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Meta-Analysis
. 2021 Apr;20(4):102778.
doi: 10.1016/j.autrev.2021.102778. Epub 2021 Feb 18.

Clinical outcomes of COVID-19 in patients with rheumatic diseases: A systematic review and meta-analysis of global data

Chuanhui Xu  1 , Zixi Yi  2 , Ruyi Cai  2 , Ru Chen  3 , Bernard Yu-Hor Thong  4 , Rong Mu  5
Affiliations
Meta-Analysis

Clinical outcomes of COVID-19 in patients with rheumatic diseases: A systematic review and meta-analysis of global data

Chuanhui Xu et al. Autoimmun Rev. 2021 Apr.

Abstract

Objectives: The impact of rheumatic diseases on COVID-19 infection remains poorly investigated. Here we performed a systematic review and meta-analysis to evaluate the outcomes of COVID-19 in patients with rheumatic diseases.

Methods: We systematically searched PubMed, Embase, Cochrane Library, Scopus and preprint database up to 29th August 2020, for publications with confirmed COVID-19 infection in patients with rheumatic diseases. The primary outcomes were the rates of hospitalization, oxygen support, intensive care unit (ICU) admission and death. A meta-analysis of effect sizes using the random-effects models was performed, and meta-regression analyses were performed to explore heterogeneity. The data from the COVID-19 Global Rheumatology Alliance physician registry (the COVID-19 GRA) was used as a reference.

Results: A total of 31 articles involving 1138 patients were included in this systematic review and meta-analysis. The publications were from Europe, Asia and North America, but none from other continents. The overall rates of hospitalization, oxygen support, ICU admission and fatality among COVID-19 infected patients with rheumatic diseases were 0.58 (95% confidence interval (CI) 0.48-0.67), 0.33 (95% CI 0.21-0.47), 0.09 (95% CI 0.05-0.15) and 0.07 (95% CI 0.03-0.11), respectively. The rate of oxygen support in Europe (0.48, 95% CI 0.4-0.57) was higher than that in other continents. Among all hospitalized patients, the rates of oxygen support, ICU admission and fatality were 0.61 (95% CI 0.48-0.73), 0.13 (95% CI 0.07-0.21) and 0.13 (95% CI 0.09-0.18), respectively. The fatality rate was highest in Europe (0.19, 95% CI 0.15-0.24). The fatality rate was higher both in this meta-analysis and the COVID-19 GRA (7.0% and 6.7%, respectively) than that (3.4%) in WHO database, although the age, gender and comorbidity were not matched.

Conclusion: Patients with rheumatic diseases remain vulnerable with substantial rates of severe outcomes and a geographic variation. More studies were urgently needed to elucidate the risk factors of severe outcomes in this population.

Keywords: COVID-19; Outcomes; Rheumatic diseases; SARS-CoV-2.

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Conflict of interest statement

This work is not funded by any organization. The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Meta-analysis and subgroup analysis of the rates of hospitalization, oxygen support, ICU admission and fatality in COVID-19 infected patients with rheumatic diseases in different continents, excluding the studies only recruiting hospitalized patients. A: the rates of hospitalization. B: the rates of oxygen support. C: the rates of ICU admission. D: the rates of fatality. Overall: meta-analysis of the rates in Asia, Europe and North America. Subtotal: subgroup meta-analysis of the rates in different continents.
Fig. 2
Fig. 2
Meta-analysis and subgroup analysis of the rates of oxygen support, ICU admission and fatality in COVID-19 infected patients with rheumatic diseases in different continents, including the studies only recruiting hospitalized patients. A: the rates of oxygen support. B: the rates of ICU admission. C: the rates of fatality. Overall: meta-analysis of the rates in Asia, Europe and North America. Subtotal: subgroup meta-analysis of the rates in different continents.
See this image and copyright information in PMC

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