Risk of Adverse Outcomes in Hospitalized Patients With Autoimmune Disease and COVID-19: A Matched Cohort Study From New York City

Objective: To examine the effect of autoimmune (AI) disease on the composite outcome of intensive care unit (ICU) admission, intubation, or death from COVID-19 in hospitalized patients.

Methods: Retrospective cohort study of 186 patients hospitalized with COVID-19 between March 1, 2020, and April 15, 2020 at NewYork-Presbyterian Hospital/Columbia University Irving Medical Center. The cohort included 62 patients with AI disease and 124 age- and sex-matched controls. The primary outcome was a composite of ICU admission, intubation, and death, with secondary outcome as time to in-hospital death. Baseline demographics, comorbidities, medications, vital signs, and laboratory values were collected. Conditional logistic regression and Cox proportional hazards regression were used to assess the association between AI disease and clinical outcomes.

Results: Patients with AI disease were more likely to have at least one comorbidity (87.1% vs 74.2%, = 0.04), take chronic immunosuppressive medications (66.1% vs 4.0%, < 0.01), and have had a solid organ transplant (16.1% vs 1.6%, < 0.01). There were no significant differences in ICU admission (13.7% vs 19.4%, = 0.32), intubation (13.7% vs 17.7%, = 0.47), or death (16.1% vs 14.5%, = 0.78). On multivariable analysis, patients with AI disease were not at an increased risk for a composite outcome of ICU admission, intubation, or death (OR 0.79, 95% CI 0.37-1.67). On Cox regression, AI disease was not associated with in-hospital mortality (HR 0.73, 95% CI 0.33-1.63).

Conclusion: Among patients hospitalized with COVID-19, individuals with AI disease did not have an increased risk of a composite outcome of ICU admission, intubation, or death.