INCIDENTAL PULMONARY FINDINGS ON CHEST CT SCANS IN PATIENTS WITH SUSPECTED COVID-19 PNEUMONIA: DATA FROM AN OUTPATIENT HOSPITAL

SESSION TITLE: Outcomes in Pneumonia and NTM SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/17/2022 12:15 pm - 1:15 pm PURPOSE: The number of patients with respiratory symptoms who underwent computed tomography (CT) for suspected COVID-19 pneumonia is high. In this study, we decided to investigate the incidental non-COVID 19 related pulmonary findings due to a large number of CT scans. METHODS: It was retrospective study in Funda Hospital of Heath Ministry of Azerbaijan, Baku city and the number of enrolled patients to the study was 2567 from 1st of October 2020 to 10 30 th of March 2021.In all patients the positive RT-PCR test for COVID-19 were confirmed.Depending on COVID-19 viral pneumonia findings in lung there were two groups :1) 1589 patients with non-COVID-19 viral pneumonia;2) 978 pateins with COVID-19 viral pneumonia RESULTS: In our study CT screening for COVID-19 viral pneumonia has detected typical viral pneumonia in 38.1%(978 of 2567) patients and in 61.9%(1689 of 2567 ) was not found CT abnormalities accordingly COVID-19 viral pneumonia.Among typical CT suggested COVID19 viral pneumonia patients the incidental pulmonary findings were found in 197(20,15%) cases, was significantly common compared to non- CT suggested viral pneumonia (OR 5.34 [0.94-12.57]95%CI;p<0.001).Common CT incidental pulmonary finding was solitary pulmonary nodule (56[28.43%] vs 21[29.58%];p<0.01) and further histopathological evaluation has detected lung cancer(primary and metastatic) in 19 patients(24.68%). Bronchectasis (commonly small size syctic and tubular bronchectasis) which was also commonest in patients with viral pneumonia (OR 2.78[0.75-6.43]95%CI;p<0.004). Emphysema was found in 69(2.69%) and was common in patients with pulmonary viral manifestation(p<0.01).Lung tuberculosis with further histological and mycobacterial confirmation was as incidentally finding in 49 cases (1.87%)( focal changes, lung inflitrate,cavitation) and commonly was found in patients with CT suggested viral pneumonia (OR 2.11[0.69-5.86]95%CI;p=0.006).Pulmonary sarcoidosis was found totally in 38(1.48%) and was common in patients with viral pneumonia (p<0.01).Idiopatic pulmonary fibrosis(IPF) with typical features of usual interstitial pneumonia(UIP) was found in 31(1,21%) patients and was commonly in male with smoking history and older age (>60 years).Common risk factors for incidental pulmonary findings were:male gender(p<0.01);tobacco smoke (p<0.01);older age(p<001);previous history of lung tuberculosis(p<0.05) comorbidities such as DM and autoimmune disorders(p<0.01) CONCLUSIONS: Risk factors for COVID-19 related viral pneumonia and incidental pulmonary findings in CT scan are similar and so incidental pulmonary findings are common in CT screening for COVID-19 related viral pnemonia.Incidental pulmonary abnormalities were not associated with increased risk for ICU admission and mortality of patients. CLINICAL IMPLICATIONS: Clinicians in paracitce with COVID-19 patients,for pulmonologists,radiologists, respiratory educators, thoracic oncologists DISCLOSURES: No relevant relationships by Alizamin Sadigov

RADIOGRAPHIC AND CLINICAL CORRELATIONS IN SURVIVORS WITH POST-ARDS RELATED COVID-19: WHAT ARE RISK FACTORS FOR RESIDUAL PULMONARY ABNORMALITIES?

SESSION TITLE: Acute COVID-19 and Beyond: from Hospital to Homebound SESSION TYPE: Original Investigations PRESENTED ON: 10/18/2022 02:45 pm - 03:45 pm PURPOSE: The aim of this study was to determine risk factors for residual pulmonary radiological and functional abnormalities and assessment of possible treatment approaches for reducing such complications in survivors with post-ARDS related to COVID-19. METHODS: There were 97 survivors enrolled, 12 weeks after severe ARDS who were intubated in COVID-19. All survivors admitted to pulmonary and critical care departments of university hospital from 30 August to 30 November 2021. 39 patients with lung radiographic abnormalities between 50-75%;58 patients with lung abnormalities more than 75%. RESULTS: At 12 weeks after discharge all patients reported persistent symptoms: dyspnea 100.0%, cough 42.3%, chest pain 51.1%, fever 29.0%, and hemoptysis 18.5%. More severe dyspnea (increased by exertion and at rest) was found with lung involvement more than 75%(OR 4.25[0.94-10.34]95%CI;p<0.0001).Pulmonary function tests were abnormal in all patients, however,more severe functional abnormalities were with lung involvement more than 75% and median FVC predicted was (46.3+_11.9 vs 64.7+_10.6;p<0.001),DLCO also was significantly lower (54.6+_9.3 vs 70.4+_8.4;p<0.01).Comorbidities such as diabetes milletus (DM) (OR 2.87[0.86-7.34]95%CI;p<0.002), obesity(OR2.44[0.79-6.98]95%CI;p=0.003), older age (OR 2.12[0.72-5.88]95%CI;p<0.004), and kidney failure (OR2.01[0.70-5.22]95%CI;p=0.005) were common in lung involvement more than 75%. Lack of dexamethasone at ICU admission with ARDS was significantly associated with more severe residual pulmonary abnormaliries: organizing pneumonia (OR 4.82[0.99-12.32]95%CI;p<0.0001),usual interstitial pneumonia(UIP)(OR 3.22[0.85-9.23]95%CI;p<0.0004),traction bronchiectasis(OR2.38[0.74-6.12]95%CI;p<0.001),and cystic changes (p<0.001) were commonest. In contrast, ground galss opacity (GGO) was commonest in use of dexamethasone (OR 2.95[0.79-7.54]95%CI;p<0.001). Multi-drug-resistant (MDR) pahtogen caused ventilator associated pneumonia (VAP) at the time intubation was significantly associated with residual OP (OR 4.76[0.91-11.66]95%CI;p<0.0001). CONCLUSIONS: There were several risk factors found for development of more severe residual pulmonary functional and radiological abnormalities: older age, and comorbidities such as DM, obesity, and kidney failure. Lack of use of dexamethasone was associated with development OP,UIP,traction bronchiectasis,and cystic changes.OP was common in patients with history of MDR-pathogen-caused VAP at intubation.The use of dexamethasone was associated with non-severe residual pulmonary functional and radiological abnormalities. CLINICAL IMPLICATIONS: The result of our investigation might be helpful for clinicians in COVID-19 practice.Our findings also may be helpful for pulmonologists, respiratory therapist, and nurses. Also our discussion may aid in correct management of ARDS and minimalizing of residual pulmonary functional and radiological abnormalities. DISCLOSURES: No relevant relationships by Alizamin Sadigov

Post-Acute Respiratory Distress Syndrome Pulmonary Fibrosis and Pulmonary Artery Hypertension in Patients Affected by Severe COVID19

Rationale:Many patientswith COVID19 who develop acute respiratory distress syndrome (ARDS) survive the acute phase of the illness ,a substantial proportion die as a result of progressive pulmonary fibrosis.The evaluation of corellation between pulmonary fibrosis after ARDS and development of pulmonary hypertension(PH) in COVID19 patients is very interesting in term on management of pulmonary fibrosis for further prevention of PH.Objective:The aim of this study was to determine the impact of pulmonary fibrosis on development of pulmonary hypertension in COVID19 patients and possibility of use of antifibrotic drugs in such patients.Methods and measurements:It was randomized and controlled study which is included 68 survivors patients with pulmonary fibrosis after ARDS in outpatient settings of Medical University ,Baku city.In all patients have invastigated the 6 minute walk distance(6MWD) ,exersice desaturation,echocariography with further measurement of the pulmonary artery pressure by using RHC,CT scan of the lungs,and pulmonary lung functions(spirometry and DLco).Results:In 41 of 68 (60%)survivors was developed PH and the degree of pulmonary hypertension severity was depneding on the extention of fibrotic and interstitial changes in lung assessing by lung CT scan.In all patients with PH (median range was 40.25+-12.86 mmHg) the 6MWD was significantly less compared to non-PH patients(220+-54m vs 390+-62m;p<0.001);exersice desaturation was significantly lower in patient with PH (10+-4% vs 6+-2 %;p<0.001);lung function although was lower (FVC :43.8+-12.5 vs 60.1+-8.7;p<0.004);diffusing capacity of the lung was markedly lower(DLco:38.54+-10.44 vs 58.65+-11.82;p<0.001).Antifibrotic drug Pifenidone was used to in 14 patients swith pulmonary fibrosis and PH.After three moinths treatment with this drug there was significantly improvement of 6MWD(=0.01),lung function(<0.001),exersice desaturation(=0.01),extention of CT changes(=0.006), and pulmonary artery pressure(=0.004).Conclusion: Pulmonary fibrosis and related to its PH is common in survivors patients with COVID19 complicated with ARDS .After dicharge from hospitals all such patients have to assess regularly for presence of pulmonary hypertension and the level of PH will depends on the severity of extetion of the lung fibrosis. Antifibrotic drug pirfenidone is useful in terms of reducing extention of lung fibrosis ,improving lung function and decreasing pulmonary artery pressure.

Relationship among disease severity, radiological extention and serum il-6 in patients with COVID19

Background:IL-6 is an important pro-inflammatory cytokine and has been associated with more rapid disease progression and a higher complication rate in COVID-19 cases.Accumlated evidence so far has demonstrated cytokine storm syndrome is associated more severe disease and complications such as respiratory failure, ARDS, septic shock and muliorgan dysfunction. Objective:We aimed to investigate the relationship among IL-6 levels, severity of the disease ,and extention of radiological appearance in patients with COVID19.Methods and measurements:We have assessed 256 moderate-to-severe patients with COVID-19 who have been admitted to the pulmonary medicine and intensive care unit(ICU) departments of hospital clinic of Medical University, Baku city from 10-th April 2020 to 15 -th June 2020.All patients have examined on CT of lung, serum IL-6 levels and all others clinical and laboratory investigations which are included for the examination of the COVID19 patients.Results :Depends on the level of the IL-6 all hospitalized patients with COVID19 have divided in two groups:1)142 patients were with serum IL-6 level >-100 pg/ml;2)114 patients were with serum IL-6 <99 pg/ml.The high levels of serum IL-6( >-100 pg/ml) in patients was associated with more severe disease severity and respiratory failure was positive corellated with high IL-6 levels(OR,4.25[0.85-10.36],95%CI;p<0.001).Kidney failure was common in patients with high level of serum IL-6 compared to low serum IL-6 level(OR,3.71[092- 8.64] 95% CI;p=0.002).In the chest CT findings reviewed for extent of parenchymal involvement more extented involvement were found in patients with high levels of serum IL-6.In all patients with serum low IL-6 levels the domonant infiltration pattern was ground -glass compared(less than <50% involvement) to patients with high serum IL-6 level(OR,4.69[1.12-12.62] 95% CI;p=0.0004).In patients with high serum IL-6 levels the dominant and extented infiltration pattern(more than >50% involvement) were crazy-paving and consolidation( OR,3.58[079-11.34] 95%CI;p=0.002).Low serum IL-6 level in patients had significantly lower rate of pleural effusion compared to the patients with higher serum level of IL-6(p=0.015).On control chest CT, patients with high levels of IL-6 had significantly higher rate of progression and the development of ARDS(OR,6.87[1.75- 14.58] 95% CI;p=0.0001).ICU department admission rate was significantly higher in patients with high serum levels of IL-6(OR,3.65[098-8.43]95% CI;p<0.002) .Conclusions:In hospitalized patients with COVID-19 the high serum IL-6 levels are associated with more severe disease course .In patients the high serum level of IL-6 is associated with more extensive parenchymal involvement with dominant type of infiltration as consolidation and crazy-paving .The increased serum level of IL-6 in patients most commonly were associated with progression of the disease and develpment complication as ARDS.

Secondary bacterial co-infection and mortality risk in intubated patients with critically ill COVID19

Background:Secondary bacterial co-infections are not common in patients with COVID19.However ,the rate of bacterial pneumonia is high in critically ill patients with COVID19 and there is increased risk of joining bacterial infection by increasing of severity of COVID19 and achieving maximal rate in intubated patients.And there is increased rate of overuse of broad-spectrum antibiotics in patients admitted to the intensive care unit(ICU) department.Objective:The aim of our investigation was to evaluate the rate of secondary bacterial co-infection in critically ill patients with COVID19 and its impact to the mortality rate in such patients.Method and measurements:Of 129 COVID-19 patients admitted in our ICU from 21 April 2020 to 15 August 2020,93 have been mechanically ventilated.BALF was performed in 68 patients during ICU stay and all were suspected of bacterial pneumonia.Bacterial cultures of BALF positively defined in case of grew with significant amount of bacteria(ie,>-104 colony-forming units/ml).All pneumonia cases in intubated patients was assessed as Ventilator-associated pneumonia(VAP) and was defined as eraly-onset and late onset as pneumonia diagnosed before and after 5 days of mechanical ventilation, respectively.Results:In 51% (n=35) of 78 patients was obtained bacterial cultires and just in 5(7.4%) of 68 patients was evaluated the early-onset VAP and in remaining 63 patients (92%) of patients was detected late-onset VAP.VAP in patients commonly was associated with ARDS compared to non-VAP patients(OR 3.57[0.89-7.92]CI 95%;p=0.001) and although late-onset VAP in patients significantly often was associated with kidney failure (OR 2.95[075-6.32]CI 95%;p=0.003) and septic shock 3.68[1.05-8.21] CI95%;p=0.001).In all early-onset pneumonia patients ,bacterial pathogens were most commonly gram positive bacteria(100%) and 80%(4/5) were susceptible to cefotaxime, cefepime, piperacillin-tazobactam, and meropenem.Conversely, in late-onset VAP, most bacterial pathogens were gram-negative bacteria(29/30) and muti-drug resistant (MDR)pathogens(14/30).Among MDR gram-negative bacteria causing late-onset VAP, most commonly was obtained Acinotebacter baumannii(9/30),followed Pseudomonas aeruginosa(6/30),folowed Klebsiella pneumoniae (5/30) and Escherichia coli(5/30) and Aspergillus fumigates(5/30).And just 13% of patients with late-onset VAP were susceptible to piperacillin-tazobactam,17% were susceptible to cefepime and 34% were susceptible to meropenem.Late-onset VAP was associated with high mortality rate among intubated compared to early-onset VAP and non-VAP patients ( OR 4.87[1,54-10.32] CI95%;p=0.001;OR 6.33[1.58-14.25] CI 95%;p=0.0008).Conclusions:Secondary bacterial co-infection is common in intubated critically ill patients with COVID19 and most commonly presentation of bacterial infection is late-onset VAP causing by multi-drug resitant pathogens which are associated commonly with ARDS, kidney failure and septic shock.In patients with late-onset VAP MDR pathogens may predict high mortality rate.

The changes of bronchoalveolar lavage fluid cytokine content in intubated survivor and non-survivar patients with COVID19

Background:The hyperinflammatory phenotype of acute respiratory distress syndrome(ARDS) is characterized by elevated proinflammatory cytokines ,an increased incidence of shock ,and adverse clinical outcomes.The characterictics of this phenotype could be considered as most consistent with those expected with the cytokine storm.However, the increased levels of proinflammatory cytokines and their predictive value in bronchoalveolar fluid(BALF) in intubated and survivors patients with COVID19 is unclear.Objective:The aim of this study was to evaluate the cytology and cytokine content of BALF in intubated survivor and non-survivor patients with critically ill COVID19.Method and Measurements: We have enrolled to this stidy 37 intubated patients with critically ill COVID19 complicated with ARDS.All patients have been admitted to the intensive care unit (ICU)department of Hospital Clinic of Medical University ,Baku city.In all patients have investigated daily portable chest X-ray ,biochemistry, immunology spectrum, microbiology of the endotracheal aspirate and BAL, and although proinflammatory cytology and cytokine content of BALF via bronchoscopy.Results:17 (46%) of 37 patients have died in ICU department ,and there were big differences between cytology content of BALF in intubated survivors and non-survivors . The level of the CD4+(%) in BALF was lesser in survivors compared to nonsurvivors( 61.3+-17.5 vs 82.6+-19.4;p<0.01), in contrary to this the level of CD8+(%) in BALF in survivors was higher compared to non-survivors(28.7+-9.5 vs 14,3+-10.4;p<0.05).CD4/CD8 ratio was lesser in survivors compared to non-survivors(5.1+-2.8 vs 8.9+-3.4;p<0.01).Plasma levels of cytokines (IL-6 and IL-8) was higher in non-survivors compared to survivors(IL-6:3986+-1435,pg/ml vs 2453+-987,pg/ml;p<0.001).BALF investigation for cytokine levels reveal markedly differences between survivors and non-survivors.Il-8 level in BALF was less in survivors compared to non-survivors(2478+-1056,pg/ml vs 6698+-1254,pg/ml;p<0.03),the content of IL-6 in BALF although was significantly higher in non-survivors compared to survivors(643+-124,pg/ml vs 219-+-94,pg/ml;p<0.005).High levels of cytokines in BALF and plasma were associated with more higher cilinical features of respiratory failure and more severe ARDS and kidney failure.In our study good predictor for high plasma and BALF levels of proinflammatory cytokines was higher level of Creactive protein.Conclusions:Hyperinflammatory status of patients with COVID19 complicated with ARDS is associated with high levels of proinflammatory cytokines in plasma and BALF .However, more higher levels of proinflammatory cytokines in BALF and plasma are associated with increased mortality in such patients.In intubated patients the identification of cytokine and cell content of BALF may predict the mortality risk of patients with crtically ill COVID19.