Abstract
Introduction: COVID-19 may be associated with greater severity and mortality in patients with systemic sclerosis (SSc). The present study aimed to evaluate the prevalence, severity and mortality of COVID-19 in a Brazilian cohort of SSc patients.
Methods: This multicenter, retrospective, observational study included 1,042 SSc patients followed in four centers of São Paulo between March 2020 and June 2021. Diagnosis of COVID-19 was established by proper positive RT-PCR testing or by highly suspicious infection. Patients were grouped into mild (outpatient setting treatment and no need for oxygen support) and moderate-to-severe (hospitalization and/or need for oxygen support) COVID-19.
Results: Of the 1,042 SSc patients, 118 patients were diagnosed with COVID-19. Interstitial lung disease (SSc-ILD) was present in 65.6% of the total cohort and in 46.3% of SSc patients with COVID-19. There were 78 (66.1%) cases of mild COVID-19, and 40 (33.9%) cases of moderate-to-severe disease, with 6 (5.1%) deaths. By univariate analysis, pulmonary arterial hypertension (OR 9.50, p=0.006), SSc-ILD (OR 3.90, p=0.007), FVC <80% (OR 2.90, p=0.01), cardiac involvement (OR 5.53, p=0.003), and use of rituximab (OR 3.92, p=0.039), but not age, gender, comorbidities or use of corticosteroids, were predictors of worse outcome for COVID-19. Using multivariate analysis, only SSc-ILD was significantly associated to a higher risk of moderate-to-severe COVID-19 (OR 2.73, 95% CI 1.12-6.69, p=0.02). Forty percent of the patients remained with symptoms after presenting COVID-19, predominantly dyspnea and/or cough (17%).
Conclusion: In this cohort of patients with SSc, those with SSc-ILD were highly impacted by COVID-19, with a higher risk of moderate-to-severe COVID-19 infection and death.
Keywords: COVID-19; Interstitial lung disease; Mortality; Severity; Systemic sclerosis.
【저자키워드】 COVID-19, Mortality, severity, Interstitial lung disease, Systemic sclerosis, 【초록키워드】 Treatment, Hospitalization, Infection, lung, Lung disease, Comorbidity, Gender, Symptom, outcome, cough, Prevalence, Cohort, Dyspnea, Patient, death, Mild, age, Systemic sclerosis, predictor, multicenter, disease, patients, pulmonary arterial hypertension, positive RT-PCR, retrospective, Analysis, deaths, systemic, Support, higher risk, 95% CI, highly suspicious infection, moderate-to-severe COVID-19, Univariate analysis, greater, evaluate, significantly, the patient, remained, presenting, impacted, cohort of patient, diagnosed with COVID-19, FVC, need for oxygen, patients with COVID-19, use of corticosteroids, 【제목키워드】 multicenter, COVID-19 in patient,