ABSTRACT
BACKGROUND: In this study, we report clinical outcomes in COVID-19 infection in a large cohort of people with cystic fibrosis (pwCF) and compare these outcomes to a propensity score matched cohort of people without CF. METHODS: Analysis of a multicenter research network TriNETX was performed including patients more than 16 years of age diagnosed with COVID-19. Outcomes in COVID-19 positive pwCF were compared with a propensity-matched cohort of people without CF. RESULTS: A total of 507,810 patients with COVID-19 were included (422 patients, 0.08% with CF; 507,388 patients, 99.92% without CF. Mean age at COVID-19 diagnosis in CF cohort was 46.6 ± 19.3 years, with female predominance (n = 225, 53.32%). Majority of the participants were Caucasian (n = 309, 73.22%). In the crude, unmatched analysis, mortality, hospitalization, critical care need, mechanical ventilation, acute kidney injury and composite (combination of intubation and mortality) outcome at 30 days was higher in the pwCF. Following robust propensity matching, pwCF had higher hospitalization rate (RR 1.56, 95% CI 1.20-2.04), critical care need (RR 1.78, 95% CI 1.13-2.79), and acute renal injury (RR 1.60, 95% CI 1.07-2.39) as compared to patients without CF. CONCLUSION: People with CF are at risk of poor outcomes with COVID-19.5.2% of these patients died within one month of COVID-19 diagnosis, and more than one in 10 patients required critical care. Therefore, the relatively young median age of cystic fibrosis patients, and lower prevalence of obesity do not protect these patients from severe disease contrary to prior reports.
Subject(s)
COVID-19/complications , COVID-19/mortality , Cystic Fibrosis/complications , Adult , Aged , COVID-19/therapy , Critical Care , Cystic Fibrosis/mortality , Cystic Fibrosis/therapy , Female , Hospitalization , Humans , Kaplan-Meier Estimate , Male , Middle Aged , Propensity Score , Respiration, Artificial , Retrospective Studies , Survival RateABSTRACT
OBJECTIVE: We studied clinical outcomes of COVID-19 infection in patients living with HIV (PLH) in comparison to non-HIV population. DESIGN: Analysis of a multicentre research network TriNETX was performed including patients more than 10 years of age diagnosed with COVID-19. METHODS: Outcomes in COVID-19 positive patients with concurrent HIV (PLH) were compared with a propensity-matched cohort of patients without HIV (non-PLH). RESULTS: Fifty thousand one hundred and sixty-seven patients with COVID-19 were identified (49,763 non-PLH, 404 PLH). PLH were more likely to be men, African-American, obese and have concurrent hypertension, diabetes, chronic kidney disease and nicotine dependence compared with non-PLH cohort (all P values <0.05). We performed 1â:â1 matching for BMI, diabetes, hypertension, chronic lung diseases, chronic kidney disease, race, history of nicotine dependence and sex. In unmatched analysis, PLH had higher mortality at 30 days [risk ratio 1.55, 95% confidence interval (95% CI): 1.01-2.39] and were more likely to need inpatient services (risk ratio 1.83, 95% CI: 1.496-2.24). After propensity score matching, no difference in mortality was noted (risk ratio 1.33, 95% CI: 0.69-2.57). A higher proportion of PLH group needed inpatient services (19.31 vs. 11.39%, risk ratio 1.696, 95% CI: 1.21-2.38). Mean C-reactive protein, ferritin, erythrocyte sedimentation rate and lactate dehydrogenase levels after COVID-19 diagnosis were not statistically different and mortality was not different for PLH with a history of antiretroviral treatment. CONCLUSION: Crude COVID-19 mortality is higher in PLH; however, propensity-matched analyses revealed no difference in outcomes, showing that higher mortality is driven by higher burden of comorbidities. Early diagnosis and intensive surveillance are needed to prevent a 'Syndemic' of diseases in this vulnerable cohort.