Evolution of fibrotic interstitial lung diseases (ILD) after COVID-19

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.