INTERSTITIAL LUNG DISEASE AFTER COVID-19 IN PATIENTS WITH CANCER AND WITHOUT: A PROSPECTIVE COHORT STUDY

ABSTRACT

SESSION TITLE Long COVID It Can Take Your Breath Away SESSION TYPE Original Investigations PRESENTED ON 10/16/2022 1030 am - 1130 am PURPOSE: Survivors of COVID-19 hospitaliaztion may be at high risk for interstitial lung disease (ILD). The incidence and natural history of post-COVID ILD may vary in cancer and non-cancer patients, particularly if survival is lower in cancer patients. We sought to determine the incidence of ILD at 3 and 6 months after hospital discharge in cancer and non-cancer patients METHODS: We analyzed a prospective cohort of patients discharged after COVID-19 hospitalization between March 2020 and March 2021. Cancer patients were referred to post-COVID clinics 3 months after discharge, while non-cancer patients self-referred to post-COVID clinics at a tertiary referral center. We classified patients into 4 groups Group 1, asymptomatic without ILD;Group 2, symptomatic without ILD;Group 3, ILD with spontaneous improvement by 6 months;Group 4, persistent ILD at 6 months. Group 1 patients were not seen after initial visits, while all others returned at 6 and 12 months after discharge. We hypothesized that initial COVID-19 severity, measured by the Radiologic Severity Index (RSI) on admission CT, would be associated with irreversible ILD. RSI measures radiologic severity by measuring percentage of involvement (normal - 0, <25% involvement-1, 25-50% involvement-2, 50-75% involvement-3, >75% involvement–4) and multiplying by a score based on the predominant pattern of infiltrate (normal-1, ground glass-2, consolidation-3) in six zones (left, right;upper, middle, lower) to yield a score between 0-72. We used logistic regression to measure whether admission CT RSI was associated with ILD at 3 months. RESULTS: 609 cancer patients were hospitalized with COVID-19 during the study period, of whom 85 (14%) died in-hospital, and 31 (5%) were sent home to hospice. A further 63 (10%) patients died before post-COVID evaluation. Similar data were not available for non-cancer patients due to self-referral. 98 cancer patients and 75 non-cancer patients were seen in post-COVID clinics. Among cancer patients, 20 were Group 1 (20%);8, Group 2 (8%);42, Group 3 (43%);24, Group 4 (25%);5 (5%) lacked post-COVID imaging. ILD was seen in 68% of patients at 3 months, but only in 25% at 6 months. 6% of all hospitalized cancer patients developed ILD. Among non-cancer patients Group 1, 2 patients (3%);Group 2, 3 patients (4%);Group 3, 26 patients (35%);Group 4, 14 patients (19%);30 (40%) had no post-COVID imaging. Higher RSI at COVID admission associated with ILD at 3 months in non-cancer patients (OR 1.03, 95% CI 1.00-1.07, p=0.054) but not cancer patients (OR 1.3, 95% CI 0.4-4.5). CONCLUSIONS: Initial COVID-19 severity is associated with ILD 3 months after discharge in non-cancer patients but not cancer patients. CLINICAL IMPLICATIONS ILD is common in survivors of COVID-19 hospitalization, particularly in non-cancer patients hospitalized for severe infection. These data may guide patient selection for referral to post-COVID clinics. DISCLOSURES No relevant relationships by Roberto Adachi No relevant relationships by Diwakar Balachandran No relevant relationships by Lara Bashoura No relevant relationships by Christopher Bertini No relevant relationships by Kodwo Dickson Owner/Founder relationship with Pulmotect, Inc Please note 2010-present by Scott Evans, value=Royalty No relevant relationships by Saadia Faiz no disclosure on file for Bruno Granwehr;no disclosure submitted for Shannon Holloway;No relevant relationships by Maryam Kaous no disclosure on file for Fareed Khawaja;No relevant relationships by Lyndon Lee No relevant relationships by Joanna Manzano No relevant relationships by Isabel Mira-Avendano No relevant relationships by Alyssa Mohammed No relevant relationships by Mayoora Muthu No relevant relationships by Sungryong Noh Research relationship with United Therapeutics;PhaseBio Please note $5001 - $20000 by Bela Patel, value=Grant/Research No relevant relationships by Vickie Shannon onsultant relationship with Psioxus Therapeutics Please note 3/1/20-7/1/20 by Ajay Sheshadri, value=Consulting fee Consultant relationship with Enanta Pharmaceuticals Please note 01/01/21-ongoing by Ajay Sheshadri, value=Consulting fee No relevant relationships by Hui Song