Hyperinflammation, Poor Outcomes Observed Among COVID-19 Patients with Rheumatic Disease

Tiffany Hsu, MD

A recent study out of Boston found that patients with COVID-19 and systemic rheumatic disease had an increased risk of hyperinflammation and kidney injury, as well as a greater likelihood of extended intensive care treatment for their infection.

The study, headed by Tiffany Y-T Hsu, MD, of Brigham & Women’s Hospital and Harvard Medical School, was conducted in an attempt to find a link between hyperinflammation in patients and the severity of their reactions to COVID-19. It is also considered to be the first known study to focus on the post-hospital discharge outcomes of patients with rheumatic diseases.

The study involved 57 patients with systemic rheumatic disease (60% of whom had an active disease) and 232 matched comparators, all of whom were admitted into hospitals in the Boston area between January 30 and July 7, 2020.

Hsu et al chose the 1:5 trial population ratio “because we expected some comparator participants to be excluded for not meeting the study eligibility requirements after initial matching, and we required each case to have at least 3 comparators to optimize power.”

Women made up a majority of patients with a rheumatic disease (67%) while a majority of comparator patients were male (68%). Age, gender and various electronic medical records of all patients were considered for the study.

The study found no sizable difference between the 2 groups regarding in-hospital mortality rates. Additionally, rates of discharge to nursing facilities, rehospitalization and post-discharge mortality also remained about the same for both groups, though Hsu et all admitted the sample was small.

However, an increase in intensive care as well as a reliance on mechanical ventilation was noted for patients with a rheumatic disease. These cases of additional treatment were linked to the propensity of hyperinflammation in immunocompromised patients. Kidney injuries were also recorded among such patients.

The investigators’ findings joined an ever-growing amount of research pertaining to the relationship between rheumatic diseases and severe COVID-19 reactions. The study referenced 2 additional findings from Sweden and China with results that both differed and at times supported the ones found in their study.

The Swedish study found a 19% increase in mortality among patients with rheumatic diseases, while the study that took place in Wuhan, China suggested that mechanical ventilation was 3 times as likely for rheumatic patients post-infection.

While the Boston study did not find an increase in mortality rates for immunocompromised patients, it did detail the need for mechanical ventilation for patients with rheumatic disease.

While the discharge and mortality rates among patients with systemic rheumatic disease are reassuring, as they do not differ greatly from the comparative group, the non-lethal reactions from contracting the virus do raise concerns. The studies conducted in Boston, Sweden and China support the notion of increased severe COVID-19 likelihood among immunocompromised patients, with further study recommended in order to uncover the lasting effects of the virus on patients with rheumatic diseases.

The study, “Laboratory trends, hyperinflammation, and clinical outcomes for patients with a systemic rheumatic disease admitted to hospital for COVID-19: a retrospective, comparative cohort study,” was published online in The Lancet Rheumatology.