☆ 4.4 Article

Severity and mortality of COVID-19 in patients with systemic sclerosis: a Brazilian multicenter study

SEMINARS IN ARTHRITIS AND RHEUMATISM (2022)

Journal

SEMINARS IN ARTHRITIS AND RHEUMATISM

Volume 55, Issue -, Pages -

Publisher

W B SAUNDERS CO-ELSEVIER INC

DOI: 10.1016/j.semarthrit.2022.151987

Keywords

Systemic sclerosis; COVID-19; Interstitial lung disease; Severity; Mortality

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Abstract

This study evaluated the prevalence, severity, and mortality of COVID-19 in a Brazilian cohort of systemic sclerosis (SSc) patients. The results showed that patients with SSc-ILD were highly impacted by COVID-19, with a higher risk of moderate-to-severe infection and death.

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 Sao 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. (c) 2022 Elsevier Inc. All rights reserved.

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Lung vascular changes as biomarkers of severity in systemic sclerosis-associated interstitial lung disease

Cosimo Bruni, Mariaelena Occhipinti, Michael Pienn, Gianna Camiciottoli, Maurizio Bartolucci, Silvia Laura Bosello, Christian Payer, Zoltan Balint, Anna Rita Larici, Alessandra Tottoli, Lorenzo Tofani, Enrico De Lorenzis, Gemma Lepri, Silvia Bellando-Randone, Amelia Spinella, Dilia Giuggioli, Francesco Masini, Giovanna Cuomo, Federico Lavorini, Stefano Colagrande, Horst Olschewski, Marco Matucci-Cerinic

Summary: Recent advancements have made it possible to quantitatively assess lung vascular and parenchymal changes in thoracic CT images using automated software tools. In this study, the researchers investigated the vessel parameters of patients with SSc and correlated them with interstitial lung disease (ILD) features. The results showed that the CT vessel parameters increased in parallel with ILD extent and functional impairment, suggesting that they may serve as a biomarker of SSc-ILD severity.

RHEUMATOLOGY (2023)