Literature DB >> 33597796

Risk and outcome of COVID-19 infection in sarcoidosis patients: results of a self-reporting questionnaire.

Robert P Baughman1, Elyse E Lower1, Mindy Buchanan2, Paola Rottoli3, Marjolein Drent4,5,6, Jacobo Sellares7,8,9, Michelle Terwiel4, Marjon Elfferich6,10, Joel Francesqui7, María Rita Barriuso Cabrerizo11, Nadera Sweiss12, Filippo Martone13, Tamara Al-Hakim2, Marc A Judson14.   

Abstract

BACKGROUND: It has been suggested that sarcoidosis patients, especially those on immunosuppressive medications, are at increased risk for COVID-19 infection and more severe disease.
METHODS: A questionnaire was developed in four languages (English, Dutch, Italian, and Spanish). The questionnaire queried whether patients had been infected with COVID-19 and outcome of the infection. Risk factors for COVID-19 infection were collected.
RESULTS: A total of 5200 sarcoidosis patients completed the questionnaire with 116 (2.23%) reporting infection and 18 (15.8%) required hospitalization. Increased hazard ratio (HR) for COVID-19 infection were seen for those with a COVID-19 infected roommate (HR=27.44, p<0.0001), health care provider (HR=2.4, p=0.0001), pulmonary sarcoidosis (HR=2.48, p=0.001), neurosarcoidosis (HR=2.02, p<0.01), or rituximab treatment (HR=5.40, p<0.0001). A higher rate of hospitalization was found for those with underlying heart disease (HR=3.19 (1.297-7.855), p<0.02). No other feature including race, other immunosuppressive agent, age, or underlying condition was associated with a significant increased risk for infection or more severe disease.
CONCLUSION: The overall rate of COVID-19 was 2.23%, suggesting an increased rate of COVID-19 infection. However, when an analysis of the questionnaires of sarcoidosis and non-sarcoidosis patients was performed in one localized area over this time period, the rate of COVID-19 infection was similar in both groups. Sarcoidosis patients who cohabitated with COVID-19 infected individuals, worked in health care, had pulmonary or neurologic sarcoidosis, or were treated with rituximab had an increased risk for COVID-19 infection. No significant increased risk for hospitalization could be identified based on age, race, gender or any specific immunosuppressive treatment. (Sarcoidosis Vasc Diffuse Lung Dis 2020; 37 (4): e2020009). Copyright:
© 2020 SARCOIDOSIS VASCULITIS AND DIFFUSE LUNG DISEASES.

Entities:  

Keywords:  COVID-19; immunosuppression; sarcoidosis

Year:  2020        PMID： 33597796      PMCID： PMC7883514          DOI： 10.36141/svdld.v37i4.10726

Source DB:  PubMed          Journal:  Sarcoidosis Vasc Diffuse Lung Dis        ISSN： 1124-0490            Impact factor:   0.670


Click here for additional data file. Click here for additional data file. Click here for additional data file. Click here for additional data file. Click here for additional data file. UC/AMC and FSR questionnaire Click here for additional data file. COVID-19 questionnaire By completing this questionnaire, you are agreeing to have this data shared with others and understand that a summary of data may be published. Do you agree? Yes No Have you been infected with COVID-19 (corona virus)? Yes No If yes, what was outcome (check all that apply) Treated only at home I was hospitalized but I did not go to an intensive care area Treated at any time in an intensive care area At any time on a ventilator (breathing machine) Have any people who live in the same house/apartment as me been diagnosed with COVID-19 (corona virus)? Yes No Are you a health care provider? Yes No I have the following medical conditions (check all that apply) Sarcoidosis If sarcoidosis, how many years have you had sarcoidosis: ________________ COPD/Asthma Cancer Diabetes Heart disease Hypertension Other Your age: ________________ Your race (check all that apply) Black White Asian Other Sex: Female Male I live in the following state (if United States) or country (if not USA): _______________ IF I HAVE SARCOIDOSIS, PLEASE ANSWER THE FOLLOWING FIVE QUESTIONS I have sarcoidosis in the following areas of my body (check all that apply) Lung Heart Brain Other I have been treated in past 3 months for sarcoidosis with (check all that apply) Prednisone/prednisolone If yes, current daily dose of prednisone/prednisolone __________ Methotrexate/Azathioprine (Imuran)/Mycophenolate (Cellcept)/Leflunomide(Arava) Infliximab (Remicade/Renflexis/Inflectra)/Adalimumab(Humira) Hydroxychloroquine(Plaquenil)/Chloroquine Rituximab (Rituxan) Other chemotherapy Other In the past, have you been treated for sarcoidosis with (check all that apply)? Prednisone/prednisolone/decadron Methotrexate/Azathioprine (Imuran)/Mycophenolate (Cellcept)/Leflunomide(Arava) Infliximab (Remicade/Renflexis/Inflectra)/Adalimumab(Humira) Hydroxychloroquine(Plaquenil)/Chloroquine Rituximab (Rituxan) Other chemotherapy Other This is the initial questionnaire? Yes No If this is the initial questionnaire, do you agree to being contacted in 3-6 months to complete this questionnaire a second time? Yes No Dutch Questionnaire Click here for additional data file. COVID-19 / Corona vragenlijst voor sarcoïdosepatiënten Patient information: In korte tijd heeft COVID-19 wereldwijd toegeslagen en het leven veranderd. Het heeft tot veel onzekerheden geleid. Bent u sarcoïdosepatiënt dan wordt u gevraagd deze survey in te vullen. Met nadruk willen we erop wijzen dat ook wanneer u geen COVID-19 infectie heeft gehad, u toch wordt verzocht de vragenlijst in te vullen. Met uw hulp kunnen we dan trachten betrouwbare cijfers ook uit Nederland te verzamelen. Betreffende sarcoïdose en COVID-19 kwamen allerlei vragen naar voren: Heeft een sarcoïdosepatiënt een hoger risico op het krijgen van een COVID-19 infectie? Als een sarcoïdosepatiënt geïnfecteerd raakt, heeft hij of zij dan een ernstiger beloop? Hebben sarcoïdosepatiënten die prednison of andere immunosuppressiva (medicijnen die het afweersysteem onderdrukken) gebruiken een hoger risico op het geïnfecteerd raken met COVID-19? Beschermt het gebruik van hydroxychloroquine een sarcoïdosepatiënt tegen COVID-19? Heeft geslacht, ras, gewicht, of leeftijd invloed op het risico of de uitkomst van COVID-19? Om deze vragen te kunnen beantwoorden zijn de Foundation for Sarcoidosis Research (FSR) en de Universiteit van Cincinnati, met als hoofdonderzoeker prof. Robert Baughman, een survey onder sarcoïdosepatiënten gestart in de USA. Om hierover ook een indruk te krijgen in de rest van de wereld zijn diverse landen benaderd om ook deze vragenlijst onder sarcoïdosepatiënten uit te zetten, waaronder Nederland. Deze vragenlijst wordt in Nederland op verzoek van de initiatiefnemers verspreid door de ild care foundation in samenwerking met Sarcoidose.nl. Door deze vragenlijst in te vullen, stemt u ermee in dat de gegevens anoniem verwerkt worden. Een samenvatting van het onderzoek zal, op basis van anonieme gegevens, gepubliceerd worden. Bij voorbaat hartelijk dank voor uw medewerking! Bent u besmet (geweest) met COVID-19 (coronavirus)? Ja Nee Weet het niet zeker, ben niet getest, maar heb wel symptomen (gehad) Zo ja, wat was er nodig voor de behandeling? (vink aan wat van toepassing is) : Kon thuis worden behandeld Ben opgenomen geweest in een ziekenhuis, maar ben niet op de intensive care verpleegd Ben opgenomen geweest op een intensive care afdeling Ben beademd met een ventilator (beademingsmachine) Niet van toepassing, geen COVID-19 gehad Zijn er mensen die in hetzelfde huis/ appartement wonen als u, die besmet zijn geweest met COVID-19 (corona virus)? Ja Nee Bent u een zorgverlener? Ja Nee Hoe lang heeft u al sarcoïdose? (jaren, maanden) Ik heb sarcoïdose in de volgende organen/delen van mijn lichaam: (vink aan wat van toepassing is, meerdere keuzes mogelijk) Longen Hart Hersenen / zenuwstelsel Anders, nl.: Ik heb naast sarcoïdose ook de volgende medische aandoeningen (vul in wat van toepassing is) geen andere aandoeningen Kanker Diabetes Hart-vaataandoening Hartfalen Hypertensie / hoge bloeddruk COPD Astma Andere aandoening: Nadat ik COVID-19 heb gehad, zijn mijn klachten: verergerd minder geworden dan voorheen hetzelfde gebleven niet van toepassing, heb geen COVID-19 gehad. Wat is u leeftijd? (jaren) Wat is uw gewicht? (in kg) Wat is uw lengte (in cm) Wat is uw geslacht? Vrouw Man gender neutraal Wat is uw etniciteit? Kaukasisch / wit Negroide / Afro Amerikaans / zwart Aziatisch Anders, nl./: Ik woon in (land) : Nederland België Anders, nl.: Bent u in de afgelopen 3 maanden behandeld voor sarcoïdose met: (vink aan wat van toepassing is, meerdere antwoorden mogelijk) Prednison/prednisolon (graag de huidige dagelijkse dosis onderaan deze vraag invullen) Methotrexaat Azathioprine (Imuran) Cellcept (Mycophenolaat) Leflunomide (Arava) Infliximab (Remicade/Renflexis/Inflectra) Adalimumab (Humira) Hydroxychloroquine (Plaquenil)/Chloroquine Rituximab (Rituxan) Andere immunotherapie Andere behandelwijze Geen medicatie of behandeling Dosering Prednison per dag (in mg): Bewerken Opties Bewerken Opties Logica Verplaatsen Kopiëren Verwijderen Bent U In het verleden behandeld voor sarcoïdose met (vink aan wat van toepassing is)? Prednison/prednisolon (graag de huidige dagelijkse dosis onderaan deze vraag invullen) Methotrexaat Azathioprine (Imuran) Cellcept (Mycophenolaat) Leflunomide (Arava) Infliximab (Remicade/Renflexis/Inflectra) Adalimumab (Humira) Hydroxychloroquine (Plaquenil)/Chloroquine Rituximab (Rituxan) Andere immunotherapie Andere behandelwijze Geen medicatie of behandeling Dosering Prednison per dag (in mg): Bewerken Opties Nieuwe vraag Hartelijk dank voor uw medewerking! Italian Questionnaire Click here for additional data file. The following questionnaire was created using GOOGLE FORMS. For further infos, please visit https://www.google.com/intl/en-US/forms/about/ Every single answer or group of answers generate both visual data and an excel file with the sum of all data. Dati epidemiologici 1. Completando questo questionario, si autorizza alla condivisione dei dati qui raccolti e si dà il benestare alla eventuale pubblicazione anonima dei dati stessi. Dai il tuo consenso? Si No 2. Età Scegli (choose - dropdown menu) 3. Sesso Maschile Femminile Preferisco non rispondere 4. Etnia Caucasica (prevalentemente europea) Afro-americana Asiatica Preferisco non rispondere 5. Sei un operatore sanitario? Si No 6. In quale regione vivi? Scegli (choose - dropdown menu) Covid-19 e Sarcoidosi 7. Sei stata/o contagiata/o dal COVID-19 (coronavirus)? No 7a. Se si, quale esito ha avuto (segnare tutte opzioni pertinenti) Trattamento esclusivamente a casa Ricovero in ospedale ma non in area intensiva Curato in terapia intensiva Curato con ventilazione assistita 8. Ci sono state persone conviventi nella tua abitazione che sono state contagíate dal COVID-19 (coronavirus)? Si No 9. Attualmente soffri di una o più delle seguenti patologie? (segnare tutte le patologie in essere) Sarcoidosi BPCO/Asma Cancro Diabete Ipertensione Altro 9a. Se hai segnato la sarcoidosi, da quanti anni ne soffri? (non si intende da che età, ma gli anni di malattia) Scegli (choose - dropdown menu) 10. Quale area del tuo corpo è interessata dalla Sarcoidosi? (specificare quale o quali) Polmoni Cuore Sistema nervoso Altro 11. Negli ultimi 3 mesi ti sei stato sottoposto ad una o più d’una delle seguenti terapie? (indica le voci pertinenti) Prednisone/Prednisolone (farmaci cortisonici) Metotrexato/Azatriopina/Micofenolato/Leflunomide Infliximab/Adalimumab Idrossiclorochina/Clorochina (Plaquenil) Rituximab Altre chemioterapie Nessuna terapia 11a. Se hai assunto prednisone/prednisolone (farmaci cortisonici), qual è stata la dose giornaliera (quantificata in mg)? Scegli (choose - dropdown menu) 11a.2 Se alla domanda precedente hai indicato ’altro’ scrivi qui la dose giornaliera di cortisonici (quantificata in mg) ______________ risposta aperta (open response) 11b. Se hai assunto Idrossiclorochina/Clorochina (Plaquenil), qual è stata la dose giornaliera (quantificata in mg)? (this question is only in the Italian Survey) Scegli (choose - dropdown menu) 11b.2 Se alla domanda precedente hai indicato ’altro’ scrivi qui la dose giornaliera di Idrossiclorochina/Clorochina(quantificata in mg) ___________ risposta aperta (open response) 12. In passato sei stato sottoposto ad una o più d’una delle seguenti terapie? (indica le voci pertinenti) Prednisone/Prednisolone (farmaci cortisonici) Metotrexato/Azatriopina/Micofenolato/Leflunomide Infliximab/Adalimumab Idrossiclorochina/Clorochina (Plaquenil) Rituximab Altre chemioterapie Nessuna terapia 13. Una versione precedente di questo questionario è già stata condotta durante il mese di aprile. Hai già compilato il 1 ° questionario di apnle? I Si I No Spanish Questionnaire Click here for additional data file. Cuestionario COVID-19 1- Al completar este cuestionario, acepta compartir estos datos con otros y comprende que se puede publicar un resumen de los datos. ¿Está de acuerdo? SÍ NO 2- ¿Ha sido infectado con COVID-19 (coronavirus)? SÍ NO En caso afirmativo, cuál fue el resultado (marque todos los que correspondan) Tratado solo en casa Fui hospitalizado pero no fui a un área de cuidados intensivos Tratado en cualquier momento en un área de cuidados intensivos En cualquier momento en un ventilador (máquina de respiración) 3- ¿Alguna de las personas que viven en la misma casa / departamento que yo ha sido diagnosticada con COVID-19 (coronavirus)? SÍ NO 4- ¿Es usted un proveedor de atención médica? SÍ NO Sarcoidosis Si tiene sarcoidosis, ¿cuántos años ha tenido sarcoidosis? ____________ EPOC / Asma Cáncer Diabetes Enfermedad del corazón Hipertensión Otro 6- Edad: 7- Origen étnico Negro Blanco Asiático Otros Prefiero no responder Masculino Femenino Prefiero no responder 9- Vivo en el siguiente estado/país ____________ 10- Este es el cuestionario inicial? Si No SI TIENE SARCOIDOSIS, RESPONDA LAS SIGUIENTES CINCO PREGUNTAS 11- Tengo sarcoidosis en las siguientes áreas de mi cuerpo (marque todas las que correspondan) Pulmón Corazón Cerebro Otro corresponda) Prednisona / prednisolona En caso afirmativo, la dosis diaria actual de prednisona / prednisolona Metotrexato / Azatioprina (Imuran) / Micofenolato (Cellcept) / Leflunomida (Arava) Infliximab (Remicade / Renflexis / Inflectra) / Adalimumab (Humira) Hidroxicloroquina (Plaquenil) / Cloroquina Rituximab (Rituxan) Otra quimioterapia Otro Ninguna 13- En el pasado, ¿ha recibido tratamiento para la sarcoidosis con (marque todo lo que corresponda)? Prednisona / prednisolona / decadron Metotrexato / Azatioprina (Imuran) / Micofenolato (Cellcept) / Leflunomida (Arava) Infliximab (Remicade / Renflexis / Inflectra) / Adalimumab (Humira) Hidroxicloroquina (Plaquenil) / Cloroquina Rituximab (Rituxan) Otra quimioterapia Otro Ninguna Results of UC/AMC questionnaire Click here for additional data file. * 9 patients did not indicate sex. † 9 patients biracial ¶ Included inflixiamb, adlimumab, and biosimilars § Included methotrexate, azathioprine, mycophenolate, and leflunomide ** 63 patients did not provide information regarding duration of disease. UC: University of Cincinnati clinic Results from FSR questionnaire Click here for additional data file. Results from Netherlands questionnaire Click here for additional data file. Results from Italian Questionnaire Click here for additional data file. *Percent positive of 511 patients who participated in study. Results from Spanish questionnaire Click here for additional data file. Number of patients and percent positive for individual countries and states within United States Click here for additional data file.

Introduction

The COVID-19 pandemic has dramatically changed and challenged the practice of medicine. Both sarcoidosis patients and their health care providers are concerned that sarcoidosis may increase the risk of contracting COVID-19 and may be associated with poor outcomes from COVID-19 infection (1). Sarcoidosis patients may have several risk factors associated with an increased rate and a poor outcome from COVID-19 infection including underlying lung disease and the use of glucocorticoids and other immunosuppressive agents (2;3). However, it is not clear that use of immunosuppressive therapy alone is a risk factor for increased rate of COVID-19 infection (4;5). A worse outcome from COVID-19 infection may be result of the common presence of other co-morbidities including heart disease, diabetes, and hypertension (2;6-8). Because of the potential risk of COVID-19 infection in those receiving immunosuppressive medications, sarcoidosis experts have proposed modifying the treatment of sarcoidosis (9). However, these recommendations were based almost exclusively on expert opinion and extrapolation from other medical conditions because of the absence of sarcoidosis-specific outcome data concerning COVID-19 infection. Because of the lack of specific information concerning risk of acquiring COVID-19 infection and its outcomes in sarcoidosis patients, we initiated an IRB approved questionnaire survey of sarcoidosis patients between April and July 2020 to investigate the prevalence of COVID-19 infection, clinical outcomes and possible risk factors for contracting COVID-19 in several sarcoidosis cohorts across several countries. The questionnaire was distributed through several platforms and was available in four languages: English, Dutch, Italian, and Spanish. Five versions of the questionnaire that were minimally different (vide infra) were distributed to various cohorts. One version of the questionnaire was distributed to sarcoidosis patients who participated in a previously described registry (10). In order to compare these findings with another high-risk group, we also surveyed a cohort of breast cancer patients during this time period. The results of these five questionnaires were pooled and analyzed to provide data concerning the frequency, severity, potential risk factors and outcomes for COVID-19 infection in sarcoidosis patients.

Methods

A questionnaire regarding COVID-19 infection was developed by three of the authors (RPB, EEL, and MAJ). The questionnaire was approved by the University of Cincinnati Institutional Review Board and is shown in Supplement S-1. IRB approval for the FSR questionnaire was obtained from Advarra (Columbus, MD), where the registry number for the FSR Registry is Pro00008556 and modification number for this sub-study is: MOD00087736. The questionnaire queried whether patients had been infected with COVID-19. If infected, they were asked to provide details regarding level of care (treated at home, hospital, or intensive care unit). They were also queried concerning risk factors for COVID-19 infection including household contacts and whether they were health care providers. The patients were asked if they had underlying medical conditions associated with increased risk for COVID-19 infection. They were also asked to provide information regarding their age, sex, and self-declared race. They provided their current residence, including their state for those living in the United States. Patients with sarcoidosis were queried about the duration of disease, specific organ involvement, and current and past immunosuppressive therapy. The questionnaire responses were collected in an anonymous manner with no patient identifiers captured. At time of completing the questionnaire, patients were asked to provide consent for use of their questionnaire responses. The distribution was meant to reach as wide an audience as possible. Patients were enrolled without incentives, since the survey was anonymous. Respondents were asked to complete the questionnaire even if they did not have any symptoms related to COVID-19 infection. There was no restriction for patients to complete more than one questionnaire. A total of five questionnaires were distributed (Supplement S-1 to S-4). Table 1 summarizes the features of the five questionnaires. All were based on the University of Cincinnati/Albany Medical Center (UC/AMC) questionnaire. The same questionnaire was distributed to those patients who were Foundation for Sarcoidosis Research (FSR) registry. The questionnaire was translated into Dutch and distributes by the Dutch Sarcoidosis Society (Sarcoidose.nl) and the ild care foundation. The Italian Association for Sarcoidosis patients (ACSI) prepared the Italian version of the COVID-19 questionnaire. The Spanish association of patients with sarcoidosis (ANES-Asociación Española de) prepared a Spanish version of the COVID-19 questionnaire.
Table 1.

Summary of Questionnaires used in Study

Title of questionnaireQuestionnaire versionInvitation distributionSarcoidosis patient groupControl groupDates of SurveyMethod of captureComments
UC/AMCUC/AMC EnglishPosted on FSR website and all patients see at Cincinnati clinicWorld wide including Cincinnati OH USACincinnati OH USA4/1/2020 to 7/1/2020REDCapFor those in USA, state also indicated
FSRUC/AMC EnglishInvitation to those in FSR registryWorld wideN/A4/6/2020 to 7/1/2020SurveyMonkey
DutchDutch version UC/AMCMembers of Sarcoidose.nl, and advertisement at the ILD Center of Excellence, Nieuwegein, the NetherlandsNetherlandsN/A6/29/2020 to 7/29/2020SurveyMonkeyCollected also if on no medication for sarcoidosis and patient’s BMI
ItalianItalian version of UC/AMCe-mail contacts of the Italian Association for Sarcoidosis patients (ACSI)ItalyN/A4/1/2020 to 7/1/2020Google Forms
SpanishSpanish version of UC/AMCrecruited through membership of the Spanish association of patients with sarcoidosis (ANES-Asociación Española de) using e-mail contactSpainN/AMay 2020Google Forms

UC/AMC: University of Cincinnati/Albany Medical Center; FSR: Foundation for Sarcoidosis Research; N/A: not available; ild care: interstial lung disease care; BMI: body mass index

REDcap: Research electronic data capture https://redcap.research.cchmc.org/

SurveyMonkey: www.surveymonkey.com

Google Forms: https://www.google.com/intl/en-US/forms/about/

Summary of Questionnaires used in Study UC/AMC: University of Cincinnati/Albany Medical Center; FSR: Foundation for Sarcoidosis Research; N/A: not available; ild care: interstial lung disease care; BMI: body mass index REDcap: Research electronic data capture https://redcap.research.cchmc.org/ SurveyMonkey: www.surveymonkey.com Google Forms: https://www.google.com/intl/en-US/forms/about/

Statistics

The hazard ratio (HR) with 95% confidence interval (CI) was calculated for various factors for each questionnaire using a statistical software package (MedCalc Software limited, Ostend, Belgium). For those questions which were identical (except for language), the results were summed. HR were calculated for the individual questionnaires and for summary data when available. A p value of less than 0.05 was considered significant.

Results

Supplement Figures S1-S5 show the numbers of patients who completed the questionnaire for each site, including those who did not give consent for final analysis or were excluded for other reasons. Table 2 summarizes the values for 5200 sarcoidosis patients who were analyzed. A total of 116 (2.23%) reported COVID-19 infection. The overall rate of COVID-19 infection is shown for each site and ranged from 0.8 to 4.76%. As shown in the table, there was no significant difference in the rate of infection based on sex, race, or age. In the Dutch questionnaire an additional question revealed that 96 out of 973 COVID-19 negative patients (10%) reported COVID-19 symptoms but were not tested.
Table 2.

Rate of COVID-19 infection for five questionnaires and total

UC/AMCFSRDutchItalySpainTotal
Total number Sarcoidosis patients197216169965111055200
Number COVID positive66132395116
Rate of COVID3.35%0.80%2.31%1.76%4.76%2.23%
Percent COVID-19 based on gender
Male3.70%0.72%1.42%1.44%3.57%2.18%
Female3.24%1.59%2.98%1.68%5.19%2.81%
Percent COVID-19 based on race
Black2.88%3.23%NANANA2.95%
White3.62%1.15%2.31%1.83%4.90%2.66%
Mean age of patients with or without COVID-19 infection
Age COVID-19 positive, years54.5 + 11.39*54.4 + 11.2955.3 ± 6.055.8+ 8.6349.80 + 9.2053.5 + 9.47
Age, COVID-19 Negative, years53.0 + 9.6056.6 + 10.3955.0±10.851.8 + 9.7444.88 + 8.8252.4 + 9.90
Percent COVID-19 infected versus current prednisone therapy
Yes3.08%1.55%2.02%0.38%4.76%2.68%
No3.52%0.62%2.38%3.00%4.76%2.08%
Percent COVID-19 based on living with COVID-19 infected roommate
Roommate COVID positive55.3%40.0%26.8%62.5%0.0%52.7%
No roommate with COVID2.33%0.68%1.26%0.80%4.95%1.53%
Percent COVID-19 based on occupation as health care provider
Health care provider5.74%1.20%3.88%4.26%18.75%5.46%
Not health care provider3.09%0.78%2.13%1.52%2.33%2.82%

NA: not analyzed because less than 10 patients who were this race

*Mean ± standard deviation

Rate of COVID-19 infection for five questionnaires and total NA: not analyzed because less than 10 patients who were this race *Mean ± standard deviation The results of the individual questionnaires are provided in Supplement S5-S9. Table 3 summarizes the hazard ratio (HR) for developing COVID-19 for all five sites. Forty-one percent of those with a COVID-19 infected roommate had COVID-19 infection (HR=27.44 (19.798-38.048, 95% confidence intervals, p<0.0001)). We did not collect information about which person was diagnosed first with COVID-19. All but the Spanish questionnaire identified a significant increased risk for COVID-19 for those with a roommate with COVID-19. In the Spanish questionnaire, only two patients reported a COVID-19 infected roommate. Neither of these sarcoidosis patients had COVID-19 infection at the time of completing the survey.
Table 3.

Hazard ratio for developing COVID-19 infection: Summary of all five questionnaires

Percent with featureTotal posTotal negTotal numberPercent PosHazards Ratio95% CIP value
Social factors
Roommate COVID positive1.81%39559441.49%27.4419.798-38.048<0.0001
No roommate with COVID77501650931.51%
Health care provider8.85%224364584.80%2.411.532-3.7990.0001
Not health care provider94462647201.99%
Current treatment for sarcoidosis
Current Prednisone
Yes30.93%36156716032.25%1.020.689-1.503>0.10
No79350135802.21%
If taking prednisone:
Prednisone >10 mg or more22.29%165205362.99%0.980.567-1.690>0.10
Prednisone < 10 mg57181218693.05%
Hydroxychloroquine
Yes9.20%84174251.88%0.800.391-1.628>0.10
No99409541842.36%
anti-TNF monoclonal antibodies (infliximab, adalmumab)
Yes7.89%83893972.02%0.890.437-1.812>0.10
No105453146362.26%
Cytotoxic (methotrexate, azathioprine, mycophenolate, leflunomide)
Yes22.54%27114111682.31%1.050.688-1.615>0.10
No88392640142.19%
Rituximab
Yes1.28%7536011.67%5.39932.621-11.123<0.0001
No100452846282.16%
Comorbidities
COPD
Yes11.43%165785942.69%1.250.744-2.108>0.10
No99450346022.15%
Diabetes mellitus
Yes10.25%95245331.69%0.740.375-1.445>0.10
No107455846652.29%
Heart disease
Yes10.40%93753842.34%1.0340.522-2.048>0.10
No75323433092.27%
Hypertension
Yes19.62%24100310272.34%1.070.686-1.666>0.10
No92411542072.19%
Organ involvement from sarcoidosis
Lung
Yes73.09%101369637972.66%2.481.446-4.2490.001
No15138313981.07%
Cardiac
Yes9.02%154424573.28%1.50.878-2.555>0.10
No101450946102.19%
Neurologic
Yes8.33%184154334.16%2.021.234-3.3070.0052
No98466447622.06%
Demographic features
Sex
Male32.42%31142014512.14%0.77840.518-1.117>0.10
Female83294130242.74%
Race
Black32.78%36139914352.51%0.93460.633-1.379>0.10
White79286429432.68%
Duration of disease
Sarcoidosis > 5 years71.61%75273528102.67%1.10120.713-1.700>0.10
Sarcoidosis < 5 years27108711142.42%

†Data not available from Dutch registry

CI: confidence interval; anti-TNF: anti-tumor necrosis factor antibody; COPD: chronic obstructive pulmonary disease

Hazard ratio for developing COVID-19 infection: Summary of all five questionnaires †Data not available from Dutch registry CI: confidence interval; anti-TNF: anti-tumor necrosis factor antibody; COPD: chronic obstructive pulmonary disease The overall risk for health care workers to have COVID-19 infection was 2.41 (1.532-3.799, p=0.0001), with nearly five percent of heath care workers who had sarcoidosis reporting COVID-19 infection. For the Spanish questionnaire, 18.8% of heath care workers reported COVID-19 infection, while less than six percent for all other questionnaires. The HR was only significant for the UC/AMC and Spanish questionnaires. For sarcoidosis immunosuppressive therapy, rituximab treatment was associated with an increased risk of COVID-19 infection (HR=5.40 (2.621-11.123), p<0.0001). Only the UC/AMC and FSR included more than one patient treated with rituximab. However, both of these identified an increased risk with rituximab use. There was no significant increase in risk for COVID-19 infection for those on any other immunosuppressive therapy. For those receiving prednisone, there was no increased risk for patients prescribed 10 mg or more a day versus a lower dose. A total of 425 patients were prescribed hydroxychloroquine. There was no difference in the risk for COVID-19 among the other questionnaires or for the summary data of all sarcoidosis patients compared to all others. In the Dutch questionnaire, patients who reported to receive any medication for sarcoidosis had a decreased COVID-19 risk (HR=0.40, 0.165 to 0.958, P<0.05). There was no significant difference for the larger UC/AMC questionnaire (HR=1.49, 0.916 to 2.437, p>0.10) or for the combined data. There was no increased risk with any of the associated with age, race, sex, duration of disease, or the comorbidities investigated. In the Dutch questionnaire, there was no difference in HR for those with a BMI above 25. There was an increased risk for sarcoidosis patients with lung involvement (HR=2.48 (1.446-4.249), p=0.001). However, the FSR was the only individual questionnaire which identified this as a significant risk. The summary identified neurosarcoidosis as an increased risk factor for COVID-19 infection (HR=2.02 (1.234-3.307), p<0.01). For neurosarcoidosis, there was a significant HR seen for the Spanish and FSR questionnaire and borderline for UC/AMC (p=0.0619). Most patients responding to the UC/AMC questionnaire provided their country of residence or state of residence if they lived in the United States, and the percentage of patients with COVID-19 infection by residence is shown in Table S-10. There was no significant difference in rates of infections between the United States and non-United States residents. For the United States, there was a wide range but not a significantly different rate of infection between states. For the UC/AMC questionnaire, we analyzed the risk of COVID-19 infection for two groups of patients seen by either EEL or RPB at the University of Cincinnati from April1 to June 30, 2020. During that time, 547 cancer patients were seen at University of Cincinnati (UC cancer). Two (0.37%) reported COVID-19 infection. Only 3 of 541 (0.55%) sarcoidosis patients seen at the UC sarcoidosis clinic during this time reported COVID-19 infection. The hazard ratio for COVID-19 infection in sarcoidosis patients at the University of Cincinnati was not significantly higher than those with cancer (HR=1.52, 0.254 to 9.041, P>0.10).

Outcome of COVID-19 infection

Table 4 shows the reported rate of hospitalization for those with COVID-19 infection for each questionnaire and for the total group. A mean of 15.8% (range 13 to 27%) of COVID-19 infected patients were hospitalized with about one-third cared for in the intensive care unit at some time during hospitalization.
Table 4.

Outcome of COVID-19 infected patients

UC/AMCFSRDutchItalySpainTotal
Home578207496
Hospitalized (%)9 (17.6%)3 (27.3%)3 (13.0%)2 (22.2%)1 (20%)18 (15.8%)
Unknown2
Outcome of COVID-19 infected patients For 105 of the COVID-19 infected patients we had information regarding current immunosuppressive therapy. Nineteen (18.1%) of these were hospitalized. Table 5 summarizes these outcomes and calculates the HR for hospitalization for various immunosuppressive therapies. There were no significant HR with any specific therapy. For the 96 COVID-19 infected patients from three questionnaires (UC/AMC, FSR, and Dutch), we were able to analyze the clinical outcome versus presence of diabetes, hypertension, COPD, and heart disease. Table 6 shows the results of this analysis. Only those with underlying heart disease had an increased rate of hospitalization (HR=3.19, 1.297-7.855, p<0.02).
Table 5.

Outcome of sarcoidosis patients infected with COVID-19 versus immunosuppressive therapy*

DRUGHomeHospitalPercent in hospitalHR95% CIp
All patients861918.1%
Prednisone
Yes29514.7%0.750.293-1.901>0.10
No571419.7%
If prednisone
Prednisone > 10 mg13213.3%0.760.186-3.106>0.10
Prednisone < 10mg471017.5%
anti-TNF monoclonal antibodies (infliximab, adalmumab)
Yes5228.6%1.650.473-5.740>0.10
No811717.3%
Hydroxychloroquine
Yes7112.5%0.670.103-4.416>0.10
No791818.6%
Cytotoxic (methotrexate, azathioprine, mycophenolate, leflunomide)
Yes17729.2%1.970.873-4.440>0.10
No691214.8%
Rituximab
Yes6114.3%0.780.121-5.006>0.10
No801818.4%

*Data not available on all patients.

HR: hazard ratio; anti-TNF: anti-tumor necrosis factor antibody;

Table 6.

Outcome of COVID-19 infection versus underlying comorbidities*

HomeHospitalNumber posRateHR95% CIP
Total
DM921111.46%1.190.308-4.585>0.10
no DM721385
HTN1451919.79%2.030.784-5.234>0.10
no HTN671077
COPD1231515.63%1.350.432-4.217>0.10
no COPD691281
Heart disease851313.54%3.191.297-7.8550.0115
no heart disease731083
Any feature3574243.75%1.120.444-2.854>0.10
No feature46854

DM: diabetes mellitus; HTN: hypertension; COPD: chronic obstructive pulmonary disease; HR hazard ratio.

*Summary data from UC/AMC, FSR, and Dutch

Outcome of sarcoidosis patients infected with COVID-19 versus immunosuppressive therapy* *Data not available on all patients. HR: hazard ratio; anti-TNF: anti-tumor necrosis factor antibody; Outcome of COVID-19 infection versus underlying comorbidities* DM: diabetes mellitus; HTN: hypertension; COPD: chronic obstructive pulmonary disease; HR hazard ratio. *Summary data from UC/AMC, FSR, and Dutch

Discussion

In this analysis of five surveys of sarcoidosis patients from the USA and Europe concerning COVID-19 infection, we found evidence that the rate of COVID-19 infection in sarcoidosis patients was higher than in the general population. We found that sarcoidosis patients who were healthcare workers or were living with a person infected with COVID were at higher risk of COVID infection; these data have been reported in the general population (12;13) and support the well-established fact that COVID-19 is highly infectious and is easily transmitted to individuals who are in close proximity to an actively infected person (14). In regard to immunosuppressive therapy, only rituximab was associated with increased risk for COVID-19 infection in sarcoidosis patients. The lack of association of prednisone use with the development of COVID-19 infection held even when comparing ≥ 10 versus < 10 mg/day. In sarcoidosis patients with diabetes, hypertension, heart disease, and co-existing chronic obstructive pulmonary disease no increased risk of acquiring COVID-19 infection was identified, even though these comorbidities have also been identified as risk factors for COVID-19 infection (6;8;15). The current data surveyed sarcoidosis patients mostly in United States and Europe from April through July 2020. This time frame co-indices with the onset of the pandemic in these two parts of the world. In our analysis of a questionnaire administered to 5200 sarcoidosis patients, 2.23% or 22,308 cases per million had become infected with COVID-19 during this time. During the time period in which this questionnaire was administered, the number of confirmed cases of COVID-19 in the United States was estimated as 1,060 per million (https://en.wikipedia.org/wiki/Template:COVID-19_pandemic_data/United_States_medical_cases). The same site reported that the cumulative rate of COVID-19 infection in Spain was 5197 per 1 million, Italy 3853 per 1 million, and Netherlands 3141 per 1 million. However, the rate of infection for COVID-19 infection in the general population may be higher. For example, a recent survey using serologic testing found that 2.5% of the Italian population had acquired COVID-19 infection by July 15, 2020 ( http://www.salute.gov.it/imgs/C_17_notizie_4998_0_file.pdf). While there was some variation in the rates of COVID-19 infection from the various questionnaires, overall there was no significant difference in the rate of COVID-19 infection. This was also true when examining the UC/AMC questionnaire, which included 1601 (3.1% infected) responders from US versus 361 (4.2% infected) from outside the United States. These data suggest that the rate of COVID infection is higher in sarcoidosis patients than the general population. However, the rate of COVID-19 infection varies by the time period as well as from country to country and even within the United States. It is therefore possible, that the rate of COVID-19 in sarcoidosis patients was no different from the general population. A significant number of the sarcoidosis patients completing the UC/AMC questionnaire were seen at the University of Cincinnati Sarcoidosis Clinic, which is in southwestern Ohio. As of July 1, 2020, the reported cumulative rate of COVID-19 infection for this area was 5103 per 1 million (https://coronavirus.ohio.gov/wps/portal/gov/covid-19/dashboards/overview). This is similar to the rate of 5545 per 1 million for our sarcoidosis patients and 3656 per 1 million for the cancer patients. The lower rate of COVID-19 infections for sarcoidosis patient at University of Cincinnati clinic versus other patients completing the questionnaires may be due to lower overall rate of COVID-19 infection in the area and/or the more rigorous criteria for diagnosis, since at our clinic we required verification by culture. This criterion may underestimate the number of cases of COVID-19 infection (16). The hospitalization rates for COVID-19 may be more accurate, since such cases are usually confirmed by cultures. For sarcoidosis patients, we identified five features associated with increased for COVID-19 infection. Sarcoidosis patients with a COVID-19 infected roommate had a greater than 20-fold increased risk for COVID-19 infection. In one meta-analysis, the risk of in home transmission of disease has been estimated as ten-fold (17). There was also a nearly two-fold increased risk for sarcoidosis patients who were health care workers. This increased risk has been noted for some time (12). The higher risk in Spain may be a reflection that some areas were hit sooner than other parts of the world. The widespread use of N-95 and other respiratory policies later in the pandemic and in other parts of the world may have blunted this risk factor (13;18). Comorbidities in sarcoidosis include diabetes, hypertension, heart disease, and co-existing chronic obstructive pulmonary disease (10;19). These have also been identified as risk factors for COVID-19 infection and more severe disease (2;6;8;15). However, in the current study, none of these was associated with an increased risk for infection. In regards to immunosuppression therapy, only rituximab was associated with increased risk for COVID-19 infection for sarcoidosis patients. This is not surprising, since rituximab has been noted to have increased the risk for acquiring viral infections (20). In addition, viral infections are more severe when patients are receiving rituximab. We studied only seven patients with COVID-19 infection treated with rituximab. Sarcoidosis is a multi-organ disease and the effect of sarcoidosis on different organs may affect the patient’s ability to avoid COVID-19 infection. In this study, we found that patients with lung or neurologic involvement were at increased risk for COVID-19 infection. Chronic lung disease has been identified as a risk factor for infection and more severe disease (21). In terms of the outcomes of COVID-19 infected sarcoidosis patients, we found that less than twenty percent required hospitalization. In a recent, retrospective study of 37 sarcoidosis patients with COVID-19 infection, the rate of hospitalization for infection was 60% and no different from the non-sarcoidosis patients seen at that center (3). However, the rate of adverse outcome as defined by requiring intubation and/or mortality was significantly higher than the non-sarcoidosis patients (3). The current study would have missed the very severe cases, at least the ones who died, as it was a study analyzing a self-reported questionnaire. In our study, the use of immunosuppressive therapy was not associated with a significant increased risk for hospitalization. The overall outcome of these patients appears more favorable than that reported in rheumatoid arthritis patients treated with immunosuppression (22-24). In one study (23), the use of ≥ 10 mg per day of prednisone or its equivalent was associated with increased risk. That study analyzed 600 COVID-19 infected patients and our study may have been underpowered to detect that difference. Interestingly, that study found that anti-TNF therapy was associated with a significantly lower risk for COVID-19 infection (23). Hydroxychloroquine has been proposed as a potential therapy for patients with COVID-19 infection and ongoing studies are evaluating this drug (25). Over 400 of our sarcoidosis patients were receiving hydroxychloroquine at time of survey. There was no change in the rate of infection or rate of hospitalization for the seven patients who developed COVID-19 infection while on hydroxychloroquine. This has also been noted in a study of patients treated with hydroxychloroquine for various rheumatologic conditions (23). Several comorbidities have been associated with a worse clinical outcome from COVID-19 infection (7;8;21;23). We were able to analyze the outcome of 96 sarcoidosis patients with COVID-19 infection and reported comorbidities. Underlying heart disease was associated with an increased risk for hospitalization. Other comorbidities examined included diabetes, COPD, and hypertension were not felt to be significant risk factors. There are several limitations to our study. The questionnaire did not try to quantitate severity of disease, especially significant pulmonary fibrosis. Therefore, we could not comment on impact of severe lung disease on risk or outcome of COVID-19 infection. Because of the low number of incident cases, we may have been underpowered to detect smaller, but significant risk factors including comorbidities and the impact of immunosuppression therapy. The questionnaires were completed by the patients, usually on-line. With the exception of those seen at the University of Cincinnati, there was no attempt to verify COVID-19 infection. Patients who had severe disease or even died would be unlikely to be able to complete the questionnaire, so this group was underrepresented. Also, the rate of COVID-19 infection in sarcoidosis patients varies based on local conditions and time into the pandemic. The rate of COVID-19 infection in the general population during the study period may be better understood over time, especially as serologic testing becomes more widely used. However, the rate of infection for COVID-19 infection in the general population may be higher. We compared our results to a standard reporting site which provided cumulative rates for various parts of the world. In the sub-study at University of Cincinnati, the rate of infection was not significantly different from cancer patients seen at the same time period. Future reports may provide a better understanding of the rate of COVID-19 infection in the community studied. Future rates may be affected as vaccines become available. Vaccines for other conditions have proved to be effective in preventing infections in sarcoidosis patients (26). In summary, our data suggests an increased rate of COVID-19 infection in sarcoidosis patients. However, when compared to non-sarcoidosis patients in the same area and time of the study, the rate of COVID-19 infection was not significantly different. The most obvious risk factor for COVID-19 infection was having a roommate with COVID-19. This means that hygiene measures and distancing are extremely important at home as well as in public. To facilitate research on prevalence and risk factors of COVID-19 infection in chronic diseases, sarcoidosis specifically, it would be helpful to report in population registries not only numbers of patients with COVID-19, but also their characteristics, such as comorbidities and medication use.
Covid PositiveCovid negativePercent with featurePercent COVID positiveHazards ratio95% CIPComments
ALL PATIENTS
Sarcoidosis66190619723.35%9.152.249-37.2530.002
Cancer25455470.37%
LOCAL
OH/KY/IN35385410.55%1.51660.2544-9.041Cincinnati Clinic patients
Cancer25455470.37%Sarc versus cancer
Sarc patients
Male1949551426.18%3.70%1.140.675-1.923>0.10
Female471402144973.82%3.24%9 no sex indicated
Black1137138220.07%2.88%0.7960.4209-1.5066>0.10
White551466152179.93%3.62%9 patients biracial
Roommate with COVID
yes2117381.94%55.26%23.677215.769-35.5514<0.0001
no451883192898.22%2.33%
Health care provider
Yes1219720910.65%5.74%1.85651.0099-3.41270.0464
no541692174688.95%3.09%
Current meds
Prednisone2475577939.50%3.08%0.87510.5343-1.4332>0.10
No prednisone421151119360.50%3.52%
Prednisone >10 mg or more1336137418.97%3.48%1.0480.5774-1.9022>0.10
Prednisone < 10 mg531545159881.03%3.32%
Plaquenil723924612.47%2.85%0.83240.3846-1.8016>0.10
No plaquenil591667172687.53%3.42%
anti-TNF61831899.58%3.17%0.94340.4131-2.1542>0.10
no anti-TNF601723178390.42%3.37%
Cytotoxic2153755828.30%3.76%1.18260.7111-1.9666>0.10
No cytotoxic451369141471.70%3.18%
Rituximab642482.43%12.50%4.00831.8213-8.82170.0006
No rituximab601864192497.57%3.12%
Underlying
COPD1232133316.89%3.60%1.09380.5917-2.0217>0.10
541585163983.11%3.29%
Diabetes529229715.06%1.68%0.46230.1873-1.14080.0941
611614167584.94%3.64%
Heart disease825426213.29%3.05%0.90020.4348-1.8637>0.10
581652171086.71%3.39%
Hypertension1548049525.10%3.03%0.87760.498-1.5466>0.10
511426147774.90%3.45%
Organ involved
Lung581596165483.87%3.51%1.39390.6721-2.8907>0.10
831031816.13%2.52%
Cardiac sarc1227829014.71%4.14%1.33030.7206-2.4557>0.10
541628168285.29%3.21%
Neuro sarc111841959.89%5.64%1.82280.9704-3.42290.0619
551722177790.11%3.10%
Origin
US501551160181.19%3.12%0.75160.4269-1.3232>0.10
non US1534636118.31%4.16%No country entered: 10
OH/KY/IN353854127.43%0.55%
631368143172.57%4.40%
Sarcoid age
Covid Positive54.5 ± 11.39 years0.088
Covid negative53.0 ± 9.60 years
COVID outcomeHomeHospitalICUVentilator
Sarc44930
Cancer1100
Sarc ≥ 5 yr481274132267.35%3.63%1.33210.7629-2.359>0.01
Sarc < 5 yr1657158729.90%2.73%
Hospital considered bad outcome
COVID positiveHomeHospitalHazard ration for
PrednisoneHospitalization
Yes204241.22%83.33%0.8750.2941-2.6036>0.10
No348422.14%80.95%
If prednisone
Prednisone ≥ 10 mg1121319.70%15.38%0.81540.2027-3.2794>0.10
Prednisone < 10mg43105380.30%18.87%
Infliximab
Yes4260.31%66.67%0.81540.2027-3.2794>0.10
No5010603.06%83.33%
Plaquenil
Yes6170.36%85.71%0.76620.1156-5.9785>0.10
No4811593.01%81.36%
Cytotoxic
Yes147211.07%66.67%31.0773-835390.0355
No405452.29%88.89%
Rituximab
Yes6060.31%100.00%0.34860.02303-5.2723>0.10
No4812603.06%80.00%

* 9 patients did not indicate sex.

† 9 patients biracial

¶ Included inflixiamb, adlimumab, and biosimilars

§ Included methotrexate, azathioprine, mycophenolate, and leflunomide

** 63 patients did not provide information regarding duration of disease.

UC: University of Cincinnati clinic

Covid PositiveCovid negativePercent with featurePercent COVID positiveHazards ratio95% CIPComments
ALL PATIENTS
Sarcoidosis13160316160.80%
Sarc patients
Male227527714.11%0.72%0.45450.1003-2.0624>0.10
Female1062063032.09%1.59%709 no sex indicated
Black390934.89%3.23%2.8170.7764-10.2227>0.10
White977778641.30%1.15%826 patients biracial
Roommate with COVID
yes2350.25%40.00%58.581817.2179-1999.317<0.0001
no111600161182.07%0.68%
Health care provider
Yes182834.23%1.20%1.53920.2025-11.6963>0.10
no121521153378.09%0.78%
Current meds *If no response, assume
Prednisone531832316.38%1.55%2.50190.824-7.5971>0.10drug not used
No prednisone81285129365.57%0.62%
Plaquenil01151155.83%0.00%0.45720.02735-7.6429>0.10
No plaquenil131418143172.57%0.91%
anti-TNF11151165.88%0.86%1.02730.1348-7.8316>0.10
no anti- TNF121418143072.52%0.84%
Cytotoxic227227413.89%0.73%0.89050.1985-3.9952>0.10
No cytotoxic111331134268.05%0.82%
Rituximab110110.56%9.09%12.15151.7255-85.57850.0122
No rituximab121592160481.34%0.75%
Underlying
COPD31771809.13%1.67%2.39330.6648-8.6150>0.10
101426143672.82%0.70%
1616
Diabetes11341356.85%0.74%0.91420.1198-6.9776>0.10
121469148175.10%0.81%
1616
Heart disease11161175.93%0.85%1.0670.14-8.1402>0.10
121487149976.01%0.80%
1616
Hypertension427527914.15%1.43%2.12980.6605-6.8673>0.10
91328133767.80%0.67%
1616
Organ involved*If no response, assume
Lung1072873837.42%1.36%3.96571.0954-14.35630.0358not involved
387587844.52%0.34%
1616
Cardiac sarc112130.66%7.69%9.45511.3244-67.50270.0251
121463147574.80%0.81%
1488
Neuro sarc484884.46%4.55%7.71722.424-24.56930.0005
91519152877.48%0.59%
1616
Origin
USNANA00.00%#VALUE!NOT AVAILABLE
non USNANA00.00%#VALUE!
0
Sarcoid age
Covid Positive54.4 ± 11.29 years>0.10
Covid negative56.6 ± 10.39 years
Sarc ≥ 5 yr872072838.14%1.10%0.53570.163-1.7602>0.01Information missing on 986 patients
Sarc < 5 yr419119510.21%2.05%
COVID outcomeHomeHospitalICUVent
Sarc83002 no information
#REF!
COVID positiveHomeHospitalIf in hospital, considered
Prednisonebad outcome
Yes3146.06%75.00%1.050.5037-2.1889>0.10Hazard ration for
No52710.61%71.43%Hospitalization
Infliximab
Yes0000.00%0.00%0.70590.09617-5.1812>0.10
No831116.67%72.73%
Plaquenil
Yes0000.00%0.00%0.70590.09617-5.1812>0.10
No831116.67%72.73%
Cytotoxic
Yes1011.52%100.00%1.42860.9512-2.14350.0849
No731015.15%70.00%
Rituximab
Yes0111.52%0.00%0.32350.02872-3.6449>0.10
No821015.15%80.00%
Site: Netherlands
Covid PositiveCovid negativePercent with featurePercent COVID positiveHazard s ratio95% CIPComments
Sarcoidosis (996 who live in the Netherlands , out of 1034 respondents )239739962.31%
Male641842421.60%1.42%0.47450.1187-1.1932>0.10
Female1755357029.04%2.98%2 no sex indicated
White2293295448.60%2.31%0.96820.1337-7.0165>0.10
Other141422.14%2.38%
BMI categories
BMI < 25834835618.14%2.25%0.9580.4029-2.2323>0.10
BMI ≥ 251562363832.50%2.35%
Current meds
Prednisone419419810.09%2.02%0.845850.2919-2.4661>0.01of 28 patients the dose is missing
No prednisone1977998740.65%2.38%
Prednisone ≥ 10 mg276783.97%2.56%1.17950.1701-8.1803>0.10
Prednisone < 10mg290924.69%2.17%
Plaquenil157582.95%1.72%0.73510.1008-5.3585>0.10
No plaquenil2291693847.78%2.35%
anti-TNF (infliximab (6), adalimumab (7))076763.87%0.00%0.25450.01561-4.14497>0.10
no anti-TNF (de lege cellen uit dezelfde kolommen)2389792046.87%2.50%1 patient was treated with both infliximab and adalimumab
Cytotoxic (methotrexa te (2), azathioprine (3), leflunomide (5))222722911.67%0.87%0.3190.07536-1.3502>0.10
No cytotoxic (lege cellen in dezelfde kolommen)2174676739.07%2.74%3 patients were treated with both methotrexat e and azathioprine
Rituximab
yes0110.05%0.00%10.59570.9295-120.78010.0573
no2397299550.69%2.31%
Current medication
yes751557226.74%1.34%0.400.165-0.958<0.05
no1645847424.04%3.38%
Underlying
COPD020201.02%0.00%0.98990.6217-15.7596>0.10
2395397649.72%2.36%
Asthma280824.18%2.44%1.06160.2534-4.448>0.10
2189391446.56%2.30%
Diabetes247492.50%4.08%1.84060.441-7.628>0.10(past) use of prednison can be studied additionally
2192694748.24%2.22%
Heart failure027271.38%0.00%0.73710.04592-11.8322>0.10
2394696949.36%2.37%
Circulation235371.88%5.41%2.46850.601-10.1387>0.10
2193895948.85%2.19%
Hypertension11071085.50%0.93%0.37370.05088-2.7452>0.10
2286688845.24%2.48%
Cancer020201.02%0.00%0.98990.06217-15.7596>0.10
2395397649.72%2.36%
Organ involved
Lung2082084042.79%2.38%1.23810.3724-4.1165>0.10
no Lung31531567.95%1.92%
heart01151155.86%0.00%0.16180.009892-2.645>0.10
no heart2385888144.88%2.61%
CNS11181196.06%0.84%0.3350.04557-2.426>0.10
no CNS2285587744.68%2.51%
Sarcoid age
COVID positive55.3 ± 6.0 years
COVID negative55.0±10. 8 years
COVID uncertain50.5 ± 11.0 years
COVID outcomeHomeHospitalICUVent
Sarc20300.00%
Sarc ≥ 5 yr1567869370.14%2.16%0.9120.3758-2.2141>0.10
Sarc < 5 yr728829529.86%2.37%8 unknown
988
Roommates with COVID-19
yes1130414.12%26.83%21.351610.0247-45-4768<0.0001
no1294395595.88%1.26%
996
Work in healthcare
Yes49910310.34%3.88%1.82520.6331-5.2618>0.10
No1987489389.66%2.13%
996
COVID positiveHomeHospitalPerce nt on drugPercent treate d in hospit alIf in hospital, considered
bad outcome
Hazard ration for
PrednisoneHospitalization
Yes40417.39%0.00%0.57140.03487-9.3644>0.10
No1631982.61%15.79%
Prednisone ≥ 10 mg20250.00%0.00%TOO SMALL
Prednisone < 10mg20250.00%0.00%
Infliximabthere were no COVID - 19 positive patients who were treated with infliximab
Plaquenil
Yes1014.35%0.00%1.64280.1236-21.835>0.10
No1932295.65%13.64%
Cytotoxic
yes2028.70%0.00%1.04760.06994-15.6914>0.10
no1832191.30%14.29%
Rituximab
none of the COVID-19 positive patients was treated with rituximab
Covid PositiveCovid negativePercent with feature *Percent COVID positiveHazards ratio95% CIPComments
ALL PATIENTS
Sarcoidosis95025111.76%
Sarc patients
Male320520840.70%1.44%0.870.203-3.628>0.10
Female529329858.32%1.68%5 no sex identified
Black0661.17%0.00%less than 10 blacks
White948349296.28%1.83%13 no race indicated
Roommate with COVID
yes5381.57%62.50%205.836.24-1169.14<0.0001
no449449897.46%0.80%5 no answer
Health care provider
Yes245479.20%4.26%2.890.583-14.324>0.10
no745546290.41%1.52%2 no answer
Current meds *
Prednisone126026151.08%0.38%0.120.015-1.0170.052
No prednisone722623345.60%3.00%17 no answer
Prednisone>10 mg1838416.44%1.19%
Prednisone<10 mg017717734.64%0.00%6.380.257-158.215>0.10only 1 COVID on predniso ne
anti-TNF0991.76%0.00%3.230.1697-61.655>0.10
no anti-TNF639940579.26%1.48%97 no answer
Cytotoxic2868817.22%2.27%1.550.307-7.793>0.10
No cytotoxic639940579.26%1.48%18 no answer
Rituximab
No rituximabNo answers on ritux
Underlying
COPD248509.78%4.00%2.680.542-13.289>0.10
745145889.63%1.53%3 no answer
Diabetes032326.26%0.00%0.760.043-13.328>0.10
946847793.35%1.89%2 no answer
Heart diseasenot answered
Hypertension412613025.44%3.08%2.370.628-8.980>0.10
537437974.17%1.32%2 did not nswer
Organ involved*If no response , assume
Lung945946891.59%1.92%1.670.096-29.299>0.10not involved
040407.83%0.00%3 did not answer
Cardiac sarc233356.85%5.71%4.030.806-20.1980.0896
746647392.56%1.48%3 did nto answer
Neuro sarc023234.50%0.00%1.070.060-18.895>0.10
947648594.91%1.86%3 did not answer
Sarcoid age
Covid Positive55.0 ± 8.63 years>0.10
Covid negative51.8 ± 9.74 years
COVID outcomeHomeHospitalICUVent
Sarc7210

*Percent positive of 511 patients who participated in study.

Covid PositiveCovid negativePercent with featurePercent COVID positiveHazards ratio95% CIPComments
ALL PATIENTS
Sarcoidosis51001054.76%
Sarc patients
Male1272826.67%3.57%0.68750.08022-5.8917>0.05
Female4737773.33%5.19%
Other0221.90%0.00%DNC
White5970297.14%4.90%1 No Answer
Current meds
Prednisone2404240.00%4.76%10.1745-5.7322>0.05
No prednisone3606360.00%4.76%
Prednisone ≥ 10 mg0191918.10%0.00%0.240.01222-4.715>0.05
Prednisone < 10mg2212321.90%8.70%
Plaquenil0665.71%0.00%1.29870.07692-21.834>0.05
No plaquenil5949994.29%5.05%
anti-TNF1676.67%14.29%3.50.4493-27.264>0.05
no anti-TNF4949893.33%4.08%
Cytotoxic0191918.10%0.00%0.39550.02278-6.8641>0.05
No cytotoxic5818681.90%5.81%
Rituximab0000.00%0.00%DNC
No rituximab5100105100.00%4.76%
Underlying
COPD0121211.43%0.00%0.65730.03854-11.2108>0.05
5889388.57%5.38%
Diabetes1192019.05%5.00%1.06250.1254-8.9993>0.05
4818580.95%4.71%
105
Heart disease0554.76%0.00%1.53030.09537-24.5561>0.05
59510095.24%5.00%
105
Hypertension0151514.29%0.00%0.5170.3003-8.9023>0.05
5859085.71%5.56%
105
Organ involved2 no answer
Lung4939792.38%4.12%0.24740.3249-1.8845>0.05
1565.71%16.67%
103
Cardiac sarc0443.81%0.00%1.81820.116-28.5055>0.05
5949994.29%5.05%
103
Neuro sarc2687.62%25.00%7.91671.5399-40.7010.0133
3929590.48%3.16%
103
Origin
SPAIN4100045.30%3.85%
NOT SPANISH1010.05%100.00%
105
Sarcoid age
Covid Positive49.80 ± 9.20years0.3
Covid negative44.88 ± 8.82 years
COVID outcomeHomeHospitalICUVent
Sarc4100
Sarc ≥ 5 yr463673.51%5.97%5.02940.27827-90.9223>0.051 no answer
Sarc < 5 yr037371.94%0.00%
04
COVID positiveHomeHospitalPercen t on drugPercent treated in hospitalIf in hospital, considered
Prednisonebad outcome
Yes2023.03%0.00%Hazard ration for
No2134.55%33.33%Hospitalization
Prednisone ≥ 10 mg0000.00%#DIV/0!
Prednisone < 10mg2023.03%0.00%
Infliximab
Yes1011.52%0.00%
No3146.06%25.00%
Plaquenil
Yes0000.00%#DIV/0!
No4157.58%20.00%
Cytotoxic
Yes0000.00%#DIV/0!
No4157.58%20.00%
Rituximab
Yes0000.00%#DIV/0!
No4157.58%20.00%
Covid PositiveCovid negative
Roommate0221.90%0.00%3.09090.2167-44.087>0.052 no answer
No roommate59610196.19%4.95%
Health provider3131615.24%18.75%8.06251.4614-44.47910.01663 no answer
No healtg provider2848681.90%2.33%
CountryStateTotal NumberNumber positivePercent Positive
USTotal1601503.1%
Alabama20420.0%
Alaska400.0%
Arizona1600.0%
Arkansas1000.0%
California5000.0%
Colorado2100.0%
Conneticut1317.7%
District of Columbia300.0%
Deleware5120.0%
Florida6011.7%
Georgia2400.0%
Hawaii100.0%
Idaho400.0%
Illinois6100.0%
Indiana4648.7%
Iowa1700.0%
Kansas500.0%
Kentucky77810.4%
Lousiana1200.0%
Maine700.0%
Maryland1300.0%
Massachusetts3800.0%
Michigan5112.0%
Minnesota1400.0%
Mississippi800.0%
Missouri1915.3%
Montana500.0%
Nebraska200.0%
Nevada700.0%
New Hampshire1100.0%
New Jersey3000.0%
New Mexico300.0%
New York8533.5%
North Carolina3800.0%
North Dakota200.0%
Ohio468224.7%
Oklahoma1400.0%
Oregon1200.0%
Pennsylvania5211.9%
Rhode Island200.0%
South Carolina2100.0%
South Dakota300.0%
Tennessee2229.1%
Texas4200.0%
Utah1200.0%
Virginia3800.0%
Washington2700.0%
West Virginia16212.5%
Wisconsin11218.2%
Wyoming200.0%
Non USTotal36115
Argentina100.0%
Australia6400.0%
Austria100.0%
Belarus100.0%
Belgium200.0%
Brazil2150.0%
Canada6234.8%
Columbia200.0%
Czech100.0%
Denmark1200.0%
Ecuador100.0%
Egypt200.0%
England9622.1%
Finland100.0%
France500.0%
Germany900.0%
Hungary100.0%
India200.0%
Ireland2000.0%
Italy100.0%
Mexico2150.0%
Morroco100.0%
New Zealand400.0%
Nigeria300.0%
Norway300.0%
Palestine200.0%
Poland200.0%
Portugal300.0%
Puerto Rico100.0%
Romania300.0%
Russia100.0%
Scotland9111.1%
Slovania100.0%
South Africa1000.0%
Spain500.0%
Sweden4375.0%
Switzerland100.0%
The Netherlands200.0%
Turkey100.0%
UAE100.0%
Wales100.0%
Zimbabwe100.0%
  26 in total

1.  COVID-19 pneumonia in a large cohort of patients treated with biological and targeted synthetic antirheumatic drugs.

Authors:  Edoardo Conticini; Elena Bargagli; Marco Bardelli; Giuseppe Domenico Rana; Caterina Baldi; Paolo Cameli; Stefano Gentileschi; David Bennett; Paolo Falsetti; Nicola Lanzarone; Francesca Bellisai; Cristiana Barreca; Roberto D'Alessandro; Luca Cantarini; Bruno Frediani
Journal:  Ann Rheum Dis       Date:  2020-05-15       Impact factor: 19.103

2.  Income and Other Contributors to Poor Outcomes in U.S. Patients with Sarcoidosis.

Authors:  Logan J Harper; Alicia K Gerke; Xiao-Feng Wang; Manuel L Ribeiro Neto; Robert P Baughman; Kelli Beyer; Marjolein Drent; Marc A Judson; Lisa A Maier; Leslie Serchuck; Noopur Singh; Daniel A Culver
Journal:  Am J Respir Crit Care Med       Date:  2020-04-15       Impact factor: 21.405

3.  Prevalence of comorbidities in patients and mortality cases affected by SARS-CoV2: a systematic review and meta-analysis.

Authors:  Omar Ariel Espinosa; Andernice Dos Santos Zanetti; Ednardo Fornanciari Antunes; Fabiana Gulin Longhi; Tatiane Amorim de Matos; Paula Franciene Battaglini
Journal:  Rev Inst Med Trop Sao Paulo       Date:  2020-06-22       Impact factor: 1.846

4.  Clinical features and outcomes of COVID-19 in patients with rheumatic diseases treated with biological and synthetic targeted therapies.

Authors:  Carlos Sanchez-Piedra; Cesar Diaz-Torne; Javier Manero; José M Pego-Reigosa; Íñigo Rúa-Figueroa; Miguel A Gonzalez-Gay; Juan Gomez-Reino; Jose M Alvaro-Gracia
Journal:  Ann Rheum Dis       Date:  2020-06-05       Impact factor: 19.103

5.  When the Game Changes: Guidance to Adjust Sarcoidosis Management During the Coronavirus Disease 2019 Pandemic.

Authors:  Nadera J Sweiss; Peter Korsten; Huzaefah J Syed; Aamer Syed; Robert P Baughman; Arthur M F Yee; Daniel A Culver; Teresa Sosenko; Arata Azuma; Francesco Bonella; Ulrich Costabel; Wonder P Drake; Marjolein Drent; Elyse E Lower; Dominique Israel-Biet; Remy L M Mostard; Hilario Nunes; Paola Rottoli; Paolo Spagnolo; Athol U Wells; Wim A Wuyts; Marc A Judson
Journal:  Chest       Date:  2020-04-29       Impact factor: 9.410

6.  Characteristics associated with hospitalisation for COVID-19 in people with rheumatic disease: data from the COVID-19 Global Rheumatology Alliance physician-reported registry.

Authors:  Milena Gianfrancesco; Kimme L Hyrich; Jinoos Yazdany; Pedro M Machado; Philip C Robinson; Sarah Al-Adely; Loreto Carmona; Maria I Danila; Laure Gossec; Zara Izadi; Lindsay Jacobsohn; Patricia Katz; Saskia Lawson-Tovey; Elsa F Mateus; Stephanie Rush; Gabriela Schmajuk; Julia Simard; Anja Strangfeld; Laura Trupin; Katherine D Wysham; Suleman Bhana; Wendy Costello; Rebecca Grainger; Jonathan S Hausmann; Jean W Liew; Emily Sirotich; Paul Sufka; Zachary S Wallace
Journal:  Ann Rheum Dis       Date:  2020-05-29       Impact factor: 19.103

Review 7.  Transmission of COVID-19 virus by droplets and aerosols: A critical review on the unresolved dichotomy.

Authors:  Mahesh Jayaweera; Hasini Perera; Buddhika Gunawardana; Jagath Manatunge
Journal:  Environ Res       Date:  2020-06-13       Impact factor: 6.498

8.  How is immunosuppressive status affecting children and adults in SARS-CoV-2 infection? A systematic review.

Authors:  Chiara Minotti; Francesca Tirelli; Elisa Barbieri; Carlo Giaquinto; Daniele Donà
Journal:  J Infect       Date:  2020-04-23       Impact factor: 6.072

9.  Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis.

Authors:  Wei-Jie Guan; Wen-Hua Liang; Yi Zhao; Heng-Rui Liang; Zi-Sheng Chen; Yi-Min Li; Xiao-Qing Liu; Ru-Chong Chen; Chun-Li Tang; Tao Wang; Chun-Quan Ou; Li Li; Ping-Yan Chen; Ling Sang; Wei Wang; Jian-Fu Li; Cai-Chen Li; Li-Min Ou; Bo Cheng; Shan Xiong; Zheng-Yi Ni; Jie Xiang; Yu Hu; Lei Liu; Hong Shan; Chun-Liang Lei; Yi-Xiang Peng; Li Wei; Yong Liu; Ya-Hua Hu; Peng Peng; Jian-Ming Wang; Ji-Yang Liu; Zhong Chen; Gang Li; Zhi-Jian Zheng; Shao-Qin Qiu; Jie Luo; Chang-Jiang Ye; Shao-Yong Zhu; Lin-Ling Cheng; Feng Ye; Shi-Yue Li; Jin-Ping Zheng; Nuo-Fu Zhang; Nan-Shan Zhong; Jian-Xing He
Journal:  Eur Respir J       Date:  2020-05-14       Impact factor: 16.671

10.  Specific risk factors for SARS-CoV-2 transmission among health care workers in a university hospital.

Authors:  Güven Çelebi; Nihal Pişkin; Arzum Çelik Bekleviç; Yurdagül Altunay; Ayşegül Salcı Keleş; Mehmet Ali Tüz; Bülent Altınsoy; Demet Hacıseyitoğlu
Journal:  Am J Infect Control       Date:  2020-08-06       Impact factor: 2.918
View more
  5 in total

1.  Characterization and Outcomes of SARS-CoV-2 Infection in Patients with Sarcoidosis.

Authors:  P Brito-Zerón; B Gracia-Tello; A Robles; A Alguacil; M Bonet; B De-Escalante; A Noblejas-Mosso; R Gómez-de-la-Torre; M Akasbi; M Pérez-de-Lis; R Pérez-Alvarez; M Ramos-Casals
Journal:  Viruses       Date:  2021-05-27       Impact factor: 5.048

Review 2.  A review of the presentation and outcome of sarcoidosis in coronavirus disease 2019.

Authors:  Lina James George; Anil Mathew Philip; Kevin John John; Anu Anna George; Jemimah Nayar; Ajay Kumar Mishra; Amos Lal
Journal:  J Clin Transl Res       Date:  2021-09-27

3.  Common genetic aspects between COVID-19 and sarcoidosis: A network-based approach using gene expression data.

Authors:  Md Roman Mogal; Sagarika Adhikary Sompa; Asadullah Junayed; Md Rashel Mahmod; Md Zainul Abedin; Md Asaduzzaman Sikder
Journal:  Biochem Biophys Rep       Date:  2022-02-01

Review 4.  Risk Assessment for Patients with Chronic Respiratory Conditions in the Context of the SARS-CoV-2 Pandemic Statement of the German Respiratory Society with the Support of the German Association of Chest Physicians.

Authors:  Marek Lommatzsch; Klaus F Rabe; Christian Taube; Marcus Joest; Michael Kreuter; Hubert Wirtz; Torsten Gerriet Blum; Martin Kolditz; Hilte Geerdes-Fenge; Ralf Otto-Knapp; Brit Häcker; Tom Schaberg; Felix C Ringshausen; Claus F Vogelmeier; Niels Reinmuth; Martin Reck; Jens Gottlieb; Stavros Konstantinides; Joachim Meyer; Heinrich Worth; Wolfram Windisch; Tobias Welte; Torsten Bauer
Journal:  Respiration       Date:  2022-01-21       Impact factor: 3.966

5.  Rationale and design of the SARCoidosis Outcomes in all respiratory Viral Infectious Diseases (SARCOVID) Study.

Authors:  Rachel Strykowski; Divya C Patel; Manny Ribeiro Neto; Kerry M Hena; Mridu Gulati; LIsa A Maier; Karen Patterson
Journal:  BMJ Open Respir Res       Date:  2022-07
  5 in total

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