tetano
Editor, Senior Moderator
J R Soc Med
. 2023 Jul 5;1410768231184162.
doi: 10.1177/01410768231184162. Online ahead of print. Impact of SARS-CoV-2 infective exacerbation of chronic obstructive pulmonary disease on clinical outcomes in a prospective cohort study of hospitalised adults
Catherine Hyams[SUP] 1 [/SUP], George Qian[SUP] 2 [/SUP], George Nava[SUP] 3 [/SUP], Robert Challen[SUP] 2 [/SUP], Elizabeth Begier[SUP] 4 [/SUP], Jo Southern[SUP] 4 [/SUP], Maria Lahuerta[SUP] 4 [/SUP], Jennifer L Nguyen[SUP] 4 [/SUP], Jade King[SUP] 5 [/SUP], Anna Morley[SUP] 6 [/SUP], Madeleine Clout[SUP] 7 [/SUP], Nick Maskell[SUP] 3 [/SUP], Luis Jodar[SUP] 4 [/SUP], Jennifer Oliver[SUP] 7 [/SUP], Gillian Ellsbury[SUP] 8 [/SUP], John M McLaughlin[SUP] 4 [/SUP], Bradford D Gessner[SUP] 4 [/SUP], Adam Finn[SUP] 9 [/SUP], Leon Danon[SUP] 2 [/SUP], James W Dodd[SUP] 10 [/SUP]; Avon CAP Research Group
Affiliations
Objectives: To determine whether acute exacerbations of chronic obstructive pulmonary disease (AECOPD) triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have worse outcomes than AECOPD caused by other infectious agents or non-infective AECOPD (NI-COPD).
Design: A two-hospital prospective cohort study of adults hospitalised with acute respiratory disease. We compared outcomes with AECOPD and a positive test for SARS-CoV-2 (n = 816), AECOPD triggered by other infections (n = 3038) and NI-COPD (n = 994). We used multivariable modelling to adjust for potential confounders and assessed variation by seasons associated with different SARS-CoV-2 variants.
Setting: Bristol UK, August 2020-May 2022.
Participants: Adults (≥18 y) hospitalised with AECOPD.
Main outcome measures: We determined the risk of positive pressure support, longer hospital admission and mortality following hospitalisation with AECOPD due to non-SARS-CoV-2 infection compared with SARS-CoV-2 AECOPD and NI-COPD.
Results: Patients with SARS-CoV-2 AECOPD, in comparison to non-SARS-CoV-2 infective AECOPD or NI-COPD, more frequently required positive pressure support (18.5% and 7.5% vs. 11.7%, respectively), longer hospital stays (median [interquartile range, IQR]: 7 [3-15] and 5 [2-10] vs. 4 [2-9] days, respectively) and had higher 30-day mortality (16.9% and 11.1% vs. 5.9%, respectively) (all p < 0.001). In adjusted analyses, SARS-CoV-2 AECOPD was associated with a 55% (95% confidence interval [95% CI]: 24-93), 26% (95% CI: 15-37) and 35% (95% CI: 10-65) increase in the risk of positive pressure support, hospitalisation length and 30-day mortality, respectively, relative to non-SARS-CoV-2 infective AECOPD. The difference in risk remained similar during periods of wild-type, Alpha and Delta SARS-CoV-2 strain dominance, but diminished during Omicron dominance.
Conclusions: SARS-CoV-2-related AECOPD had worse patient outcomes compared with non-SARS-CoV-2 AECOPD or NI-AECOPD, although the difference in risks was less pronounced during Omicron dominance.
Keywords: COPD; COVID-19; SARS-CoV-2; acute exacerbation of COPD; airways disease.
. 2023 Jul 5;1410768231184162.
doi: 10.1177/01410768231184162. Online ahead of print. Impact of SARS-CoV-2 infective exacerbation of chronic obstructive pulmonary disease on clinical outcomes in a prospective cohort study of hospitalised adults
Catherine Hyams[SUP] 1 [/SUP], George Qian[SUP] 2 [/SUP], George Nava[SUP] 3 [/SUP], Robert Challen[SUP] 2 [/SUP], Elizabeth Begier[SUP] 4 [/SUP], Jo Southern[SUP] 4 [/SUP], Maria Lahuerta[SUP] 4 [/SUP], Jennifer L Nguyen[SUP] 4 [/SUP], Jade King[SUP] 5 [/SUP], Anna Morley[SUP] 6 [/SUP], Madeleine Clout[SUP] 7 [/SUP], Nick Maskell[SUP] 3 [/SUP], Luis Jodar[SUP] 4 [/SUP], Jennifer Oliver[SUP] 7 [/SUP], Gillian Ellsbury[SUP] 8 [/SUP], John M McLaughlin[SUP] 4 [/SUP], Bradford D Gessner[SUP] 4 [/SUP], Adam Finn[SUP] 9 [/SUP], Leon Danon[SUP] 2 [/SUP], James W Dodd[SUP] 10 [/SUP]; Avon CAP Research Group
Affiliations
- PMID: 37404021
- DOI: 10.1177/01410768231184162
Objectives: To determine whether acute exacerbations of chronic obstructive pulmonary disease (AECOPD) triggered by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have worse outcomes than AECOPD caused by other infectious agents or non-infective AECOPD (NI-COPD).
Design: A two-hospital prospective cohort study of adults hospitalised with acute respiratory disease. We compared outcomes with AECOPD and a positive test for SARS-CoV-2 (n = 816), AECOPD triggered by other infections (n = 3038) and NI-COPD (n = 994). We used multivariable modelling to adjust for potential confounders and assessed variation by seasons associated with different SARS-CoV-2 variants.
Setting: Bristol UK, August 2020-May 2022.
Participants: Adults (≥18 y) hospitalised with AECOPD.
Main outcome measures: We determined the risk of positive pressure support, longer hospital admission and mortality following hospitalisation with AECOPD due to non-SARS-CoV-2 infection compared with SARS-CoV-2 AECOPD and NI-COPD.
Results: Patients with SARS-CoV-2 AECOPD, in comparison to non-SARS-CoV-2 infective AECOPD or NI-COPD, more frequently required positive pressure support (18.5% and 7.5% vs. 11.7%, respectively), longer hospital stays (median [interquartile range, IQR]: 7 [3-15] and 5 [2-10] vs. 4 [2-9] days, respectively) and had higher 30-day mortality (16.9% and 11.1% vs. 5.9%, respectively) (all p < 0.001). In adjusted analyses, SARS-CoV-2 AECOPD was associated with a 55% (95% confidence interval [95% CI]: 24-93), 26% (95% CI: 15-37) and 35% (95% CI: 10-65) increase in the risk of positive pressure support, hospitalisation length and 30-day mortality, respectively, relative to non-SARS-CoV-2 infective AECOPD. The difference in risk remained similar during periods of wild-type, Alpha and Delta SARS-CoV-2 strain dominance, but diminished during Omicron dominance.
Conclusions: SARS-CoV-2-related AECOPD had worse patient outcomes compared with non-SARS-CoV-2 AECOPD or NI-AECOPD, although the difference in risks was less pronounced during Omicron dominance.
Keywords: COPD; COVID-19; SARS-CoV-2; acute exacerbation of COPD; airways disease.