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Respir Med ; 191: 106714, 2022 01.
Article in English | MEDLINE | ID: covidwho-1559656


BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) have poor outcomes in the setting of community-acquired pneumonia (CAP) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The primary objective is to compare outcomes of SARS-CoV-2 CAP and non-SARS-CoV-2 CAP in patients with COPD. The secondary objective is to compare outcomes of SARS-CoV-2 CAP with and without COPD. METHODS: In this analysis of two observational studies, three cohorts were analyzed: (1) patients with COPD and SARS-CoV-2 CAP; (2) patients with COPD and non-SARS-CoV-2 CAP; and (3) patients with SARS-CoV-2 CAP without COPD. Outcomes included length of stay, ICU admission, cardiac events, and in-hospital mortality. RESULTS: Ninety-six patients with COPD and SARS-CoV-2 CAP were compared to 1129 patients with COPD and non-SARS-CoV-2 CAP. 536 patients without COPD and SARS-CoV-2 CAP were analyzed for the secondary objective. Patients with COPD and SARS-CoV-2 CAP had longer hospital stay (15 vs 5 days, p < 0.001), 4.98 higher odds of cardiac events (95% CI: 3.74-6.69), and 7.31 higher odds of death (95% CI: 5.36-10.12) in comparison to patients with COPD and non-SARS-CoV-2 CAP. In patients with SARS-CoV-2 CAP, presence of COPD was associated with 1.74 (95% CI: 1.39-2.19) higher odds of ICU admission and 1.47 (95% CI: 1.05-2.05) higher odds of death. CONCLUSION: In patients with COPD and CAP, presence of SARS-CoV-2 as an etiologic agent is associated with more cardiovascular events, longer hospital stay, and seven-fold increase in mortality. In patients with SARS-CoV-2 CAP, presence of COPD is associated with 1.5-fold increase in mortality.

COVID-19/physiopathology , Cardiovascular Diseases/epidemiology , Community-Acquired Infections/physiopathology , Hospital Mortality , Intensive Care Units/statistics & numerical data , Length of Stay/statistics & numerical data , Pneumonia/physiopathology , Pulmonary Disease, Chronic Obstructive/physiopathology , Aged , Arrhythmias, Cardiac/epidemiology , COVID-19/epidemiology , COVID-19/therapy , Case-Control Studies , Community-Acquired Infections/epidemiology , Community-Acquired Infections/therapy , Comorbidity , Edema, Cardiac/epidemiology , Female , Heart Failure/epidemiology , Hospitalization , Humans , Male , Middle Aged , Myocardial Infarction/epidemiology , Pneumonia/epidemiology , Pneumonia/therapy , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/therapy , Pulmonary Edema/epidemiology , Pulmonary Embolism/epidemiology , Stroke/epidemiology
Int J Infect Dis ; 102: 316-318, 2021 Jan.
Article in English | MEDLINE | ID: covidwho-1060468


The ongoing worldwide COVID-19 pandemic has become a huge threat to global public health. Using CT image, 3389 COVID-19 patients, 1593 community-acquired pneumonia (CAP) patients, and 1707 nonpneumonia subjects were included to explore the different patterns of lung and lung infection. We found that COVID-19 patients have a significant reduced lung volume with increased density and mass, and the infections tend to present as bilateral lower lobes. The findings provide imaging evidence to improve our understanding of COVID-19.

COVID-19/diagnostic imaging , Lung/physiopathology , Big Data , COVID-19/physiopathology , COVID-19/virology , Community-Acquired Infections/diagnostic imaging , Community-Acquired Infections/physiopathology , Community-Acquired Infections/virology , Female , Humans , Lung/diagnostic imaging , Lung/virology , Male , Middle Aged , Pandemics , Respiratory Function Tests , Retrospective Studies , SARS-CoV-2/physiology , Tomography, X-Ray Computed/methods
CMAJ ; 192(27): E756-E767, 2020 07 06.
Article in English | MEDLINE | ID: covidwho-262616


BACKGROUND: Very little direct evidence exists on use of corticosteroids in patients with coronavirus disease 2019 (COVID-19). Indirect evidence from related conditions must therefore inform inferences regarding benefits and harms. To support a guideline for managing COVID-19, we conducted systematic reviews examining the impact of corticosteroids in COVID-19 and related severe acute respiratory illnesses. METHODS: We searched standard international and Chinese biomedical literature databases and prepublication sources for randomized controlled trials (RCTs) and observational studies comparing corticosteroids versus no corticosteroids in patients with COVID-19, severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS). For acute respiratory distress syndrome (ARDS), influenza and community-acquired pneumonia (CAP), we updated the most recent rigorous systematic review. We conducted random-effects meta-analyses to pool relative risks and then used baseline risk in patients with COVID-19 to generate absolute effects. RESULTS: In ARDS, according to 1 small cohort study in patients with COVID-19 and 7 RCTs in non-COVID-19 populations (risk ratio [RR] 0.72, 95% confidence interval [CI] 0.55 to 0.93, mean difference 17.3% fewer; low-quality evidence), corticosteroids may reduce mortality. In patients with severe COVID-19 but without ARDS, direct evidence from 2 observational studies provided very low-quality evidence of an increase in mortality with corticosteroids (hazard ratio [HR] 2.30, 95% CI 1.00 to 5.29, mean difference 11.9% more), as did observational data from influenza studies. Observational data from SARS and MERS studies provided very low-quality evidence of a small or no reduction in mortality. Randomized controlled trials in CAP suggest that corticosteroids may reduce mortality (RR 0.70, 95% CI 0.50 to 0.98, 3.1% lower; very low-quality evidence), and may increase hyperglycemia. INTERPRETATION: Corticosteroids may reduce mortality for patients with COVID-19 and ARDS. For patients with severe COVID-19 but without ARDS, evidence regarding benefit from different bodies of evidence is inconsistent and of very low quality.

Adrenal Cortex Hormones/therapeutic use , Betacoronavirus/drug effects , Community-Acquired Infections/drug therapy , Coronavirus Infections/drug therapy , Influenza, Human/drug therapy , Pneumonia, Viral/drug therapy , Respiratory Distress Syndrome/drug therapy , COVID-19 , Community-Acquired Infections/physiopathology , Coronavirus Infections/physiopathology , Guidelines as Topic , Humans , Influenza, Human/physiopathology , Pandemics , Pneumonia, Viral/physiopathology , Respiration, Artificial , Respiratory Distress Syndrome/physiopathology , Risk Assessment , SARS-CoV-2 , Treatment Outcome