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

Daniya Sheikh; Nishita Tripathi; Thomas R Chandler; Stephen Furmanek; Jose Bordon; Julio A Ramirez; Rodrigo Cavallazzi

doi:10.1016/j.rmed.2021.106714

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

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

Authors

Daniya Sheikh¹, Nishita Tripathi², Thomas R Chandler², Stephen Furmanek², Jose Bordon³, Julio A Ramirez², Rodrigo Cavallazzi⁴

Affiliations

¹ Division of Infectious Diseases, University of Louisville, Louisville, KY, USA. Electronic address: d0shei01@louisville.edu.
² Division of Infectious Diseases, University of Louisville, Louisville, KY, USA.
³ Washington Health Institute, George Washington University, Washington, DC, USA.
⁴ Division of Pulmonary, Critical Care Medicine and Sleep Disorders, University of Louisville, Louisville, KY, USA.

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.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Aged
Arrhythmias, Cardiac / epidemiology
COVID-19 / epidemiology
COVID-19 / physiopathology*
COVID-19 / therapy
Cardiovascular Diseases / epidemiology*
Case-Control Studies
Community-Acquired Infections / epidemiology
Community-Acquired Infections / physiopathology*
Community-Acquired Infections / therapy
Comorbidity
Edema, Cardiac / epidemiology
Female
Heart Failure / epidemiology
Hospital Mortality*
Hospitalization
Humans
Intensive Care Units / statistics & numerical data*
Length of Stay / statistics & numerical data*
Male
Middle Aged
Myocardial Infarction / epidemiology
Pneumonia / epidemiology
Pneumonia / physiopathology*
Pneumonia / therapy
Pulmonary Disease, Chronic Obstructive / epidemiology
Pulmonary Disease, Chronic Obstructive / physiopathology*
Pulmonary Disease, Chronic Obstructive / therapy
Pulmonary Edema / epidemiology
Pulmonary Embolism / epidemiology
Stroke / epidemiology