoidosis. A 2:1 age-sex-matched subset of patients with sarcoidosis without SARS-CoV-2 infection was selected as control population. Forty-five patients with SARS-CoV-2 infection were identified (28 women, mean age 55 years). Thirty-six patients presented a symptomatic SARS-CoV-2 infection and 14 were hospitalized (12 required supplemental oxygen, 2 intensive care unit admission and 1 mechanical ventilation). Four patients died due to progressive respiratory failure. Patients who required hospital admission had an older mean age (64.9 vs. 51.0 years, p = 0.006), a higher frequency of baseline comorbidities including cardiovascular disease (64% vs. 23%, p = 0.016), diabetes mellitus (43% vs. 13%, p = 0.049) and chronic liver/kidney diseases (36% vs. 0%, p = 0.002) and presented more frequently fever (79% vs. 35%, p = 0.011) and dyspnea (50% vs. 3%, p = 0.001) in comparison with patients managed at home. Age- and sex-adjusted multivariate analysis identified the age at diagnosis of SARS-Cov-2 infection as the only independent variable associated with hospitalization (adjusted odds ratio 1.18, 95% conficence interval 1.04–1.35). A baseline moderate/severe pulmonary impairment in function tests was associated with a higher rate of hospitalization but the difference was not statistically significant (50% vs. 23%, p = 0.219). A close monitoring of SARS-CoV-2 infection in elderly patients with sarcoidosis, especially in those with baseline cardiopulmonary diseases and chronic liver or renal failure, is recommended. The low frequency of severe pulmonary involvement in patients with sarcoidosis from Southern Europe may explain the weak prognostic role of baseline lung impairment in our study, in contrast to studies from other geographical areas.
Highlights
A novel coronavirus was identified in January 2020 as the etiological agent of a cluster of cases of pneumonia detected in Wuhan City (China)
Since biopsy is usually not considered necessary for histological confirmation of a diagnosis in patients presenting with manifestations highly consistent with the disease (e.g., Lofgren’s syndrome or Heerfordt’s syndrome), or with an asymptomatic bilateral hilar lymphadenopathy, we allowed the inclusion of patients lacking the histopathological criteria (b) only if they presented the two other criteria and, in addition, at least one of the following features suggestive of sarcoidosis: elevated serum angiotensinconverting enzyme, organ-specific abnormal uptake on gallium-67 citrate scintigraphy, elevated lymphocyte count or elevated CD4/CD8 ratio in bronchoalveolar lavage fluid or active extrathoracic involvement classified as highly probable according to the WASOG extrathoracic classification [20,21]
We have tried to capture the broadest, real-life spectrum of SARS-CoV2 infection in patients with sarcoidosis, including hospitalized cases, and asymptomatic patients and those diagnosed with a mild COVID-19 that were followed up at home in a primary care setting or under hospital at home programs
Summary
A novel coronavirus was identified in January 2020 as the etiological agent of a cluster of cases of pneumonia detected in Wuhan City (China). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the seventh coronavirus known to infect humans [1] and the lack of a prior immunity has resulted in a rapid increase in infected patients worldwide [2] with more than 110 million confirmed cases until 23 February 2021. The disease caused by SARS-CoV-2 is named as COVID-19 and has a very wide clinical spectrum [2]. The most frequent presentation requiring hospitalization is a bilateral pneumonia that in some patients may progress to respiratory and multiorgan failure [3]. People with autoimmune diseases (AD) are considered to be at increased risk of having a more severe infection [4], considering they have an underlying abnormal immune response and that are often under immunosuppressive therapy [8]
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