Influence of radiologic pattern and the presence of diffuse parenchymal lung disease on outcome in ventilated patients with COVID-19 pneumonia: impact on prognosis

Abstract

Background: Suspected organising pneumonia (OP) is a common finding in patients with severe coronavirus disease 2019 (COVID-19), but the impact on outcomes of the radiological patterns of diffuse parenchymal lung disease on outcome of these patients is still uncertain.

Aims: Investigate the presence of radiological images compatible with OP and its association with clinical outcomes in patients with COVID-19 submitted to invasive mechanical ventilation (IMV).

Methods: Retrospective, unicentric cohort study composed of patients who required IMV and underwent chest computerized tomography to investigate secondary complications of COVID-19. We compared patients with radiological findings characteristic of suspected OP with those without this condition. The main outcome was hospital mortality.

Results: Two hundred and ten patients were included, and 65 had signals compatible with OP. All patients with suspected OP were treated with corticosteroids. There was no difference in IVM-free days until day 28 between the groups (median, 0 days; interquartile range [IQR], 0-14.8) in the group with suspected OP vs 0 days (IQR, 0-11) in the group without suspected OP (P = 0.14). In univariate analysis, the presence of suspected OP was associated with lower hospital mortality; however, after correction for potential confounding variables, it was not associated with the outcome, even after matching by propensity score in patients without this condition.

Conclusion: OP radiologic pattern in patients with severe COVID-19 is not associated with worse outcomes.

Keywords: COVID-19; corticosteroids; intensive care unit; mechanical ventilation; organising pneumonia.

Figure 1

Radiologic features compatible with COVID‐19–associated organising pneumonia. Computerized tomography (CT) axial scan showed bilateral consolidative and atelectatic changes in lesions in the lingula and lower lobes, with traction bronchiectasis. Areas of consolidation with peripheral predominance are seen in the upper lobes, with bronchiolectasis and septal thickening.

Figure 2

Chest computerized tomography (CT) scan revealed bilateral, predominantly peripheral, opacities with ground‐glass attenuation and consolidation. There are some perilobular consolidative opacities and inverted halo sign opacities (arrowhead).