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KMID : 0338420230390030417
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The Korean Journal of Internal Medicine
2023 Volume.39 No. 3 p.417 ~ p.426
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Clinical significance of antinuclear antibody positivity in patients with severe coronavirus disease 2019
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Park Soo-Hyun
Suh Jin-Woong
Yang Kyung-Sook
Kim Jeong-Yeon
Kim Sun-Bean
Sohn Jang-Wook
Yoon Young-Kyung
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Abstract
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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 [HR], 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.
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KEYWORD
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COVID-19, SARS-CoV-2, Autoantibodies, Risk factors
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