Session: (1796–1826) Epidemiology & Public Health Poster III
1800: Factors Associated with an Electronic Health Record-Based Definition of Post-Acute Sequelae of COVID-19 in Patients with Systemic Autoimmune Rheumatic Diseases
Massachusetts General Hospital Boston, MA, United States
Disclosure information not submitted.
Naomi Patel1, Xiaosong Wang2, Yumeko Kawano2, Abigail Schiff2, Rathnam Venkat2, Claire Cook1, Kathleen Vanni2, Grace Qian2, Katarina Bade2, Shruthi Srivatsan1, Krishan Guzzo1, Zachary Williams1, Emily Kowalski2, Alene Saavedra2, Jeffrey Sparks3 and Zachary Wallace4, 1Massachusetts General Hospital, Boston, MA, 2Brigham and Women's Hospital, Boston, MA, 3Division of Rheumatology, Inflammation, and Immunity, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, 4Massachusetts General Hospital, Newton, MA
Background/Purpose: Immunosuppression for treatment of systemic autoimmune rheumatic diseases (SARDs) is associated with increased risk of severe acute COVID-19 due to blunted vaccine responses and impaired immune response to infection. Whether immunosuppression may also alter the risk for post-acute sequelae of COVID-19 (PASC), or "long COVID," is unclear. Previous studies (Al-Aly et al, Nature Medicine, 2022) have developed electronic health record (EHR)-based definitions of PASC that have the benefit of including all COVID-19 survivors, rather than relying on prospective studies that may have selection bias, but have not been performed among SARD patients. We evaluated baseline demographic and disease factors associated with PASC in a large EHR-based cohort of patients with SARDs.
Methods: We systematically identified patients with SARDs and confirmed COVID-19 in a large healthcare system (up to 1/18/2023). We required patients to have baseline data in the EHR prior to the index date, defined as initial COVID-19 infection. Patients who survived COVID-19 were followed from 30 days after the index date until the development of any incident PASC feature, repeat COVID-19 infection, 1 year of follow-up, death, or until 4/14/2023. We evaluated the proportion with incident PASC features, defined by incident ICD codes, relevant vital signs or labs, and/or medications, extracted from the EHR. We estimated the association of baseline characteristics with the risk of PASC using multivariable Cox regression.
Results: We identified 2,459 patients with SARDs and confirmed COVID-19 (76% female, mean age 57 years, Table 1). The majority of patients (1566; 64%) had at least one incident feature of PASC. The most common incident PASC features were hyperlipidemia (561; 23%), anxiety (419; 17%), dyspnea (303; 12%), fatigue (263; 11%), and chest pain (246; 10%) (Figure). Compared to antimalarial monotherapy, TNF inhibitors were associated with lower PASC risk (aHR 0.78, 95% CI 0.64-0.94) and CD20 inhibitors were associated with higher PASC risk (aHR 1.27, 95% CI 1.02-1.59) (Table 2). Glucocorticoid use (vs. non-use) was associated with higher PASC risk (aHR 1.15, 95% CI 1.02-1.29). Compared to those with COVID-19 infection early in the pandemic, those with infection during the Delta wave (aHR 0.59, 95% CI 0.46-0.76) and Omicron era (aHR 0.51, 95% CI 0.41-0.63) had a lower risk of PASC. Older age, Black race, increased comorbidity burden, hospitalization for acute COVID-19 infection, and diagnosis of SLE or ANCA-associated vasculitis (compared to RA) were also associated with higher PASC risk.
Conclusion: Among patients with SARDs, CD20 inhibitor users had a higher PASC risk while TNF inhibitor users had a lower PASC risk following COVID-19 infection, suggesting that baseline immunosuppression may alter the post-acute COVID-19 course. Other factors associated with PASC included SLE or ANCA-associated vasculitis, as well as general population risk factors including calendar time (as a marker of SARS-CoV-2 variant and available treatments), older age, race, and hospitalization for acute COVID-19. These findings emphasize the potentially large burden of PASC among patients with SARDs.
Figure. Proportion of patients who developed Post-Acute Sequelae of COVID-19 during the study period by organ system involvement
Table 1. Demographics and rheumatic disease characteristics of patients with history of COVID-19 infection
Table 2. Selected baseline factors at the time of COVID-19 infection and their associations with Post-Acute Sequelae of COVID-19.
N. Patel: Arrivo Bio, 2, Chronius Health, 2, FVC Health, 2; X. Wang: None; Y. Kawano: None; A. Schiff: None; R. Venkat: None; C. Cook: None; K. Vanni: None; G. Qian: None; K. Bade: None; S. Srivatsan: None; K. Guzzo: None; Z. Williams: None; E. Kowalski: None; A. Saavedra: None; J. Sparks: AbbVie, 2, Amgen, 2, Boehringer Ingelheim, 2, Bristol-Myers Squibb, 2, 5, Gilead, 2, Inova Diagnostics, 2, Janssen, 2, Optum, 2, Pfizer, 2, ReCor, 2; Z. Wallace: BioCryst, 2, Bristol-Myers Squibb(BMS), 5, Horizon, 1, 2, 5, MedPace, 2, Novartis, 1, PPD, 2, Sanofi, 1, 5, Shionogi, 1, Visterra, 1, 2, Zenas, 1, 2.