Abstract
Introduction: In severe COVID-19 patients, a pre-inflamatory condition leads to a cytokine storm syndrome. This may signify the need for using immunomodulatory drugs. Patients with rheumatic diseases (RDs) are prone to severe infectious diseases. Objectives: Whether the presence of the RD itself or the use of its drugs in patients with COVID-19 increases the severity of symptoms and outcomes remains largely unknown. Patients and Methods: In a prospective cohort study conducted in Khorshid hospital of Isfahan, Iran, 219 patients with COVID-19 were enrolled and divided into two groups of patients with a positive history for RD (n=19) and those without this history (NRD, n=200). The severity of symptoms and outcomes was compared between the groups. Results: Shortness of breath (P=0.001), cough (P=0.019), and weakness (P=0.001) were significantly higher in the RD than the NRD group after, but not before, recovery. All the patients in the RD group had comorbid diseases (hypertension, diabetes mellitus, ischemic heart disease, and cerebrovascular disease), the number of which was significantly higher than that of the NRD group (P<0.001). The Charlson Comorbidity Index (CCI) was used to predict 10-year survival in patients with multiple comorbidities. It was significantly lower in the RD group as opposed to the NRD group (P<0.001). Logistic regression also showed a non-significantly higher chance of the composite outcome (ICU admission, death status, and intubation status) in the RD group as opposed to the NRD group, both before and after adjustment for confounding factors. However, no difference was found between the RD patient who received corticosteroid as a treatment (RD-CS) and those who did not (RD-NCS). Conclusion: The results showed an increased risk for severe forms of COVID-19 in RD patients. This risk is possibly attributable to a high prevalence of comorbidities in these patients.
Highlights
In severe COVID-19 patients, a pre-inflamatory condition leads to a cytokine storm syndrome
The results indicated that patients with rheumatic diseases (RDs) had a significantly higher number of comorbid diseases compared with the NRD
Our findings revealed that the Charlson Comorbidity Index (CCI) was remarkably higher in the RD group than the NRD group, predicting lower 10-year survival rates in the former
Summary
In severe COVID-19 patients, a pre-inflamatory condition leads to a cytokine storm syndrome This may signify the need for using immunomodulatory drugs. A pre-inflammatory condition with an increase in the IL-1β, tumor necrosis factor-α (TNF-α), granulocyte colony-stimulating factor (G-CSF), IP10/CXCL10, monocyte chemoattractant protein 1 (MCP-1), and macrophage inflammatory protein 1-α It remains unresolved whether the rheumatic disease (RD) itself or the use of glucocorticoids and disease-modifying antirheumatic drugs in patients with concurrent rheumatic diseases and COVID-19 increases or decreases the severity of symptoms and outcome. 1) levels has been reported in COVID-19 patients, leading to a cytokine storm syndrome in those in need of intensive care This may signify the need for using immunomodulatory drugs in severe cases [2].
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