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Autoimmune inflammatory rheumatic diseases and COVID-19 outcomes in South Korea: a nationwide cohort study

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dc.description.abstractBackground: Real-world evidence on the association between autoimmune inflammatory rheumatic diseases, therapies related to these diseases, and COVID-19 outcomes are inconsistent. We aimed to investigate the potential association between autoimmune inflammatory rheumatic diseases and COVID-19 early in the COVID-19 pandemic. Methods: We did an exposure-driven, propensity score-matched study using a South Korean nationwide cohort linked to general health examination records. We analysed all South Korean patients aged older than 20 years who underwent SARS-CoV-2 RT-PCR testing between Jan 1 and May 30, 2020, and received general health examination results from the Korean National Health Insurance Service. We defined autoimmune inflammatory rheumatic diseases (inflammatory arthritis and connective tissue diseases) based on the relevant ICD-10 codes, with at least two claims (outpatient or inpatient) within 1 year. The outcomes were positive SARS-CoV-2 RT-PCR test, severe COVID-19 (requirement of oxygen therapy, intensive care unit admission, application of invasive ventilation, or death), and COVID-19-related death. Adjusted odds ratios (ORs) with 95% CIs were estimated after adjusting for the potential confounders. Findings: Between Jan 1 and May 30, 2020, 133 609 patients (70 050 [52·4%] female and 63 559 [47·6%] male) completed the general health examination and were tested for SARS-CoV-2; 4365 (3·3%) were positive for SARS-CoV-2, and 8297 (6·2%) were diagnosed with autoimmune inflammatory rheumatic diseases. After matching, patients with an autoimmune inflammatory rheumatic disease showed an increased likelihood of testing positive for SARS-CoV-2 (adjusted OR 1·19, 95% CI 1·03-1·40; p=0·026), severe COVID-19 outcomes (1·26, 1·02-1·59; p=0·041), and COVID-19-related death (1·69, 1·01-2·84; p=0·046). Similar results were observed in patients with connective tissue disease and inflammatory arthritis. Treatment with any dose of systemic corticosteroids or disease-modifying antirheumatic drugs (DMARDs) were not associated with COVID-19-related outcomes, but those receiving high dose (≥10 mg per day) of systemic corticosteroids had an increased likelihood of a positive SARS-CoV-2 test (adjusted OR 1·47, 95% CI 1·05-2·03; p=0·022), severe COVID-19 outcomes (1·76, 1·06-2·96; p=0·031), and COVID-19-related death (3·34, 1·23-8·90; p=0·017). Interpretation: Early in the COVID-19 pandemic, autoimmune inflammatory rheumatic diseases were associated with an increased likelihood of a positive SARS-CoV-2 PCR test, worse clinical outcomes of COVID-19, and COVID-19-related deaths in South Korea. A high dose of systemic corticosteroid, but not DMARDs, showed an adverse effect on SARS-CoV-2 infection and COVID-19-related clinical outcomes. Funding: National Research Foundation of Korea.-
dc.relation.isPartOfLANCET RHEUMATOLOGY-
dc.rightsCC BY-NC-ND 2.0 KR-
dc.titleAutoimmune inflammatory rheumatic diseases and COVID-19 outcomes in South Korea: a nationwide cohort study-
dc.contributor.collegeCollege of Medicine (의과대학)-
dc.contributor.departmentDept. of Pediatrics (소아과학교실)-
dc.contributor.googleauthorYoun Ho Shin-
dc.contributor.googleauthorJae Il Shin-
dc.contributor.googleauthorSung Yong Moon-
dc.contributor.googleauthorHyun Young Jin-
dc.contributor.googleauthorSo Young Kim-
dc.contributor.googleauthorJee Myung Yang-
dc.contributor.googleauthorSeong Ho Cho-
dc.contributor.googleauthorSungeun Kim-
dc.contributor.googleauthorMinho Lee-
dc.contributor.googleauthorYoungjoo Park-
dc.contributor.googleauthorMin Seo Kim-
dc.contributor.googleauthorHong-Hee Won-
dc.contributor.googleauthorSung Hwi Hong-
dc.contributor.googleauthorAndreas Kronbichler-
dc.contributor.googleauthorAi Koyanagi-
dc.contributor.googleauthorLouis Jacob-
dc.contributor.googleauthorLee Smith-
dc.contributor.googleauthorKeum Hwa Lee-
dc.contributor.googleauthorDong In Suh-
dc.contributor.googleauthorSeung Won Lee-
dc.contributor.googleauthorDong Keon Yon-
dc.contributor.alternativeNameShin, Jae Il-
dc.identifier.bibliographicCitationLANCET RHEUMATOLOGY, Vol.3(10) : e698-e706, 2021-10-
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Pediatrics (소아과학교실) > 1. Journal Papers


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