Factors Associated With an Electronic Health Record-Based Definition of Postacute Sequelae of COVID-19 in Patients With Systemic Autoimmune Rheumatic Disease

Naomi J Patel; Xiaosong Wang; Miao Lin; Emily N Kowalski; Claire E Cook; Kathleen M M Vanni; Krishan Guzzo; Grace Qian; Katarina J Bade; Alene Saavedra; Rathnam Venkat; Shruthi Srivatsan; Zachary K Williams; Jennifer S Hanberg; Yumeko Kawano; Abigail E Schiff; Jeffrey A Sparks; Zachary S Wallace

doi:10.3899/jrheum.2023-1092

Factors Associated With an Electronic Health Record-Based Definition of Postacute Sequelae of COVID-19 in Patients With Systemic Autoimmune Rheumatic Disease

J Rheumatol. 2024 May 1;51(5):529-537. doi: 10.3899/jrheum.2023-1092.

Authors

Naomi J Patel¹, Xiaosong Wang², Miao Lin³, Emily N Kowalski², Claire E Cook³, Kathleen M M Vanni², Krishan Guzzo³, Grace Qian², Katarina J Bade², Alene Saavedra², Rathnam Venkat⁴, Shruthi Srivatsan³, Zachary K Williams³, Jennifer S Hanberg⁵, Yumeko Kawano⁵, Abigail E Schiff⁶, Jeffrey A Sparks⁵, Zachary S Wallace⁷

Affiliations

¹ N.J. Patel, MD, MPH, Z.S. Wallace, MD, MSc, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Harvard Medical School, and Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital.
² X. Wang, MS, E.N. Kowalski, BS, K.M.M. Vanni, BA, G. Qian, BA&Sc, K.J. Bade, BS, A. Saavedra, BA, Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital.
³ M. Lin, MS, C.E. Cook, MPH, K. Guzzo, BA, S. Srivatsan, BS, Z.K. Williams, BS, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital.
⁴ R. Venkat, BS, Tufts University School of Medicine.
⁵ J.S. Hanberg, MD, Y. Kawano, MD, J.A. Sparks, MD, MMSc, Harvard Medical School, and Division of Rheumatology, Inflammation, and Immunity, Brigham and Women's Hospital.
⁶ A.E. Schiff, MD, PhD, Harvard Medical School, and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
⁷ N.J. Patel, MD, MPH, Z.S. Wallace, MD, MSc, Division of Rheumatology, Allergy, and Immunology, Massachusetts General Hospital, and Harvard Medical School, and Rheumatology and Allergy Clinical Epidemiology Research Center, Mongan Institute, Department of Medicine, Massachusetts General Hospital; zswallace@mgh.harvard.edu.

PMID: 38428964
PMCID: PMC11065568 (available on 2025-05-01)
DOI: 10.3899/jrheum.2023-1092

Abstract

Objective: Many individuals with rheumatic disease are at higher risk for severe acute coronavirus disease 2019 (COVID-19). We aimed to evaluate risk factors for postacute sequelae of COVID-19 (PASC) using an electronic health record (EHR)-based definition.

Methods: We identified patients with prevalent rheumatic diseases and COVID-19 within the Mass General Brigham healthcare system. PASC was defined by the International Classification of Diseases, 10th revision (ICD-10) codes, relevant labs, vital signs, and medications at least 30 days following the first COVID-19 infection. Patients were followed until the earliest of incident PASC, repeat COVID-19 infection, 1 year of follow-up, death, or February 19, 2023. We used multivariable Cox regression to estimate the association of baseline characteristics with PASC risk.

Results: Among 2459 patients (76.37% female, mean age 57.4 years), the most common incident PASC manifestations were cough (14.56%), dyspnea (12.36%), constipation (11.39%), and fatigue (10.70%). Serious manifestations including acute coronary disease (4.43%), thromboembolism (3.09%), hypoxemia (3.09%), stroke (1.75%), and myocarditis (0.12%) were rare. The Delta wave (adjusted hazard ratio [aHR] 0.63, 95% CI 0.49-0.82) and Omicron era (aHR 0.50, 95% CI 0.41-0.62) were associated with lower risk of PASC than the early pandemic period (March 2020-June 2021). Age, obesity, comorbidity burden, race, and hospitalization for acute COVID-19 infection were associated with greater risk of PASC. Glucocorticoid (GC) use (aHR 1.19, 95% CI 1.05-1.34 compared to no use) was associated with greater risk of PASC.

Conclusion: Among patients with rheumatic diseases, following their first COVID-19 infection, we found a decreased risk of PASC over calendar time using an EHR-based definition. Aside from GCs, no specific immunomodulatory medications were associated with increased risk, and risk factors were otherwise similar to those seen in the general population.

Keywords: COVID-19; electronic health record; immunosuppression; postacute sequelae of COVID-19; rheumatic disease.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adult
Aged
Autoimmune Diseases / complications
Autoimmune Diseases / epidemiology
COVID-19* / complications
COVID-19* / epidemiology
Comorbidity
Electronic Health Records*
Female
Humans
Male
Middle Aged
Post-Acute COVID-19 Syndrome
Rheumatic Diseases* / complications
Rheumatic Diseases* / epidemiology
Risk Factors
SARS-CoV-2

Abstract

Publication types

MeSH terms

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