Ximpact of chronic obstructive pulmonary disease and/or emphysema on outcomes of hospitalized patients with COVID-19 pneumonia

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.