COVID-19 outcomes in patients with a history of immune-mediated glomerular diseases

Philipp Gauckler; Jana S Kesenheimer; Duvuru Geetha; Balazs Odler; Kathrin Eller; Timothee Laboux; Federico Alberici; Mattia Zappa; Natasha Chebotareva; Sergey Moiseev; Marco Bonilla; Kenar D Jhaveri; Julie Oniszczuk; Vincent Audard; Denise Costa; Gianna Mastroianni-Kirsztajn; Annette Bruchfeld; Masahiro Muto; Martin Windpessl; Gert Mayer; Andreas Kronbichler

doi:10.3389/fimmu.2023.1228457

COVID-19 outcomes in patients with a history of immune-mediated glomerular diseases

Front Immunol. 2023 Sep 12:14:1228457. doi: 10.3389/fimmu.2023.1228457. eCollection 2023.

Authors

Philipp Gauckler¹, Jana S Kesenheimer², Duvuru Geetha³, Balazs Odler^{4

5}, Kathrin Eller⁵, Timothee Laboux^{6

7}, Federico Alberici⁸, Mattia Zappa⁸, Natasha Chebotareva⁹, Sergey Moiseev⁹, Marco Bonilla¹⁰, Kenar D Jhaveri¹⁰, Julie Oniszczuk¹¹, Vincent Audard¹¹, Denise Costa^{12

13}, Gianna Mastroianni-Kirsztajn¹⁴, Annette Bruchfeld^{15

16}, Masahiro Muto¹⁷, Martin Windpessl¹⁸, Gert Mayer¹, Andreas Kronbichler^{1

4}

Affiliations

¹ Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, Innsbruck, Austria.
² Department of Psychology, University of Innsbruck, Innsbruck, Austria.
³ Division of Nephrology, Johns Hopkins University, Baltimore, MD, United States.
⁴ Department of Medicine, University of Cambridge, Cambridge, United Kingdom.
⁵ Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
⁶ Nephrology Department, Univ. Lille, Centre Hospitalier Universitaire de Lille (CHU Lille), Lille, France.
⁷ Institut Pasteur de Lille, Univ. Lille, Inserm, Centre Hospitalier Universitaire de Lille (CHU Lille), Lille, France.
⁸ Division of Nephrology and Dialysis, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia and Azienda Socio Sanitaria Territoriale (ASST) Spedali Civili, Brescia, Italy.
⁹ Tareev Clinic of Internal Diseases, Sechenov First Moscow State Medical University, Moscow, Russia.
¹⁰ Glomerular Center at Northwell Health, Division of Kidney Diseases and Hypertension, Zucker School of Medicine at Hofstra/Northwell, Northwell Health, Great Neck, NY, United States.
¹¹ Department of Nephrology and Transplantation, Rare French Disease Centre "Idiopathic Nephrotic Syndrome", Henri-Mondor/Albert-Chenevier Hospital Assistance Publique-Hôpitaux de Paris, Inserm U955, Paris-East University, Créteil, France.
¹² Department of Nephrology, Clinical Hospital, Federal University of Pernambuco, Recife, Brazil.
¹³ Recife Medical School, Federal University of Pernambuco, Recife, Pernambuco, Brazil.
¹⁴ Division of Nephrology, Federal University of Sao Paulo, São Paulo, SP, Brazil.
¹⁵ Department of Health, Medicine and Caring Sciences, Linköpings Universitet, Linköping, Sweden.
¹⁶ Department of Clinical Science, Intervention and Technology, Division of Renal Medicine Karolinska Institutet, Stockholm, Sweden.
¹⁷ Department of Nephrology, Juntendo University Faculty of Medicine, Tokyo, Japan.
¹⁸ Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Wels, Austria.

Abstract

Introduction: Patients with immune-mediated glomerular diseases are considered at high risk for severe COVID-19 outcomes. However, conclusive evidence for this patient population is scarce.

Methods: We created a global registry and retrospectively collected clinical data of patients with COVID-19 and a previously diagnosed immune-mediated glomerular disease to characterize specific risk factors for severe COVID-19 outcomes.

Results: Fifty-nine patients with a history of immune-mediated glomerular diseases were diagnosed with COVID-19 between 01.03.2020 and 31.08.2021. Over a mean follow-up period of 24.79 ± 18.89 days, ten patients (16.9%) developed acute kidney injury. Overall, 44.1% of patients were managed in an outpatient setting and therefore considered as having "non-severe" COVID-19, while 55.9% of patients had severe COVID-19 requiring hospitalization including worse outcomes. Comparing both groups, patients with severe COVID-19 were significantly older (53.55 ± 17.91 versus 39.77 ± 14.95 years, p = .003), had lower serum albumin levels at presentation (3.00 ± 0.80 g/dL versus 3.99 ± 0.68 g/dL, p = .016) and had a higher risk of developing acute kidney injury (27% versus 4%, p = .018). Male sex (p <.001) and ongoing intake of corticosteroids at presentation (p = .047) were also significantly associated with severe COVID-19 outcomes, while the overall use of ongoing immunosuppressive agents and glomerular disease remission status showed no significant association with the severity of COVID-19 (p = .430 and p = .326, respectively).

Conclusion: Older age, male sex, ongoing intake of corticosteroids and lower serum albumin levels at presentation were identified as risk factors for severe COVID-19 outcomes in patients with a history of various immune-mediated glomerular diseases.

Keywords: autoimmune disease; coronavirus; glomerulonephritis; immunosuppression; kidney disease; risk factor.

Copyright © 2023 Gauckler, Kesenheimer, Geetha, Odler, Eller, Laboux, Alberici, Zappa, Chebotareva, Moiseev, Bonilla, Jhaveri, Oniszczuk, Audard, Costa, Mastroianni-Kirsztajn, Bruchfeld, Muto, Windpessl, Mayer and Kronbichler.