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Risk factors for hospital admissions related to COVID-19 in patients with autoimmune inflammatory rheumatic diseases
  1. Dalifer D Freites Nuñez1,
  2. Leticia Leon1,2,
  3. Arkaitz Mucientes1,
  4. Luis Rodriguez-Rodriguez1,
  5. Judit Font Urgelles3,
  6. Alfredo Madrid García1,
  7. Jose I Colomer1,
  8. Juan A Jover3,4,
  9. Benjamín Fernandez-Gutierrez3,
  10. Lydia Abasolo1
  1. 1 Rheumatology Department and IDISSC, La Fundacion para la Investigacion Biomedica del Hospital Clinico San Carlos, Madrid, Spain
  2. 2 Department of Health and Education, Universidad Camilo Jose Cela, Villafranca del Castillo, Madrid, Spain
  3. 3 Rheumatology Department, Hospital Clinico San Carlos, Madrid, Spain
  4. 4 Medicine Department, Universidad Complutense de Madrid, Madrid, Comunidad de Madrid, Spain
  1. Correspondence to Dr Leticia Leon, IdISSC and Rheumatology, La Fundacion para la Investigacion Biomedica del Hospital Clinico San Carlos, Madrid, Spain; lleon.hcsc{at}


Objectives To describe patients with autoimmune inflammatory rheumatic diseases (AIRD) who had COVID-19 disease; to compare patients who required hospital admission with those who did not and assess risk factors for hospital admission related to COVID-19.

Methods An observational longitudinal study was conducted during the pandemic peak of severe acute respiratory syndrome coronavirus 2 (1 March 2020 to 24 April). All patients attended at the rheumatology outpatient clinic of a tertiary hospital in Madrid, Spain with a medical diagnosis of AIRD and with symptomatic COVID-19 were included. The main outcome was hospital admission related to COVID-19. The covariates were sociodemographic, clinical and treatments. We ran a multivariable logistic regression model to assess risk factors for the hospital admission.

Results The study population included 123 patients with AIRD and COVID-19. Of these, 54 patients required hospital admission related to COVID-19. The mean age on admission was 69.7 (15.7) years, and the median time from onset of symptoms to hospital admission was 5 (3–10) days. The median length of stay was 9 (6–14) days. A total of 12 patients died (22%) during admission. Compared with outpatients, the factors independently associated with hospital admission were older age (OR: 1.08; p=0.00) and autoimmune systemic condition (vs chronic inflammatory arthritis) (OR: 3.55; p=0.01). No statistically significant findings for exposure to disease-modifying antirheumatic drugs were found in the final model.

Conclusion Our results suggest that age and having a systemic autoimmune condition increased the risk of hospital admission, whereas disease-modifying antirheumatic drugs were not associated with hospital admission.

  • antirheumatic agents
  • communicable diseases
  • imported
  • epidemiology
  • outcome assessment
  • health care

This article is made freely available for use in accordance with BMJ’s website terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, non-commercial purpose (including text and data mining) provided that all copyright notices and trade marks are retained.

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  • Handling editor Josef S Smolen

  • Twitter @Fergutbe2001

  • Contributors BF-G, LL, JAJ, LR-R and LA conceived and designed the study. DDFN, JFU, AMG, JIC and LL collected data. LA and LL performed the data analysis and interpreted the data. All of the authors were involved in the drafting and/or revising of the manuscript.

  • Funding This work was supported by the Instituto de Salud Carlos III (ISCIII), Ministry of Health, Spain (CP16/00916; PI18/01188; and RD16/0012/0014) and cofunded by el Fondo Europeo de Desarrollo Regional (FEDER). The funders had no role in study design, data collection, analysis, manuscript preparation or decision to publish.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Hospital Clínico San Carlos institutional ethics committee (approval number 20/268-E-BS). This study was conducted according to the principles of the Declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.