Clinical characteristics of 17 patients with COVID-19 and systemic autoimmune diseases: a retrospective study

Abstract

Objectives: Increasing data about COVID-19 have been acquired from the general population. We aim to further evaluate the clinical characteristics of COVID-19 in patients with systemic autoimmune diseases (AIDs).

Methods: We included all confirmed inpatients with COVID-19 and systemic AIDs in Wuhan Tongji Hospital from 29 January to 8 March 2020. We retrospectively collected and analysed information on epidemiology of 1255 inpatients and additional clinical characteristics of patients with systemic AIDs. Outcomes were followed up until 16 April 2020.

Results: Of the 1255 patients with COVID-19, the median age was 64.0 years and 53.1% were male. More than half (63.0%) had chronic comorbidities. The proportions of elderly, male and patients with comorbidities were significantly higher in intensive care unit (ICU) than in the general ward (p<0.001). 17 (0.61%) patients with systemic AIDs were further screened and analysed from 2804 inpatients. The median age was 64.0 years and 82.4% were female. All patients were living in Wuhan and two family clusters were found. 1 (5.9%) patient was admitted to ICU and one died. 10 (62.5%) of 16 patients changed or stopped their anti-AIDs treatments during hospitalisation, and 5 of them felt that the disease had worsened after the quarantine.

Conclusions: Older males with chronic comorbidities are more vulnerable to severe COVID-19. The lower proportion of COVID-19 in patients with systemic AIDs needs more high-quality human clinical trials and in-depth mechanism researches. Of note, the withdrawal of anti-AIDs treatments during hospitalisation can lead to flares of diseases.

Keywords: autoimmune diseases; epidemiology; glucocorticoids; hydroxychloroquine.

Figure 1

Distribution of 1255 inpatients with COVID-19 in Tongji Hospital. (A) Number of hospital admissions by sex and age group. (B) Number of hospital admissions by comorbid conditions.

Figure 2

Chest CT scans (transverse plane) of 10 patients. (A) Case 1: bilateral patchy shadowing. (B) Case 2: bilateral emphysema; bilateral scattered ground-glass opacities and patchy shadowing. (C) Case 3: bilateral scattered ground-glass opacities and patchy shadowing. (D) Case 4: bilateral ground-glass opacities and patchy shadowing. (E) Case 5: light patchy shadowing in the upper left and lower right lobes. (F) Case 6: bilateral blurred shadowing and strip shadowing, and some of them show grid-like changes. (G) Case 7: bilateral scattered ground-glass opacities and consolidation. (H) Case 8: diffuse multiple ground-glass opacities and consolidation bilaterally, showing sign of air bronchus. (I) Case 9: multiple bilateral patchy shadowing with honeycomb-like changes, bilateral pleural effusion and bilateral atelectasis. (J) Case 10: bilateral patchy shadowing with ‘white lung’ changes, bilateral pleural effusion, left ventricular enlargement and pericardial effusion.