Severe COVID-19 in Patients with Immune-Mediated Rheumatic Disorders: A Case-Control Study
Year: 2025
Type: article
Abstract: Jamal Al-Saleh,1 Wafae Rachidi,1,2 Naureen Ali Khan,1 Mohammed G Ahmed,1,3 Hend Al-Saidi,1 Noura Zamani,1 Nasir Elamin Elhag Elsidig,1 Ahmed Abdelmoniem Negm,1,3 Faisal Elbadawi1 1Rheumatology Section, Dubai Hospital, Dubai Health, Dubai, United Arab Emirates; 2Department of Rheumatology, Faculty of Medicine, Hassan II University, Casablanca, Morocco; 3Rheumatology Department, AL-Azhar University, Cairo, EgyptCorrespondence: Jamal Al-Saleh, Rheumatology Section, Dubai Hospital, Dubai Health, Makani, 30971 97491, Dubai, United Arab Emirates, Tel +971-4-219-5577, Fax +971-4-219-5000, Email [email protected]: To assess the impact of severe COVID-19 in patients with immune-mediated rheumatic diseases (im-RD) and compare their morbidity, mortality, hospitalization issues, post-COVID-19 sequelae, and the financial burden of COVID-19 with those of patients without im-RD.Patients and Methods: We conducted a retrospective case–control study that included 132 consecutive patients with im-RD who visited the Rheumatology Department of a public hospital in the Emirate of Dubai and were hospitalized for COVID-19 infection between March 1st, 2020, and December 31st, 2021, (cases). We included 264 and 132 age- and sex-matched patients without im-RD in matched-I and matched-II control groups, respectively. The median age of patients and controls was 48.5 years, and 74.2% were female. Patients with im-RD were paired with an unforced nearest neighbor match using a caliper width of 0.2 standard deviations of the matched-II control group’s propensity score. We compared the relative risk of death, disease progress, use of medical resources, and financial impact of COVID-19 between patients and controls.Results: Patients with im-RD had higher mortality rates than the matched-I (odds ratio, OR: 11.2, p < 0.000) and matched-II (OR: 16.8, p < 0.006) control groups. The overall complication rate was also significantly higher in patients with im-RD than in matched-I (OR = 2.9, p < 0.000) and matched-II (OR = 2.8, P < 0.0001) control groups. Lastly, patients with im-RD required more frequent visits to the clinic, a longer recovery time following hospital discharge, and increased healthcare costs compared to the control groups.Conclusion: COVID-19 infection in patients with im-RD is associated with increased morbidity and mortality, exerting a significant burden on the healthcare system.Plain Language Summary: We performed a retrospective case–control study to evaluate the effect of severe COVID-19 in patients with immune-mediated rheumatic disease (im-RD). In this study, we compared the morbidity, mortality, facility-level factors, post-COVID sequelae, and financial burden of 132 cases of im-RD with two control groups, matched by age and sex, who did not have im-RD. Our key findings are that patients with im-RD:Exhibited a considerably greater death rate than controls.Have higher disease complication rates, including pneumonia, secondary infections, and immunological thrombocytopenia.Experience longer hospital stays and more ICU admissions.Have higher use of healthcare resources after discharge.Have higher direct and indirect expenditures.The implications of our study are as follows:Patients with im-RD require more aggressive COVID-19 treatment strategies.Tailored protocols and closer monitoring is needed for this high-risk group.Healthcare systems should allocate more resources for im-RD patients with COVID-19.Prioritization of vaccination and booster programs for im-RD patients is required.Further research is required on optimizing COVID-19 management in this population.In summary, this study highlights the significantly higher clinical and financial burden of severe COVID-19 in patients with im-RD, emphasizing the need for specialized care approaches and resource allocation for this vulnerable group.Keywords: rheumatic diseases, COVID-19, mortality, morbidity, financial burden
Authors: Al-Saleh J, Rachidi W, Khan NA, Ahmed MG, Al-Saidi H, Zamani N, Elsidig NEE, Negm AA, Elbadawi F
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7005908428
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