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Observational Study
. 2022 Jan:191:106714.
doi: 10.1016/j.rmed.2021.106714. Epub 2021 Dec 9.

Clinical outcomes in patients with COPD hospitalized with SARS-CoV-2 versus non- SARS-CoV-2 community-acquired pneumonia

Daniya Sheikh  1 , Nishita Tripathi  2 , Thomas R Chandler  2 , Stephen Furmanek  2 , Jose Bordon  3 , Julio A Ramirez  2 , Rodrigo Cavallazzi  4
Affiliations
Observational Study

Clinical outcomes in patients with COPD hospitalized with SARS-CoV-2 versus non- SARS-CoV-2 community-acquired pneumonia

Daniya Sheikh et al. Respir Med. 2022 Jan.

Abstract

Background: Patients with chronic obstructive pulmonary disease (COPD) have poor outcomes in the setting of community-acquired pneumonia (CAP) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The primary objective is to compare outcomes of SARS-CoV-2 CAP and non-SARS-CoV-2 CAP in patients with COPD. The secondary objective is to compare outcomes of SARS-CoV-2 CAP with and without COPD.

Methods: In this analysis of two observational studies, three cohorts were analyzed: (1) patients with COPD and SARS-CoV-2 CAP; (2) patients with COPD and non-SARS-CoV-2 CAP; and (3) patients with SARS-CoV-2 CAP without COPD. Outcomes included length of stay, ICU admission, cardiac events, and in-hospital mortality.

Results: Ninety-six patients with COPD and SARS-CoV-2 CAP were compared to 1129 patients with COPD and non-SARS-CoV-2 CAP. 536 patients without COPD and SARS-CoV-2 CAP were analyzed for the secondary objective. Patients with COPD and SARS-CoV-2 CAP had longer hospital stay (15 vs 5 days, p < 0.001), 4.98 higher odds of cardiac events (95% CI: 3.74-6.69), and 7.31 higher odds of death (95% CI: 5.36-10.12) in comparison to patients with COPD and non-SARS-CoV-2 CAP. In patients with SARS-CoV-2 CAP, presence of COPD was associated with 1.74 (95% CI: 1.39-2.19) higher odds of ICU admission and 1.47 (95% CI: 1.05-2.05) higher odds of death.

Conclusion: In patients with COPD and CAP, presence of SARS-CoV-2 as an etiologic agent is associated with more cardiovascular events, longer hospital stay, and seven-fold increase in mortality. In patients with SARS-CoV-2 CAP, presence of COPD is associated with 1.5-fold increase in mortality.

Keywords: COVID-19; Cardiovascular events; ICU admission; Mortality; Respiratory tract infections; Viral pneumonia.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Flow diagram displaying the number of participants in each study group. CAP: Community-acquired pneumonia; COPD: Chronic obstructive pulmonary disease; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2. This analysis was a combination of two large observational studies. The left arm of the flow diagram represents the University of Louisville Pneumonia Study, which ran from June 1, 2014 to May 31, 2016. The right arm of the flow diagram represents the Burden of COVID-19 study, running from March 1, 2020 to June 30, 2020.
Fig. 2
Fig. 2
Adjusted effect estimates for the primary and secondary objectives. IPW-OR: inverse propensity scores weighted odds ratio; 95% CI: 95% confidence interval for the IPW-OR. The primary objective compared patients with COPD hospitalized for SARS-CoV-2 CAP and non-SARS-CoV-2 CAP. The secondary objective compared patients with SARS-CoV-2 CAP with and without COPD.
Fig. 3
Fig. 3
Kaplan-Meier estimates for length of stay. CAP: Community-acquired pneumonia; COPD: Chronic obstructive pulmonary disease; SARS-CoV-2: Severe acute respiratory syndrome coronavirus 2. The black line depicts time to discharge for patients with SARS-CoV-2 CAP. The dashed gray line depicts time to discharge for patients with non-SARS-CoV-2 CAP. The horizontal dotted line represents the time at which 50% of the patients have been discharged from the hospital per group. The test statistic comes from inverse-propensity score weighted log-rank tests comparing the two curves.
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References

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