ABSTRACT
Background: Comorbid disease was identified early during the COVID-19 pandemic as a risk factor for severe infection, however, initial rates of chronic obstructive pulmonary disease (COPD) in case series were low and severity of COVID-19 in COPD patients was variable. Methods: We performed a retrospective study of patients admitted with COVID-19 and evaluated outcomes in those with and without COPD and/or emphysema. Patients were identified as having COPD if they had a diagnosis in the medical record and a history of airflow-obstruction on spirometry, or a history of tobacco use and prescribed long-acting bronchodilator(s). Computed tomography scans were evaluated by radiologists. Propensity matching was performed for age, body-mass index (BMI), and serologic data correlated with severity of COVID-19 disease (D-dimer, C-reactive protein, ferritin, fibrinogen, absolute lymphocyte count, lymphocyte percentage, and lactate dehydrogenase).Results: Of 577 patients admitted with COVID-19, 103 had a diagnosis of COPD and/or emphysema. The COPD and/or emphysema cohort was older (67 years vs 58 years, p<0.0001) than the other cohort and had a lower BMI (28.3 kg/m2 vs 31.1 kg/m2, p<0.01). Among unmatched cohorts those with COPD and/or emphysema had higher rates of intensive care unit (ICU) admission (35% vs 24.9%, p=0.036) and maximal respiratory support requirements (p=0.007), with more frequent invasive mechanical ventilation (21.4% vs 11.8%), and a trend towards higher mortality (12.6% vs 8.2%) that was not statistically significant (p=0.158). After propensity-matching there was no difference in rates of ICU admission, maximal respiratory support requirements, or mortality. The propensity-matched group with COPD and/or emphysema had higher median pack-years of tobacco use (35.0 vs 17.5, p=0.046) and rates of active smoking (28.2% vs 9.7%, p<0.01). Propensity matching was not performed for rates of comorbid disease such as coronary artery disease but the propensity-matched groups had no significant differences in cardiac comorbidities.DiscussionOur propensity-matched retrospective cohort study suggests that patients hospitalized with COVID-19 that have COPD and/or emphysema may not have worse outcomes than those without these comorbid conditions.
ABSTRACT
Rationale: The novel coronavirus disease-19 (COVID-19) has presented major challenges for global health systems. Given limited availability of diagnostic testing and delays in test results during the first wave of the pandemic, our hospital used computed tomography (CT) to risk stratify patients with suspected COVID-19. The aim of this study was to describe the various patterns of disease on chest CT and relate them to chest x-ray (CXR) findings. Methods: This is a retrospective review of 559 symptomatic patients infected with COVID-19 (diagnosed by real-time reverse transcription polymerase chain reaction) admitted from March 2020 to May 2020 at Temple University Hospital (Philadelphia, PA) who received admission CXR and chest CT scans that were performed within 24 hours of admission. Scans were independently reviewed by a group of radiologists. CXRs was interpreted as “consistent with COVID-19” if there were lower lobe peripheral opacities. Chest CTs were evaluated for the presence of ground glass opacities, consolidations, interlobular septal thickening, centrilobular nodules, and crazy paving pattern. Chest CT was also assessed for background lung disease (emphysema, interstitial lung disease). Results: Of the 559 patients, median age was 58 years old, 55.5% were female, and 56.7% were African American. Median BMI was 31.61. Median duration of symptoms at time of chest imaging was 5 days. 153 (27.4%) of patient's admission CXR was not consistent with COVID-19. Of those, 124 (81%) had abnormalities on chest CT. Median number of lobes involved with disease on CT was 3.8 and 317 patients (56.7%) had all 5 lobes with disease. The most common abnormalities found were ground glass opacities (n=507, 90.7%), consolidations (n=224, 40%) and centrilobular nodules (n=127, 22.7%). Less common findings included pleural effusion (n=62, 11.8%), lymphadenopathy (n=55, 9.8%), pericardial effusion (n=24, 4.2%), and pneumothorax (n=3, 0.53%). Of note, 82 (14.7%) patients were found to have emphysema, and 2 (0.35%) were found to have interstitial lung disease. Conclusion: We present one of the largest reviews of CT scans in patients admitted for COVID-19. The majority of our population had significant burden of disease on CT at time of presentation. Ground glass opacities and consolidations were the predominant findings. Most patients did not have background emphysema or interstitial lung disease. The fact that many patients with normal CXR had abnormalities on chest CT highlights the utility of chest CT in evaluating patients with COVID-19.
ABSTRACT
Rationale: The novel coronavirus disease-19 (COVID-19) has overwhelmed global healthcare systems. It would be beneficial to identify clinical signs that predict adverse outcomes to anticipate clinical deterioration and optimize management. COVID-19 has presented with a variety of patterns on computed tomography (CT) and these findings may assist in disease stratification. This study aims to identify potential CT characteristics that may portend adverse outcomes. Methods: This is a retrospective review of 559 symptomatic patients infected with COVID-19 admitted from March 2020 to May 2020 at Temple University Hospital (Philadelphia, PA) who received thorax CT scans on admission. These scans were independently reviewed by a chest radiologist and evaluated for the presence of ground glass opacities, consolidations, interlobular septal thickening, enlarged pulmonary artery (PA) diameter, centrilobular nodules, and crazy paving pattern. Common CT findings were then associated with a combined adverse inpatient outcome (requiring high-flow oxygen, mechanical ventilation, and/or death) through univariate and multivariate logistic regression. Results: Of the 559 patients, 182 (32.6%) required high-flow oxygen, mechanical ventilation, and/or died. The cohort with adverse outcomes were older (mean age 65.0 years vs 56.7 years, p<0.0001), but had statistically similar gender, BMI and duration of symptoms compared to the cohort without adverse outcomes. The adverse outcome cohort had more COPD (18.7% vs 8.2%) but had statistically similar proportions of hypertension, diabetes, asthma, coronary artery disease, and congestive heart failure. On multivariate logistic regression, a PA diameter greater than 30mm (OR 1.056 [95% CI 1.015-1.097], p=0.0064), segmental consolidations (OR 2.359 [95% CI 1.446-3.848], p=0.0009), and non-segmental consolidations (OR 2.441, [95% CI 1.440-4.140], p=0.0009) were found to be significant predictors of adverse inpatient outcomes of either requiring high-flow nasal cannula, mechanical ventilation, or death. Conclusion: In symptomatic COVID-19 patients, enlarged PA diameter and consolidations on chest CT were associated with worse outcomes. These findings are likely representative of advanced pulmonary involvement and may be predictors of patients who require more aggressive upfront therapy. Multicenter analysis would be beneficial to confirm these findings.