Patients with pulmonary sarcoidosis do not appear to be at increased risk for worse outcomes associated with COVID-19, but these patients may have a higher risk of COVID-19-related morbidity given the population’s increased prevalence of risk factors for severe disease, according to research findings published in Respiratory Medicine.
Outcomes associated with COVID-19 among patients with autoimmune and inflammatory disorders have been largely understudied. In addition, much of the data on COVID-19-related outcomes in patients with sarcoidosis are limited to case reports and series with limited follow-up durations.
Theoretically, patients with underlying chronic lung disease may have a higher risk of complications associated with COVID-19, given some research suggesting that concomitant pulmonary disease may be associated with worse outcomes following infection with the novel coronavirus.
To further understand the outcomes of SARS-CoV-2 infection in this patient population, a team of researchers from West Virginia University retrospectively analyzed a cohort of patients within the multicenter research network, TriNETX.
Out of 278,271 patients in the research network who had COVID-19, a total of 954 patients (mean age, 56.3±13.2 years; 64.89% women) had a diagnosis of pulmonary sarcoidosis. Outcomes of these patients were compared with a propensity score-matched cohort of 954 patients without a diagnosis of pulmonary sarcoidosis.
Patients with pulmonary sarcoidosis were found to have a higher prevalence of comorbidities, including hypertension, diabetes, nicotine dependence, ischemic heart disease, chronic lower respiratory disease, and chronic kidney disease (P <.01 for all).
In the sarcoidosis group, 30- and 60-day mortality rates following COVID-19 diagnosis were 3.46% and 4.30%, respectively, and 6.08% and 6.50% of patients with pulmonary sarcoidosis reached the composite outcome of death or mechanical ventilation at 30 and 60 days, respectively.
Crude analysis revealed patients with pulmonary sarcoidosis to have higher rates of 30-day mortality (risk ratio [RR], 1.92; 95% CI, 1.37-2.68) and the composite endpoint (RR, 2.04; 95% CI, 1.59-2.61), and similar trends were noted at 90 days.
After propensity matching, however, there were no significant differences between the 2 groups in terms of mortality, the composite endpoint, acute kidney injury, need for renal replacement therapy, inpatient admission, and critical care need at 30 or 60 days.
Patients with sarcoidosis had statistically significantly lower mean levels of C-reactive protein (54.53 mg/L vs 78.56 mg/L; P <.001) and alanine aminotransferase (30.94 U/L vs 40.32 U/L; P =.04) vs the group of patients without sarcoidosis.
In terms of limitations, the researchers were unable to examine the effect of immunosuppressants, malignancies, pregnancy, and other immunosuppressive states on COVID-19-related outcomes in these patients.
The researchers wrote that the “data emphasize the importance of adherence to preventative measures in this high-risk cohort” of patients with pulmonary sarcoidosis.
Hadi YB, Lakhani DA, Naqvi SFZ, Singh S, Kupec JT. Outcomes of SARS-CoV-2 infection in patients with pulmonary sarcoidosis: a multicenter retrospective research network study. Respir Med. Published online July 22, 2021. doi:10.1016/j.rmed.2021.106538