Dr. D’Silva and colleagues found patients with systemic autoimmune rheumatic diseases had a 14% higher risk of hospitalization and a 32% higher risk of intensive care unit admission compared to patients without systemic autoimmune rheumatic disease in their primary model. These patients had an 81% higher risk of acute kidney injury and need for renal replacement therapy, and a 74% higher risk of venous thromboembolism. However, the team found no significantly increased risk of ischemic stroke or death.
“These risks were attenuated after adjusting for comorbidities, which are likely causal intermediates,” Dr. D’Silva explained.
There was a persistently higher risk of venous thromboembolism, even after adjusting for comorbidities. Therefore, patients with rheumatic disease should be closely monitored for venous thromboembolism during COVID-19 infection.”
In future studies, the team hopes to see if different levels of risk emerge among different kinds of systemic autoimmune rheumatic diseases.
Racial Disparities in Patients with Lupus
Shivani Garg, MD, MS, assistant professor in the Division of Rheumatology, University of Wisconsin, Madison, presented data that built on information presented at a 2019 Plenary Session. At that time, her group reported the risk of cardiovascular disease was 18-fold higher in patients with lupus who are Black than in those who are white.
Discrepancies in the medical literature about the timing of the greatest risk of stroke and myocardial ischemia in lupus patients led them to investigate this finding, as well as potential predictors of these events, in Black patients with lupus. Dr. Garg and colleagues used a population-based registry of lupus patients from Atlanta and found 336 new incident cases of lupus from 2002–04, of which 87% were women and 75% were Black. They matched these data with information from two other population databases to identify cardiovascular disease events.
Using a Cox proportional hazards model, the researchers compared the timing of stroke and ischemic heart disease events in their cohort. Dr. Garg said, “We found there were a disproportionately higher number of stroke-related deaths or events during the second year of lupus diagnosis, while the peak of ischemic heart disease or deaths was seen much later, during the 14th year of lupus diagnosis.”
Next, the team examined disparities in stroke risk. “We found that Black patients had a threefold higher risk of stroke compared to non-Black patients, with maximum events occurring earlier during the disease course,” Dr. Garg continued. Other analyses revealed that Black lupus patients had a 24-fold higher risk of ischemic heart disease compared to non-Black patients. Moreover, the timeline of stroke and ischemic heart disease was significantly accelerated in Black patients compared with non-Blacks.
