tetano
Editor, Senior Moderator
Clin Transplant
. 2021 Nov 18;e14540.
doi: 10.1111/ctr.14540. Online ahead of print.
Predictors and Outcomes of Respiratory Failure among Lung Transplant Patients with COVID-19
Adrian Lawrence[SUP] 1 [/SUP], Luke D Mahan[SUP] 1 [/SUP], Manish R Mohanka[SUP] 1 [/SUP], Srinivas Bollineni[SUP] 1 [/SUP], Vaidehi Kaza[SUP] 1 [/SUP], Ricardo M La Hoz[SUP] 2 [/SUP], Song Zhang[SUP] 3 [/SUP], Corey Kershaw[SUP] 1 [/SUP], Lance S Terada[SUP] 1 [/SUP], Fernando Torres[SUP] 1 [/SUP], Amit Banga[SUP] 1 [/SUP]
Affiliations
Abstract
Background: There is limited data on the predictors and outcomes of new or worsening respiratory failure among lung transplant (LT) patients with Coronavirus disease 2019 (COVID-19).
Methods: We included all the LT patients diagnosed with COVID-19 during a one-year period (March 2020 to Feb 2021; n = 54; median age: 60, 20-73 years; M:F 37:17). Development of new or worsening respiratory failure (ARF) was the primary outcome variable.
Results: The overall incidence of ARF was 48.1% (n = 26). More than 20% of patients (n = 11) needed intubation and mechanical ventilation. Body mass index >25 Kg/m[SUP]2[/SUP] (adjusted OR: 5.7, 0.99-32.93; p = 0.05) and peak D-dimer levels >0.95 mcg/mL (adjusted OR: 24.99, 1.77-353.8; p = .017) were independently associated with ARF while anticoagulation use prior to COVID-19 was protective (adjusted OR: 0.024, 0.001-0.55; p = 0.02). Majority patients survived the acute illness (85.2%). Pre-infection chronic lung allograft dysfunction (CLAD) was an independent predictor of mortality (adjusted HR: 5.03, 1.14-22.25; p = 0.033).
Conclusions: COVID-19 is associated with significant morbidity and mortality among LT patients. Patients on chronic anticoagulation seem to enjoy favorable outcomes, while higher BMI and peak D-dimer levels are associated with a higher risk of ARF. Pre-infection CLAD is associated with an increased risk of death from COVID-19. This article is protected by copyright. All rights reserved.
Keywords: D-dimer; SARS-CoV-2; allograft dysfunction; anticoagulants; coagulation; survival.
. 2021 Nov 18;e14540.
doi: 10.1111/ctr.14540. Online ahead of print.
Predictors and Outcomes of Respiratory Failure among Lung Transplant Patients with COVID-19
Adrian Lawrence[SUP] 1 [/SUP], Luke D Mahan[SUP] 1 [/SUP], Manish R Mohanka[SUP] 1 [/SUP], Srinivas Bollineni[SUP] 1 [/SUP], Vaidehi Kaza[SUP] 1 [/SUP], Ricardo M La Hoz[SUP] 2 [/SUP], Song Zhang[SUP] 3 [/SUP], Corey Kershaw[SUP] 1 [/SUP], Lance S Terada[SUP] 1 [/SUP], Fernando Torres[SUP] 1 [/SUP], Amit Banga[SUP] 1 [/SUP]
Affiliations
- PMID: 34792221
- DOI: 10.1111/ctr.14540
Abstract
Background: There is limited data on the predictors and outcomes of new or worsening respiratory failure among lung transplant (LT) patients with Coronavirus disease 2019 (COVID-19).
Methods: We included all the LT patients diagnosed with COVID-19 during a one-year period (March 2020 to Feb 2021; n = 54; median age: 60, 20-73 years; M:F 37:17). Development of new or worsening respiratory failure (ARF) was the primary outcome variable.
Results: The overall incidence of ARF was 48.1% (n = 26). More than 20% of patients (n = 11) needed intubation and mechanical ventilation. Body mass index >25 Kg/m[SUP]2[/SUP] (adjusted OR: 5.7, 0.99-32.93; p = 0.05) and peak D-dimer levels >0.95 mcg/mL (adjusted OR: 24.99, 1.77-353.8; p = .017) were independently associated with ARF while anticoagulation use prior to COVID-19 was protective (adjusted OR: 0.024, 0.001-0.55; p = 0.02). Majority patients survived the acute illness (85.2%). Pre-infection chronic lung allograft dysfunction (CLAD) was an independent predictor of mortality (adjusted HR: 5.03, 1.14-22.25; p = 0.033).
Conclusions: COVID-19 is associated with significant morbidity and mortality among LT patients. Patients on chronic anticoagulation seem to enjoy favorable outcomes, while higher BMI and peak D-dimer levels are associated with a higher risk of ARF. Pre-infection CLAD is associated with an increased risk of death from COVID-19. This article is protected by copyright. All rights reserved.
Keywords: D-dimer; SARS-CoV-2; allograft dysfunction; anticoagulants; coagulation; survival.