Outcome of Hospitalization for COVID-19 in Patients with Interstitial Lung Disease. An International Multicenter Study.
Outcome of Hospitalization for COVID-19 in Patients with Interstitial Lung Disease. An International Multicenter Study.
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DOI：
10.1164/rccm.202007-2794oc
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发表时间：
2020-12-15
影响因子：
24.7
通讯作者：
ISARIC4C Investigators
中科院分区：
文献类型：
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作者：
Drake TM;Docherty AB;Harrison EM;Quint JK;Adamali H;Agnew S;Babu S;Barber CM;Barratt S;Bendstrup E;Bianchi S;Villegas DC;Chaudhuri N;Chua F;Coker R;Chang W;Crawshaw A;Crowley LE;Dosanjh D;Fiddler CA;Forrest IA;George PM;Gibbons MA;Groom K;Haney S;Hart SP;Heiden E;Henry M;Ho LP;Hoyles RK;Hutchinson J;Hurley K;Jones M;Jones S;Kokosi M;Kreuter M;MacKay LS;Mahendran S;Margaritopoulos G;Molina-Molina M;Molyneaux PL;O'Brien A;O'Reilly K;Packham A;Parfrey H;Poletti V;Porter JC;Renzoni E;Rivera-Ortega P;Russell AM;Saini G;Spencer LG;Stella GM;Stone H;Sturney S;Thickett D;Thillai M;Wallis T;Ward K;Wells AU;West A;Wickremasinghe M;Woodhead F;Hearson G;Howard L;Baillie JK;Openshaw PJM;Semple MG;Stewart I;Jenkins RG;ISARIC4C Investigators
依据：尚未确定冠状病毒病（COVID-19）对间质性肺病（ILD）患者的影响。目的：在年龄、性别和合并症匹配的同期人群中，评估因COVID-19住院的ILD患者与无ILD患者的结局。研究方法：对2020年3月1日至5月1日期间因COVID-19入院的既往诊断为ILD的患者进行了一项国际多中心稽查，并与同期因COVID-19入院的ISARIC 4C（国际严重急性呼吸道和新发感染联盟冠状病毒临床表征联盟）队列中获得的无ILD患者进行了比较。主要结局是生存率。次要分析区分特发性肺纤维化和非特发性肺纤维化ILD，并使用肺功能确定死亡的最大风险。测量和主要结果：纳入了来自欧洲349名ILD患者的数据，其中161名患者因COVID-19的实验室或临床证据入院，并符合倾向评分匹配条件。COVID-19 ILD患者的总体死亡率为49%（79/161）。匹配后，与年龄、性别和合并症匹配的无ILD对照组相比，患有ILD的COVID-19患者的生存率显著更差（风险比[HR]，1.60;置信区间，1.17-2.18; P = 0.003）。与FVC ≥ 80%的患者相比，FVC <80%的患者的死亡风险增加（HR，1.72; 1.05-2.83）。此外，患有ILD的肥胖患者死亡风险升高（HR，2.27; 1.39−3.71）。结论：ILD患者死于COVID-19的风险增加，特别是肺功能差和肥胖的患者。应采取严格的预防措施，以避免ILD患者出现COVID-19。
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.