Clinical characteristics of COVID-19 infection in chronic obstructive pulmonary disease: a multicenter, retrospective, observational study

Fan Wu; Yumin Zhou; Zhongfang Wang; Min Xie; Zhe Shi; Zhiqiang Tang; Xiaohe Li; Xiaochen Li; Chunliang Lei; Yimin Li; Zhengyi Ni; Yu Hu; Xiaoqing Liu; Wenguang Yin; Linling Cheng; Feng Ye; Jieqi Peng; Lingmei Huang; Jia Tian; Lingjuan Zhang; Xiaoneng Mo; Ying Zhang; Ke Hu; Yongliang Jiang; Weijie Guan; Jie Xiang; Yingxia Liu; Yixiang Peng; Li Wei; Yahua Hu; Peng Peng; Jianming Wang; Jiyang Liu; Wei Huang; Ruchong Chen; Jianping Zhao; Shiyue Li; Nuofu Zhang; Jincun Zhao; Nanshan Zhong; Pixin Ran; Medical Treatment Expert Group for COPD and COVID-19

doi:10.21037/jtd-20-1914

Clinical characteristics of COVID-19 infection in chronic obstructive pulmonary disease: a multicenter, retrospective, observational study

J Thorac Dis. 2020 May;12(5):1811-1823. doi: 10.21037/jtd-20-1914.

Authors

Fan Wu¹, Yumin Zhou¹, Zhongfang Wang¹, Min Xie², Zhe Shi³, Zhiqiang Tang⁴, Xiaohe Li⁵, Xiaochen Li⁶, Chunliang Lei⁷, Yimin Li¹, Zhengyi Ni⁸, Yu Hu⁹, Xiaoqing Liu¹, Wenguang Yin¹, Linling Cheng¹, Feng Ye¹, Jieqi Peng¹, Lingmei Huang¹⁰, Jia Tian¹¹, Lingjuan Zhang³, Xiaoneng Mo⁷, Ying Zhang⁵, Ke Hu⁶, Yongliang Jiang¹², Weijie Guan¹, Jie Xiang⁸, Yingxia Liu⁵, Yixiang Peng¹³, Li Wei¹⁴, Yahua Hu¹⁵, Peng Peng¹⁶, Jianming Wang¹⁷, Jiyang Liu¹⁸, Wei Huang¹⁹, Ruchong Chen¹, Jianping Zhao², Shiyue Li¹, Nuofu Zhang¹, Jincun Zhao¹, Nanshan Zhong¹, Pixin Ran¹; Medical Treatment Expert Group for COPD and COVID-19

Affiliations

¹ State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.
² Department of Pulmonary and Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
³ Huizhou First Hospital, Huizhou, China.
⁴ The Second People's Hospital of Changde City, Changde, China.
⁵ Shenzhen Third People's Hospital, Shenzhen, China.
⁶ Renmin Hospital of Wuhan University, Wuhan, China.
⁷ Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China.
⁸ Wuhan Jinyintan Hospital, Wuhan, China.
⁹ Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
¹⁰ The First people's Hospital of Yueyang, Yueyang, China.
¹¹ The Second People's Hospital of Hunan Province, Changsha, China.
¹² Department of Respiratory and Critical Care Medicine, Hunan Provincial People's Hospital, Changsha, China.
¹³ The Central Hospital of Wuhan, Wuhan, China.
¹⁴ Wuhan No. 1 Hospital, Wuhan Hospital of Traditional Chinese and Western Medicine, Wuhan, China.
¹⁵ Huangshi Central Hospital of Edong Healthcare Group, Affiliated Hospital of Hubei Polytechnic University, Huangshi, China.
¹⁶ Wuhan Pulmonary Hospital, Wuhan, China.
¹⁷ Tianyou Hospital Affiliated to Wuhan University of Science and Technology, Wuhan, China.
¹⁸ The First Hospital of Changsha, Changsha, China.
¹⁹ Jiangling County People's Hospital, Jingzhou, China.

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).