ILD a risk factor for poor outcomes from COVID-19
Older adults with interstitial lung disease and COVID-19 have increased risk for severe disease, hospitalization and death, researchers reported in the American Journal of Respiratory and Critical Care Medicine.
“In this case-control study, patients with ILD who contracted COVID-19 had a greater than fourfold increased adjusted odds of death, were more likely to be hospitalized and require ICU level of care, and were less likely to be discharged, particularly to home, compared to a matched cohort of COVID-19 patients without ILD,” Anthony J. Esposito, MD, research fellow in the department of medicine in the division of pulmonary and critical care medicine at Brigham and Women’s Hospital, and colleagues wrote. “Accordingly, this study suggests that comorbid ILD is a risk factor for poor outcomes from COVID-19.”
The multicenter, case-control study included 46 adults with pre-existing ILD and a COVID-19 diagnosis from March to June at six Mass General Brigham hospitals. For comparison, the researchers also analyzed a control cohort of 92 patients with COVID-19 without ILD.
Fifteen (33%) of the patients with ILD and COVID-19 died compared with 12 (13%) patients in the control group (OR = 3.2; 95% CI, 1.3-7.3; P = .01). Researchers observed increased mortality among patients with ILD and COVID-19 even after adjusting for age, sex, race, smoking status, cardiovascular disease and chronic immunosuppression (OR = 4.3; 95% CI, 1.4-14; P = .01).
Patients with ILD and COVID-19 were more likely to be admitted to the hospital and require ICU care than those without COVID-19, and were less likely to be discharged from the hospital.
In other results, non-survivors with ILD and COVID-19 were significantly older compared with survivors (76 years vs. 67 years).
Patients with ILD should be counseled of their increased risk and public health measures to prevent COVID-19 infection in this susceptible population should be emphasized, according to the researchers.
“These results are consistent with those from previous coronavirus epidemics, notably severe acute respiratory syndrome and Middle East respiratory syndrome in which chronic immunosuppression did not portend worse outcomes,” the researchers wrote. “Additional studies are needed to further assess safety of chronic immunosuppression in COVID-19.”