Risk factors for severe COVID-19 infection and the impact of COVID-19 infection on disease progression among patients with AAV

Abstract Objective To identify risk factors for COVID-19 infection and investigate the impact of COVID-19 infection on chronic kidney disease (CKD) progression and vasculitis flare in patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Methods This cohort study retrospectively analyzed the prevalence and severity of COVID-19 infection in 276 patients with AAV who were followed up. Logistic regression was employed to estimate the risk of COVID-19 infection as well as CKD progression and vasculitis flare upon COVID-19 infection. Results During the 6-month observation period, 213 (77.2%) of 276 patients had a diagnosis of COVID-19 infection. Of these 213 patients, 49 (23.0%) had a COVID-19-related inpatient admission, including 17 patients who died of COVID-19 infection. AAV patients with severe COVID-19 infection were more likely to be male (OR 1.921 95% CI 1.020–3.619, P = 0.043), suffered from worse kidney function (serum creatinine Scr, OR 1.901 95% CI 1.345–2.687, P P = 0.017) and less likely to have evidence of initial vaccination (OR 0.469 95% CI 0.231–0.951, P = 0.036), and Scr and COVID-19 vaccination were proven to be significantly associated with severe COVID-19 infection even after multivariable adjustment. Severe COVID-19 infection was significantly associated with subsequent CKD progression (OR 7.929 95% CI 2.030-30.961, P = 0.003) and vasculitis flare (OR 11.842 95% CI 1.048-133.835, P = 0.046) among patients with AAV. Conclusion AAV patients who were male, and with worse kidney function were more susceptible to severe COVID-19 infection, which subsequently increased the risk of CKD progression and vasculitis flare.