Characteristics of SARS-CoV-2 Infection in an Actively Monitored Cohort of Patients with Lupus Nephritis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population and Data Collection
2.2. SARS-CoV-2 Infection Diagnosis and Assessment of Severity
2.3. Statistical Analysis
3. Results
3.1. Study Population
3.2. SARS-CoV-2 Infection Characteristics
3.3. Risk Factors for SARS-CoV-2 Infection
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Variable | Value |
---|---|
Number of patients | 95 |
Number of patients with COVID-19 (n, %) | 15 (15.8%) |
Symptoms | |
Fatigue (%) | 73.3% |
Fever (%) | 46.7% |
Cough (%) | 20% |
Odynophagia/sore throat (%) | 20% |
Myalgia/arthralgia (%) | 40% |
Dyspnea (%) | 13.3% |
Loss of taste/smell (%) | 53.3% |
Diarrhea (%) | 26.7% |
Outcome | |
Hospitalization (%) | 40% |
Length of hospitalization (days) | 11.5 (IQR, 3.75–14) |
Non-invasive ventilation (%) | 0% |
Invasive mechanical ventilation (%) | 0% |
Death due to COVID-19 (%) | 0% |
Severity of SARS-CoV-2 infection | |
Mild (%) | 73.3% |
Moderate (%) | 26.7% |
Severe (%) | 0% |
LN evolution following SARS-CoV-2 infection | |
Increase in SCr of at least 0.5 mg/dL (%) | 20% |
Increase in proteinuria (%) | 13.3% |
Increase in hematuria (%) | 6.6% |
Variable | Entire Cohort | SARS-CoV-2 | No SARS-CoV-2 | p-Value |
---|---|---|---|---|
Number of patients | 95 | 15 | 80 | |
Sex (% females) | 83.2% | 86.7% | 82.3% | 0.83 |
Age (years) | 39 ± 14 | 38 ± 12 | 40 ± 14 | 0.77 |
Arterial hypertension (%) | 45.3% | 53.3% | 43.8% | 0.49 |
Diabetes (%) | 9.5% | 0% | 11.2% | 0.34 |
Duration of SLE (years) | 7.3 (IQR: 2.3–13.6) | 6.7 (IQR: 2.6–10.7) | 7.3 (IQR: 2.3–15.3) | 0.25 |
Extrarenal involvement | ||||
Cardiac | 3.2% | 0% | 3.8% | 0.99 |
Neurological | 11.6% | 13.3% | 11.2% | 0.68 |
Hematological | 65% | 73.3% | 65% | 0.53 |
Articular | 67.4% | 46.7% | 71.2% | 0.07 |
Serositis | 22.1% | 20% | 22.5% | 0.99 |
Cutaneous | 61.1% | 40% | 65% | 0.06 |
Gastro-intestinal tract | 8.4% | 6.7% | 8.8% | 0.99 |
Laboratory data | ||||
Serum creatinine (mg/dL) | 1.6 ± 1.9 | 1.87 ± 2.26 | 1.63 ± 1.84 | 0.97 |
eGFR (mL/min) | 69 ± 32 | 64 ± 33 | 70 ± 32 | 0.56 |
Serum albumin (g/dL) | 4 ± 0.85 | 3.5 ± 1.2 | 4.1 ± 0.76 | 0.09 |
Fibrinogen (mg/dL) | 418 ± 121 | 430 ± 169 | 415 ± 112 | 0.75 |
Hematuria (cells/mmc) | 10 (IQR: 4.3–30.2) | 29 (IQR: 10–118) | 10 (IQR: 4–26.7) | 0.01 |
24-h proteinuria (g/day) | 0.3 (IQR: 0–1.2) | 0.8 (IQR: 0.4–2.5) | 0.2 (IQR: 0–1) | 0.13 |
Leukocytes (cells/mmc) | 7411 ± 3174 | 8702 ± 2465 | 7169 ± 3246 | 0.04 |
Neutrophils (cell/mmc) | 5007 ± 2447 | 6282 ± 2377 | 4768 ± 2399 | 0.03 |
Lymphocytes (cells/mmc) | 1647 ± 954 | 1593 ± 789 | 1657 ± 986 | 0.78 |
Hemoglobin (g/dL) | 12.1 ± 1.9 | 12.4 ± 1.9 | 12.1 ± 1.9 | 0.52 |
Serum IgA (mg/dL) | 250 (IQR: 153–337) | 224 (IQR: 184–392) | 250 (IQR: 141–333) | 0.54 |
Serum IgG (mg/dL) | 1141 (IQR: 811–1519) | 1260 (IQR: 573–1550) | 1130 (IQR: 824–1519) | 0.88 |
Serum IgM (mg/dL) | 86 (IQR: 47–157) | 63 (IQR: 37–149) | 89 (IQR: 47–166) | 0.6 |
C-reactive protein (mg/L) | 8.9 ± 16.8 | 14.3 ± 29.5 | 8 ± 13.7 | <0.001 |
Serum C3 (mg/dL) | 98 ± 30 | 96 ± 31 | 98 ± 30 | 0.81 |
Serum C4 (mg/dL) | 19 ± 9 | 18 ± 7 | 19 ± 9 | 0.63 |
Immunosuppression | ||||
On immunosuppression (%) | 83.2% | 80% | 83.8% | 0.71 |
During induction (%) | 8.4% | 20% | 6.2% | 0.11 |
During maintenance (%) | 74.7% | 60% | 77.5% | 0.19 |
Hydroxychloroquine (%) | 85.3% | 66.7% | 88.8% | 0.04 |
Hydroxychloroquine dose (%) | ||||
• 200 mg | 50.5% | 33.3% | 53.8% | 0.07 |
• 400 mg | 34.7% | 33.3% | 35% | |
Calcineurin inhibitor (%) | 9.5% | 13.3% | 8.8% | 0.63 |
Mycophenolate mofetil (%) | 34.7% | 46.7% | 32.5% | 0.29 |
Mycophenolate mofetil dose (g/day) | 1 (IQR: 1–1.5) | 1 (IQR: 1–1.5) | 1 (IQR: 1–1.5) | 0.67 |
Cumulative cyclophosphamide dose (g) | 3 (IQR: 0.125–7.5) | 2.87 (IQR: 1.1–7.1) | 3 (IQR: 0–8.75) | 0.75 |
Rituximab (%) | 10.5% | 13.3% | 10% | 0.65 |
Azathioprine (%) | 15.8% | 6.7% | 17.6% | 0.45 |
Oral corticosteroids (%) | 60% | 66.7% | 58.8% | 0.56 |
Corticosteroid dose (mg/day) | 8 (IQR: 5–10) | 16 (IQR: 7–21) | 6 (IQR: 4–10) | 0.007 |
On clinical remission (%) | 63.2% | 40% | 67.5% | 0.04 |
Variable | Univariate Analysis | Multivariate Analysis | ||
---|---|---|---|---|
Odds Ratio (95%CI) | p Value | Odds Ratio (95%CI) | p Value | |
eGFR (for 1 mL/min/1.73m2) | 0.99 (0.97–1.012) | 0.54 | - | - |
Serum albumin (for 1 g/dL) | 0.55 (0.31–0.96) | 0.03 | 1.04 (0.35–3.03) | 0.94 |
C-reactive protein (for 1 mg/L) | 1.01 (0.98–1.04) | 0.25 | 1.006 (0.97–1.04) | 0.75 |
Hematuria (for 1 cell/mmc) | 1.00 (0.99–1.001) | 0.8 | - | - |
On immunosuppression (yes vs. no) | 0.77 (0.19–3.14) | 0.72 | - | - |
During induction therapy (yes vs. no) | 3.75 (0.79–17.7) | 0.09 | 3.91 (0.56–30.4) | 0.1 |
During maintenance therapy (yes vs. no) | 0.43 (0.13–1.38) | 0.16 | - | - |
On hydroxychloroquine (yes vs. no) | 0.25 (0.07–0.91) | 0.03 | 0.09 (0.01–0.59) | 0.01 |
Hydroxychloroquine dose (vs. no HCQ) | - | - | - | - |
• 200 mg | 0.2 (0.05–0.87) | 0.03 | - | - |
• 400 mg | 0.32 (0.07–1.36) | 0.12 | - | - |
On CNI (yes vs. no) | 1.6 (0.29–8.59) | 0.58 | - | - |
On MMF (yes vs. no) | 1.81 (0.59–5.55) | 0.29 | - | - |
On azathioprine (yes vs. no) | 0.33 (0.04–2.77) | 0.31 | - | - |
On rituximab (yes vs. no) | 1.38 (0.26–7.26) | 0.7 | - | - |
Current oral corticosteroid dose (≥15 mg/d vs. <15 mg/d) | 10 (2.53–39.49) | 0.005 | 7.69 (1.3–45.46) | 0.02 |
Cumulative cyclophosphamide dose (≥3 g vs. <3 g) | 0.75 (0.22–2.6) | 0.65 | - | - |
With clinical remission (yes vs. no) | 0.27 (0.08–0.85) | 0.02 | 0.28 (0.05–1.45) | 0.72 |
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Obrișcă, B.; Vornicu, A.; Jurubiță, R.; Mocanu, V.; Dimofte, G.; Andronesi, A.; Sorohan, B.; Achim, C.; Micu, G.; Bobeică, R.; et al. Characteristics of SARS-CoV-2 Infection in an Actively Monitored Cohort of Patients with Lupus Nephritis. Biomedicines 2022, 10, 2423. https://doi.org/10.3390/biomedicines10102423
Obrișcă B, Vornicu A, Jurubiță R, Mocanu V, Dimofte G, Andronesi A, Sorohan B, Achim C, Micu G, Bobeică R, et al. Characteristics of SARS-CoV-2 Infection in an Actively Monitored Cohort of Patients with Lupus Nephritis. Biomedicines. 2022; 10(10):2423. https://doi.org/10.3390/biomedicines10102423
Chicago/Turabian StyleObrișcă, Bogdan, Alexandra Vornicu, Roxana Jurubiță, Valentin Mocanu, George Dimofte, Andreea Andronesi, Bogdan Sorohan, Camelia Achim, Georgia Micu, Raluca Bobeică, and et al. 2022. "Characteristics of SARS-CoV-2 Infection in an Actively Monitored Cohort of Patients with Lupus Nephritis" Biomedicines 10, no. 10: 2423. https://doi.org/10.3390/biomedicines10102423