Characteristics and outcomes of COVID-19 patients with COPD from the United States, South Korea, and Europe

Background: Characterization studies of COVID-19 patients with chronic obstructive pulmonary disease (COPD) are limited in size and scope. The aim of the study is to provide a large-scale characterization of COVID-19 patients with COPD. Methods: We included thirteen databases contributing data from January-June 2020 from North America (US), Europe and Asia. We defined two cohorts of patients with COVID-19 namely a ‘diagnosed' and ‘hospitalized' cohort. We followed patients from COVID-19 index date to 30 days or death. We performed descriptive analysis and reported the frequency of characteristics and outcomes among COPD patients with COVID-19. Results: The study included 934,778 patients in the diagnosed COVID-19 cohort and 177,201 in the hospitalized COVID-19 cohort. Observed COPD prevalence in the diagnosed cohort ranged from 3.8% (95%CI 3.5-4.1%) in French data to 22.7% (95%CI 22.4-23.0) in US data, and from 1.9% (95%CI 1.6-2.2) in South Korean to 44.0% (95%CI 43.1-45.0) in US data, in the hospitalized cohorts. COPD patients in the hospitalized cohort had greater comorbidity than those in the diagnosed cohort, including hypertension, heart disease, diabetes and obesity. Mortality was higher in COPD patients in the hospitalized cohort and ranged from 7.6% (95%CI 6.9-8.4) to 32.2% (95%CI 28.0-36.7) across databases. ARDS, acute renal failure, cardiac arrhythmia and sepsis were the most common outcomes among hospitalized COPD patients. Conclusion: COPD patients with COVID-19 have high levels of COVID-19-associated comorbidities and poor COVID-19 outcomes. Further research is required to identify patients with COPD at high risk of worse outcomes. Copyright: © 2023 Moreno-Martos D et al.

RAAS inhibition and risk of AKI in COVID-19

Background: Direct viral invasion of the kidney via ACE2 has been hypothesized as a mechanism of AKI in COVID-19 (COVID). The impact of RAASi on the risk of AKI in COVID is not known. We hypothesized that active use of RAASi preceding admission would be associated with a greater proportional risk of AKI in COVID than influenza (flu). Methods: In this retrospective cohort, we compared the AKI incidence by RAASi status in 11,898 hospitalized Veterans with COVID or flu between Oct 1, 2019 and Sept 30, 2020. To control for confounding, propensity score weighting balanced baseline conditions, labs, and co-therapies in 4 exposure groups: RAASi users with COVID, non-users with COVID, RAASi users with flu, and non-users with flu. Weighted logistic regression estimated the main effects of RAASi and COVID, and their interaction. Results: In flu, 7% of RAASi users had a stage 2-3 AKI vs 5% of non-users, a 2% increase (p=0.03). In COVID, 16% of RAASi users had a stage 2-3 AKI vs 12% of nonusers, a 4% increase. While the absolute increase in AKI incidence for RAASi users vs non-users was greater in COVID patients vs flu, the difference was not statistically significant (p=0.66) and the RAASi association was proportionally smaller in COVID (see interaction in Table). Similar absolute differences were observed in stage 1-3 AKI (Table), and the interaction was also not statistically significant (p=0.66). Conclusions: COVID was associated with a greater incidence of AKI than flu. RAASi was associated with an increased incidence of Stage 2-3 AKI in patients with COVID or flu. The proportional effect of RAASi was similar in COVID and flu patients. These findings do not support a disproportionate risk of AKI among RAASi users with COVID.