tetano
Editor, Senior Moderator
Korean J Intern Med
. 2023 Apr 6.
doi: 10.3904/kjim.2022.352. Online ahead of print.
Clinical significance of antinuclear antibody positivity in patients with severe coronavirus disease 2019
Soo Hyun Park[SUP] 1 [/SUP], Jin Woong Suh[SUP] 1 [/SUP], Kyung-Sook Yang[SUP] 2 [/SUP], Jeong Yeon Kim[SUP] 1 [/SUP], Sun Bean Kim[SUP] 1 [/SUP], Jang Wook Sohn[SUP] 1 [/SUP], Young Kyung Yoon[SUP] 1 [/SUP]
Affiliations
Abstract
Background/aims: This study aimed to investigate the clinical characteristics and outcomes of fluorescent antinuclear antibody (FANA)-positive patients admitted for coronavirus disease 2019 (COVID-19) and identify FANA as a prognostic factor of mortality.
Methods: This retrospective study was conducted at a university-affiliated hospital with 1,048 beds from September 2020 to March 2022. The participants were consecutive patients who required oxygenation through a high-flow nasal cannula, non-invasive or mechanical ventilation, or extracorporeal membrane oxygenation, and conducted the FANA test within 48 hours of admission.
Results: A total of 132 patients with severe COVID-19 were included in this study, of which 77 (58.3%) had FANA-positive findings (≥ 1:80). FANA-positive patients were older and had higher inflammatory markers and 28-day mortality than FANA- negative patients. In the multivariate Cox proportional hazard regression analysis, FANA-positive findings (hazard ratio
, 2.65; 95% confidence interval [CI], 1.04-6.74), age (per 1-year; HR, 1.05; 95% CI, 1.01-1.10), underlying pulmonary disease (HR, 3.16; 95% CI, 0.97-10.26), underlying hypertension (HR, 2.97; 95% CI, 1.28-6.87), and blood urea nitrogen > 20 mg/dL (HR, 3.72; 95% CI, 1.09-12.64) were independent predictors of 28-day mortality. Remdesivir (HR, 0.34; 95% CI, 0.15-0.74) was found to be an independent predictor that reduced mortality.
Conclusions: Our findings revealed an autoimmune phenomenon in patients with severe COVID-19, which provides an ancillary rationale for strategies to optimize immunosuppressive therapy. In particular, this study suggests the potential of FANA to predict the outcomes of COVID-19.
Keywords: Autoantibodies; COVID-19; Risk factors; SARS-CoV-2.
. 2023 Apr 6.
doi: 10.3904/kjim.2022.352. Online ahead of print.
Clinical significance of antinuclear antibody positivity in patients with severe coronavirus disease 2019
Soo Hyun Park[SUP] 1 [/SUP], Jin Woong Suh[SUP] 1 [/SUP], Kyung-Sook Yang[SUP] 2 [/SUP], Jeong Yeon Kim[SUP] 1 [/SUP], Sun Bean Kim[SUP] 1 [/SUP], Jang Wook Sohn[SUP] 1 [/SUP], Young Kyung Yoon[SUP] 1 [/SUP]
Affiliations
- PMID: 37016892
- DOI: 10.3904/kjim.2022.352
Abstract
Background/aims: This study aimed to investigate the clinical characteristics and outcomes of fluorescent antinuclear antibody (FANA)-positive patients admitted for coronavirus disease 2019 (COVID-19) and identify FANA as a prognostic factor of mortality.
Methods: This retrospective study was conducted at a university-affiliated hospital with 1,048 beds from September 2020 to March 2022. The participants were consecutive patients who required oxygenation through a high-flow nasal cannula, non-invasive or mechanical ventilation, or extracorporeal membrane oxygenation, and conducted the FANA test within 48 hours of admission.
Results: A total of 132 patients with severe COVID-19 were included in this study, of which 77 (58.3%) had FANA-positive findings (≥ 1:80). FANA-positive patients were older and had higher inflammatory markers and 28-day mortality than FANA- negative patients. In the multivariate Cox proportional hazard regression analysis, FANA-positive findings (hazard ratio
, 2.65; 95% confidence interval [CI], 1.04-6.74), age (per 1-year; HR, 1.05; 95% CI, 1.01-1.10), underlying pulmonary disease (HR, 3.16; 95% CI, 0.97-10.26), underlying hypertension (HR, 2.97; 95% CI, 1.28-6.87), and blood urea nitrogen > 20 mg/dL (HR, 3.72; 95% CI, 1.09-12.64) were independent predictors of 28-day mortality. Remdesivir (HR, 0.34; 95% CI, 0.15-0.74) was found to be an independent predictor that reduced mortality.
Conclusions: Our findings revealed an autoimmune phenomenon in patients with severe COVID-19, which provides an ancillary rationale for strategies to optimize immunosuppressive therapy. In particular, this study suggests the potential of FANA to predict the outcomes of COVID-19.
Keywords: Autoantibodies; COVID-19; Risk factors; SARS-CoV-2.