To the Editor:
We read with great interest the article by Dr. Rutherford and colleagues on the risk factors for severe COVID‐19 in patients with systemic vasculitis (1). This has been the first report to describe the features of COVID‐19 among a vasculitis‐specific cohort. We would like to address several points of interest.
First, 9% of patients with COVID‐19 in this study had a negative SARS–CoV‐2 polymerase chain reaction test result. Viral (including influenza) (2, 3) and bacterial (4) coinfections and various opportunistic superinfections (5) have been reported in the literature. Were these cases investigated for other causes of respiratory infections?
Second, vasculitis disease activity was determined using the physician's global assessment of disease activity. Given that the majority (85%) of the COVID‐19 cases were among patients with antineutrophil cytoplasmic antibody–associated vasculitis, validated scoring systems such as the Birmingham Vasculitis Activity Score (6) and its modification for granulomatosis with polyangiitis (7) could have been used to denote the level of disease activity.
Finally, no further information regarding the patients who died was provided in the report. For instance, given that the rate of active disease was high among these patients, did any of them die due to the complications of active vasculitis (rather than COVID‐19)?
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References
- 1. Rutherford MA, Scott J, Karabayas M, Antonelou M, Gopaluni S, Gray D, et al. Risk factors for severe outcomes in patients with systemic vasculitis and COVID‐19: a binational, registry‐based cohort study. Arthritis Rheumatol 2021;73:1713–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 2. Karaba SM, Jones G, Helsel T, Smith LL, Avery R, Dzintars K, et al. Prevalence of co‐infection at the time of hospital admission in COVID‐19 patients, a multicenter study. Open Forum Infect Dis 2021;8:ofaa578. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3. Dadashi M, Khaleghnejad S, Elkhichi PA, Goudarzi M, Goudarzi H, Taghavi A, et al. COVID‐19 and ınfluenza co‐infection: a systematic review and meta‐analysis. Front Med (Lausanne) 2021;8:681469. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4. Moreno‐Torres V, de Mendoza C, de la Fuente S, Sánchez E, Martínez‐Urbistondo M, Herráiz J, et al. Bacterial infections in patients hospitalized with COVID‐19. Intern Emerg Med 2021. doi: 10.1007/s11739-021-02824-7. E‐pub ahead of print. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5. Abdoli A, Falahi S, Kenarkoohi A. COVID‐19‐associated opportunistic infections: a snapshot on the current reports [review]. Clin Exp Med 2021. doi: 10.1007/s10238-021-00751-7. E‐pub ahead of print. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6. Mukhtyar C, Lee R, Brown D, Carruthers D, Dasgupta B, Dubey S, et al. Modification and validation of the Birmingham Vasculitis Activity Score (version 3). Ann Rheum Dis 2009;68:1827–32. [DOI] [PubMed] [Google Scholar]
- 7. Stone JH, Hoffman GS, Merkel PA, Min YI, Uhlfelder ML, Hellmann DB, et al, for the International Network for the Study of the Systemic Vasculitides (INSSYS) . A disease‐specific activity index for Wegener's granulomatosis: modification of the Birmingham Vasculitis Activity Score. Arthritis Rheum 2001;44:912–20. [DOI] [PubMed] [Google Scholar]
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