Patients with systemic lupus erythematosus (SLE) are no more likely to die from COVID-19 than the general population, but they have higher risks for adverse events such as hospitalization, mechanical ventilation, and venous thromboembolism (VTE), a new study finds.

Using TriNetX data from January 2020 to May 2021, investigators compared 2140 patients with SLE who contracted COVID-19 with 29,853 uninfected patients with SLE matched by propensity score. The team also compared the SLE group and 732,291 matched individuals from the general population.

Mortality within 30 days of COVID-19 diagnosis did not differ significantly between the SLE and general populations, Chengappa Kavadichanda, MD, of Jawaharlal Institute of Postgraduate Medical Education and Research in Puducherry, India, and colleagues reported in the Journal of Autoimmunity. COVID-19 in SLE however, was significantly associated with approximately 1.3-, 1.4-, and 1.6-fold increased risk of hospitalization, ICU admission, and mechanical ventilation, respectively, compared with the general population. COVID-19 in SLE was also significantly associated with a 1.4-, 2.2-, and 2.2-fold increased risk for sepsis, stroke, and VTE, respectively.

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Among patients with SLE, those who contracted COVID-19 had significant 4.9-, 3.8-, 3.7-, and 1.6-fold increased risks for mortality, mechanical ventilation, ICU admission, and hospitalization, respectively, compared with those without COVID-19. Patients infected with the coronavirus also had significant 4.8-, 2.1-, and 1.5-fold, increased risks for sepsis, acute kidney injury (AKI), and VTE, respectively. Among patients with SLE and COVID-19, male sex was significantly associated with a 2.1-fold higher risk for AKI than female sex.

The presence of lupus nephritis, compared with its absence, was associated with significant 1.4-, 2.1-, and 2.3-fold increased risks for hospitalization, sepsis, and AKI, respectively, after propensity score matching.

Use of glucocorticoids (but not disease-modifying antirheumatic drugs) was significantly associated with 3.0-, 3.6-, and 4.8-fold increased risk for hospitalization, ICU admission, and severe COVID (a composite of mortality and mechanical ventilation), respectively. Use of steroids was also significantly associated with a 2.9-, 3.0-, and 3.4-fold increased risk for sepsis, AKI, and VTE, respectively.

“Male sex and lupus nephritis increase the risk of AKI, thus probably increasing hospitalisation and sepsis,” Dr Kavadichanda’s team suggested. “Therefore, it is crucial to identify the high-risk group among SLE and ensure early vaccination and continuity of lupus care.”


Raiker R, Pakhchanian H, DeYoung C, et al. Short term outcomes of COVID-19 in lupus: propensity score matched analysis from a nationwide multi-centric research network. J Autoimmun. Published online October 9, 2021. doi:10.1016/j.jaut.2021.102730