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. 2020 May;12(5):1811-1823.
doi: 10.21037/jtd-20-1914.

Clinical characteristics of COVID-19 infection in chronic obstructive pulmonary disease: a multicenter, retrospective, observational study

Fan Wu  1 , Yumin Zhou  1 , Zhongfang Wang  1 , Min Xie  2 , Zhe Shi  3 , Zhiqiang Tang  4 , Xiaohe Li  5 , Xiaochen Li  6 , Chunliang Lei  7 , Yimin Li  1 , Zhengyi Ni  8 , Yu Hu  9 , Xiaoqing Liu  1 , Wenguang Yin  1 , Linling Cheng  1 , Feng Ye  1 , Jieqi Peng  1 , Lingmei Huang  10 , Jia Tian  11 , Lingjuan Zhang  3 , Xiaoneng Mo  7 , Ying Zhang  5 , Ke Hu  6 , Yongliang Jiang  12 , Weijie Guan  1 , Jie Xiang  8 , Yingxia Liu  5 , Yixiang Peng  13 , Li Wei  14 , Yahua Hu  15 , Peng Peng  16 , Jianming Wang  17 , Jiyang Liu  18 , Wei Huang  19 , Ruchong Chen  1 , Jianping Zhao  2 , Shiyue Li  1 , Nuofu Zhang  1 , Jincun Zhao  1 , Nanshan Zhong  1 , Pixin Ran  1 ; Medical Treatment Expert Group for COPD and COVID-19
Affiliations

Clinical characteristics of COVID-19 infection in chronic obstructive pulmonary disease: a multicenter, retrospective, observational study

Fan Wu et al. J Thorac Dis. 2020 May.

Abstract

Background: Coronavirus disease 2019 (COVID-19) has been a global pandemic disease, with more than 4 million cases and nearly 300,000 deaths. Little is known about COVID-19 in patients with chronic obstructive pulmonary disease (COPD). We aimed to evaluate the influence of preexisting COPD on the progress and outcomes of COVID-19.

Methods: This was a multicenter, retrospective, observational study. We enrolled 1,048 patients aged 40 years and above, including 50 patients with COPD and 998 patients without COPD, and with COVID-19 confirmed via high-throughput sequencing or real-time reverse transcription-polymerase chain reaction, between December 11, 2019 and February 20, 2020. We collected data of demographics, pathologic test results, radiologic imaging, and treatments. The primary outcomes were composite endpoints determined by admission to an intensive care unit, the use of mechanical ventilation, or death.

Results: Compared with patients who had COVID-19 but not COPD, those with COPD had higher rates of fatigue (56.0% vs. 40.2%), dyspnea (66.0% vs. 26.3%), diarrhea (16.0% vs. 3.6%), and unconsciousness (8.0% vs. 1.7%) and a significantly higher proportion of increased activated partial thromboplastin time (23.5% vs. 5.2%) and D-dimer (65.9% vs. 29.3%), as well as ground-glass opacities (77.6% vs. 60.3%), local patchy shadowing (61.2% vs. 41.4%), and interstitial abnormalities (51.0% vs. 19.8%) on chest computed tomography. Patients with COPD were more likely to develop bacterial or fungal coinfection (20.0% vs. 5.9%), acute respiratory distress syndrome (ARDS) (20.0% vs. 7.3%), septic shock (14.0% vs. 2.3%), or acute renal failure (12.0% vs. 1.3%). Patients with COPD and COVID-19 had a higher risk of reaching the composite endpoints [hazard ratio (HR): 2.17, 95% confidence interval (CI): 1.40-3.38; P=0.001] or death (HR: 2.28, 95% CI: 1.15-4.51; P=0.019), after adjustment.

Conclusions: In this study, patients with COPD who developed COVID-19 showed a higher risk of admission to the intensive care unit, mechanical ventilation, or death.

Keywords: Clinical characteristics; chronic obstructive pulmonary disease (COPD); coronavirus disease 2019 (COVID-19).

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd-20-1914). NZ serves as the unpaid Editor-in Chief of Journal of Thoracic Disease. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow chart of study participants. COVID-19, coronavirus disease 2019; COPD, chronic obstructive pulmonary disease.
Figure 2
Figure 2
Comparison of the time-dependent risk of clinical outcomes. Compared with patients who had COVID-19 but not COPD, those with COPD had greater likelihood of death (A) and reaching the composite endpoints (B), with an HR of 2.28 (95% CI: 1.15 to 4.51, P=0.019) and 2.17 (95% CI: 1.40 to 3.38, P=0.001), respectively, adjusted by confounding factors including age, sex, smoking status, and other comorbidities.
Figure S1
Figure S1
Comparison of the time-dependent risk of clinical outcomes.
See this image and copyright information in PMC

Comment in

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