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Multicenter Study
. 2020 Dec 15;202(12):1656-1665.
doi: 10.1164/rccm.202007-2794OC.

Outcome of Hospitalization for COVID-19 in Patients with Interstitial Lung Disease. An International Multicenter Study

Thomas M Drake  1 , Annemarie B Docherty  1 , Ewen M Harrison  1 , Jennifer K Quint  2 , Huzaifa Adamali  3   4 , Sarah Agnew  5 , Suresh Babu  6 , Christopher M Barber  7 , Shaney Barratt  3   4 , Elisabeth Bendstrup  8 , Stephen Bianchi  7 , Diego Castillo Villegas  9 , Nazia Chaudhuri  10   11 , Felix Chua  12 , Robina Coker  13 , William Chang  14 , Anjali Crawshaw  15 , Louise E Crowley  16 , Davinder Dosanjh  15 , Christine A Fiddler  17 , Ian A Forrest  18 , Peter M George  2   12 , Michael A Gibbons  19 , Katherine Groom  13 , Sarah Haney  20 , Simon P Hart  21 , Emily Heiden  22 , Michael Henry  23 , Ling-Pei Ho  24 , Rachel K Hoyles  24 , John Hutchinson  25 , Killian Hurley  26   27 , Mark Jones  22   28 , Steve Jones  29 , Maria Kokosi  12   30 , Michael Kreuter  31 , Laura S MacKay  20 , Siva Mahendran  32 , George Margaritopoulos  10 , Maria Molina-Molina  33 , Philip L Molyneaux  2 , Aiden O'Brien  34 , Katherine O'Reilly  35 , Alice Packham  15 , Helen Parfrey  17 , Venerino Poletti  8   36 , Joanna C Porter  37 , Elisabetta Renzoni  12 , Pilar Rivera-Ortega  10 , Anne-Marie Russell  2   38 , Gauri Saini  14 , Lisa G Spencer  5 , Giulia M Stella  39 , Helen Stone  40 , Sharon Sturney  41 , David Thickett  15   16 , Muhunthan Thillai  17 , Tim Wallis  22   28 , Katie Ward  2 , Athol U Wells  12 , Alex West  30 , Melissa Wickremasinghe  38 , Felix Woodhead  42 , Glenn Hearson  43 , Lucy Howard  43 , J Kenneth Baillie  44   45 , Peter J M Openshaw  2 , Malcolm G Semple  46   47 , Iain Stewart  43 , R Gisli Jenkins  14   43 ; ISARIC4C Investigators
Collaborators, Affiliations
Multicenter Study

Outcome of Hospitalization for COVID-19 in Patients with Interstitial Lung Disease. An International Multicenter Study

Thomas M Drake et al. Am J Respir Crit Care Med. .

Abstract

Rationale: The impact of coronavirus disease (COVID-19) on patients with interstitial lung disease (ILD) has not been established.Objectives: To assess outcomes in patients with ILD hospitalized for COVID-19 versus those without ILD in a contemporaneous age-, sex-, and comorbidity-matched population.Methods: An international multicenter audit of patients with a prior diagnosis of ILD admitted to the hospital with COVID-19 between March 1 and May 1, 2020, was undertaken and compared with patients without ILD, obtained from the ISARIC4C (International Severe Acute Respiratory and Emerging Infection Consortium Coronavirus Clinical Characterisation Consortium) cohort, admitted with COVID-19 over the same period. The primary outcome was survival. Secondary analysis distinguished idiopathic pulmonary fibrosis from non-idiopathic pulmonary fibrosis ILD and used lung function to determine the greatest risks of death.Measurements and Main Results: Data from 349 patients with ILD across Europe were included, of whom 161 were admitted to the hospital with laboratory or clinical evidence of COVID-19 and eligible for propensity score matching. Overall mortality was 49% (79/161) in patients with ILD with COVID-19. After matching, patients with ILD with COVID-19 had significantly poorer survival (hazard ratio [HR], 1.60; confidence interval, 1.17-2.18; P = 0.003) than age-, sex-, and comorbidity-matched controls without ILD. Patients with an FVC of <80% had an increased risk of death versus patients with FVC ≥80% (HR, 1.72; 1.05-2.83). Furthermore, obese patients with ILD had an elevated risk of death (HR, 2.27; 1.39-3.71).Conclusions: Patients with ILD are at increased risk of death from COVID-19, particularly those with poor lung function and obesity. Stringent precautions should be taken to avoid COVID-19 in patients with ILD.

Keywords: COVID-19; idiopathic pulmonary fibrosis; interstitial lung disease; lung function; obesity.

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Figures

Figure 1.
Figure 1.
Audit flow diagram showing patients recruited and flow to matching. COVID-19 = coronavirus disease; ILD = interstitial lung disease; ISARIC4C = International Severe Acute Respiratory and Emerging Infection Consortium Coronavirus Clinical Characterisation Consortium.
Figure 2.
Figure 2.
(A) In-hospital mortality with 95% confidence intervals for female patients with interstitial lung disease (ILD) hospitalized with coronavirus disease (COVID-19) stratified by age compared with those without ILD. (B) In-hospital mortality with 95% confidence intervals for male patients with ILD hospitalized with COVID-19 stratified by age compared with those without ILD.
Figure 3.
Figure 3.
(A) Effect of interstitial lung disease (ILD) on mortality after coronavirus disease (COVID-19) (propensity matched), (B) effect of obesity and ILD (propensity matched), and (C) effect of FVC on outcome in patients with ILD only. CI = confidence interval; HR = hazard ratio; IPF = idiopathic pulmonary fibrosis.
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