Risk of new onset of immune-mediated diseases after SARS-CoV-2 infection: A systematic review and meta-analysis

Objectives: The association between SARS-CoV-2 infection and new onset of immune-mediated diseases is of interest given the conflicting evidence. This study aims to gather evidence and estimate the risk of immune-mediated diseases following SARS-CoV-2 infection. Methods: Analytical observational studies reporting immune-mediated diseases after confirmed SARS-CoV-2 infection, compared to individuals without infection history, were included. Thirty-nine immune-mediated diseases were defined as outcomes of interest. Studies including diagnosis within the first 30 days post-infection were excluded. PubMed, EMBASE, CINAHL, Web of Science, and Europe PMC were consulted. Relative risks were pooled using a random-effects model and the Mantel-Haenszel method. Results: Eight studies met the eligibility criteria. Meta-analyses were conducted for 13 outcomes of interest from six studies. The SARS-CoV-2 exposed group exhibited significantly higher risks for 11 conditions compared to non-exposed group: Behçet's disease, spondyloarthritis, systemic sclerosis, systemic lupus erythematosus, polymyalgia rheumatica, psoriasis, rheumatoid arthritis, Sjögren's syndrome, type 1 diabetes (in adults), vasculitis, and inflammatory bowel disease. The range of the associations varied between 2.31 (95 % CI: 1.87–2.85) for systemic sclerosis to 3.71 (95 % CI: 1.18–11.72) for Behçet's disease. Guillain-Barré syndrome and type 1 diabetes (in the paediatric population) showed no evidence of association with SARS-CoV-2 infection. Conclusion: Our results support a higher risk of developing at least 11 immune-mediated diseases evaluated. As autoimmunity is a hallmark of post-COVID-19 syndrome, an increase in these diseases may be expected in the future. Healthcare professionals and stakeholders should prioritize research and public health surveillance based on these findings.