J Thorac Dis . Clinical Characteristics of COVID-19 Infection in Chronic Obstructive Pulmonary Disease: A Multicenter, Retrospective, Observational Study

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J Thorac Dis


. 2020 May;12(5):1811-1823.
doi: 10.21037/jtd-20-1914.
Clinical Characteristics of COVID-19 Infection in Chronic Obstructive Pulmonary Disease: A Multicenter, Retrospective, Observational Study


Fan Wu ¹ , Yumin Zhou ¹ , Zhongfang Wang ¹ , Min Xie ² , Zhe Shi ³ , Zhiqiang Tang ⁴ , Xiaohe Li ⁵ , Xiaochen Li ⁶ , Chunliang Lei ⁷ , Yimin Li ¹ , Zhengyi Ni ⁸ , Yu Hu ⁹ , Xiaoqing Liu ¹ , Wenguang Yin ¹ , Linling Cheng ¹ , Feng Ye ¹ , Jieqi Peng ¹ , Lingmei Huang ¹⁰ , Jia Tian ¹¹ , Lingjuan Zhang ³ , Xiaoneng Mo ⁷ , Ying Zhang ⁵ , Ke Hu ⁶ , Yongliang Jiang ¹² , Weijie Guan ¹ , Jie Xiang ⁸ , Yingxia Liu ⁵ , Yixiang Peng ¹³ , Li Wei ¹⁴ , Yahua Hu ¹⁵ , Peng Peng ¹⁶ , Jianming Wang ¹⁷ , Jiyang Liu ¹⁸ , Wei Huang ¹⁹ , Ruchong Chen ¹ , Jianping Zhao ² , Shiyue Li ¹ , Nuofu Zhang ¹ , Jincun Zhao ¹ , Nanshan Zhong ¹ , Pixin Ran ¹ , Medical Treatment Expert Group for COPD and COVID-19



Affiliations

• PMID: 32642086
• PMCID: PMC7330323
• DOI: 10.21037/jtd-20-1914

Abstract

Background: Coronavirus disease 2019 (COVID-19) has been a global pandemic disease, with more than 4 million cases and nearly 300,000 deaths. Little is known about COVID-19 in patients with chronic obstructive pulmonary disease (COPD). We aimed to evaluate the influence of preexisting COPD on the progress and outcomes of COVID-19.
Methods: This was a multicenter, retrospective, observational study. We enrolled 1,048 patients aged 40 years and above, including 50 patients with COPD and 998 patients without COPD, and with COVID-19 confirmed via high-throughput sequencing or real-time reverse transcription-polymerase chain reaction, between December 11, 2019 and February 20, 2020. We collected data of demographics, pathologic test results, radiologic imaging, and treatments. The primary outcomes were composite endpoints determined by admission to an intensive care unit, the use of mechanical ventilation, or death.
Results: Compared with patients who had COVID-19 but not COPD, those with COPD had higher rates of fatigue (56.0% vs. 40.2%), dyspnea (66.0% vs. 26.3%), diarrhea (16.0% vs. 3.6%), and unconsciousness (8.0% vs. 1.7%) and a significantly higher proportion of increased activated partial thromboplastin time (23.5% vs. 5.2%) and D-dimer (65.9% vs. 29.3%), as well as ground-glass opacities (77.6% vs. 60.3%), local patchy shadowing (61.2% vs. 41.4%), and interstitial abnormalities (51.0% vs. 19.8%) on chest computed tomography. Patients with COPD were more likely to develop bacterial or fungal coinfection (20.0% vs. 5.9%), acute respiratory distress syndrome (ARDS) (20.0% vs. 7.3%), septic shock (14.0% vs. 2.3%), or acute renal failure (12.0% vs. 1.3%). Patients with COPD and COVID-19 had a higher risk of reaching the composite endpoints [hazard ratio (HR): 2.17, 95% confidence interval (CI): 1.40-3.38; P=0.001] or death (HR: 2.28, 95% CI: 1.15-4.51; P=0.019), after adjustment.
Conclusions: In this study, patients with COPD who developed COVID-19 showed a higher risk of admission to the intensive care unit, mechanical ventilation, or death.

Keywords: Clinical characteristics; chronic obstructive pulmonary disease (COPD); coronavirus disease 2019 (COVID-19).