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. 2021 Dec 2;58(6):2004125.
doi: 10.1183/13993003.04125-2020. Print 2021 Dec.

Interstitial lung disease increases susceptibility to and severity of COVID-19

Hyun Lee  1   2 , Hayoung Choi  3   2 , Bumhee Yang  4   2 , Sun-Kyung Lee  1   5 , Tai Sun Park  1 , Dong Won Park  1 , Ji-Yong Moon  1 , Tae-Hyung Kim  1 , Jang Won Sohn  1 , Ho Joo Yoon  1 , Sang-Heon Kim  6
Affiliations

Interstitial lung disease increases susceptibility to and severity of COVID-19

Hyun Lee et al. Eur Respir J. .

Abstract

Background: There are limited data regarding the relationship between interstitial lung disease (ILD) and the natural course of COVID-19. In this study, we investigate whether patients with ILD are more susceptible to COVID-19 than those without ILD and evaluate the impact of ILD on disease severity in patients with COVID-19.

Methods: A nationwide cohort of patients with COVID-19 (n=8070) and a 1:15 age-, sex- and residential area-matched cohort (n=121 050) were constructed between 1 January 2020 and 30 May 2020 in Korea. We performed a nested case-control study to compare the proportions of patients with ILD between the COVID-19 cohort and the matched cohort. Using the COVID-19 cohort, we also evaluated the risk of severe COVID-19 in patients with ILD versus those without ILD.

Results: The proportion of patients with ILD was significantly higher in the COVID-19 cohort than in the matched cohort (0.8% versus 0.4%; p<0.001). The odds of having ILD was significantly higher in the COVID-19 cohort than in the matched cohort (adjusted OR 2.02, 95% CI 1.54-2.61). Among patients in the COVID-19 cohort, patients with ILD were more likely to have severe COVID-19 than patients without ILD (47.8% versus 12.6%), including mortality (13.4% versus 2.8%) (all p<0.001). The risk of severe COVID-19 was significantly higher in patients with ILD than in those without ILD (adjusted OR 2.23, 95% CI 1.24-4.01).

Conclusion: The risks of COVID-19 and severe presentation were significantly higher in patients with ILD than in those without ILD.

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Conflict of interest statement

Conflict of interest: H. Lee has nothing to disclose. Conflict of interest: H. Choi has nothing to disclose. Conflict of interest: B. Yang has nothing to disclose. Conflict of interest: S-K. Lee has nothing to disclose. Conflict of interest: T.S. Park has nothing to disclose. Conflict of interest: D.W. Park has nothing to disclose. Conflict of interest: J-Y. Moon has nothing to disclose. Conflict of interest: T-H. Kim has nothing to disclose. Conflict of interest: J.W. Sohn has nothing to disclose. Conflict of interest: H.J. Yoon has nothing to disclose. Conflict of interest: S-H. Kim has nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Flowchart of the study population. NHIS: National Health Insurance Service.
FIGURE 2
FIGURE 2
The impact of each type of interstitial lung disease (ILD) on the susceptibility to COVID-19. CTD: connective tissue disease; IPF: idiopathic pulmonary fibrosis; HP: hypersensitivity pneumonitis. The adjusted model was adjusted for type of insurance, lung cancer, CTD, hypertension, diabetes mellitus, cardiovascular disease (angina pectoris, myocardial infarction and heart failure) and cerebrovascular disease.
FIGURE 3
FIGURE 3
Severe COVID-19 disease according to the presence or absence of interstitial lung disease (ILD). Patients receiving oxygen therapy did not include cases receiving mechanical ventilation (MV) treatment or extracorporeal membrane oxygenation (ECMO) and mortality cases; those receiving MV treatment did not include cases receiving ECMO and mortality cases; those receiving ECMO did not include mortality cases. ICU: intensive care unit.
FIGURE 4
FIGURE 4
The impact of each type of interstitial lung disease (ILD) on the occurrence of severe COVID-19. CTD: connective tissue disease; IPF: idiopathic pulmonary fibrosis. The adjusted model was adjusted for age, sex and comorbidities (lung cancer, CTD, hypertension, diabetes mellitus, cardiovascular disease (angina pectoris, myocardial infarction and heart failure), cerebrovascular disease and malignancies other than lung cancer).
See this image and copyright information in PMC

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