ABSTRACT
Introduction: Data about the impact of COVID-19 on patients with fibrotic ILD are limited. These patients have impaired lung function and increased risk of acute exacerbation driven by viral infection, so COVID-19 is of particular concern. Aim(s): To evaluate the impact of SARS-CoV-2 infection on patients with previous fibrotic ILD. Method(s): Single-center retrospective study including adult patients with previous fibrotic ILD and SARS-CoV-2 infection. Clinical, imaging, and respiratory functional data, pre and post infection, were revised. Result(s): A total of 49 patients (median age 68.4+/-11.1 years, 61.2% male) were analysed and major comorbidities included dyslipidaemia (69.4%), hypertension (53.1%) and obesity (29.9%). Hypersensitivity pneumonitis was the most frequent diagnosis (22.4%) followed by CTD-ILD (20.4%). Non-corticosteroid immunosuppression was present in 38.8% of the cases. Regarding COVID-19 severity, most cases were mild (55.1%) and 34.7% were severe disease requiring hospitalization. Fifteen patients died and 14 patients experienced progression of fibrosis, which was associated with a significant clinical (mean mMRC 0.86+/-0.53 vs 1.57+/-1.09, p=0.015) and DLCO decline (5.12+/-2.57 vs 4.54+/-2.96, p=0.002). Independent predictor of fibrotic worsening was the absence of non-corticosteroid immunosuppression (OR 0.072, p=0.019). Mortality correlated with OSA (p=0.011), heart failure (p=0.032), previous hypoxemic respiratory failure (p=0.013), severe COVID-19 disease (p<0.001) and hospitalization (p=0.004). Conclusion(s): Non-corticosteroid immunosuppression may have a protective role in fibrotic ILD patients. Mortality associated with COVID-19 severity, OSA, heart failure and previous hypoxemic respiratory failure.
ABSTRACT
Introduction: Few studies have evaluated the impact of COVID-19 on interstitial lung diseases (ILDs). Our aim was to compare outcomes in patients with fibrotic-ILDs (F-ILDs) and non-fibrotic-ILDs (NF-ILDs) after COVID-19. Method(s): We reviewed patients with ILD followed in a Portuguese university hospital. Patients' features and COVID- 19 outcomes were compared between F-ILDs and NF-ILDs groups. We used Kaplan-Meyer analysis to estimate overall survival (OS) and cox-proportional-hazards regression models to identify factors associated with OS. Result(s): A total of 103 patients (49.5% were male;mean age of 61.5+/-14.5 years) were included. The most prevalent ILDs were sarcoidosis (26.2%), HP (14.6%), CTD-ILD (14.6%), OP (8.7%), IPF (7.8%) and unclassifiable idiopathic interstitial pneumonia (7.8%). 47.6% of patients had F-ILD, and they had a higher prevalence of dyslipidemia (p=0.006) and immunosuppressive therapy (p<.001). Regarding the severity of COVID-19, 64.7% had mild, 11.7% moderate and 24.3% severe disease. There was a higher proportion of severe disease among F-ILDs patients (34.7% vs 14.8%, p=0.019). Post-COVID-19 mortality (median follow-up of 44 weeks) was significantly higher in FILD than NF-ILD cases (30.6% vs 5.6%, p=0.001). The median OS was significantly lower for patients who had severe disease (18.0 vs 45.5 weeks;p<.001) and F-ILD (41 vs 45 weeks;p=0.001). According to multivariate analysis, F-ILD (HR:4.00, p=0.042) and severe disease (HR:6.98, p=0.008) were the factors associated with worse OS. Concluding: In our analysis, COVID-19 was associated with worse outcomes in patients with F-ILDs and severe COVID-19, regardless of cardiovascular risk factors.