Conflicting results have been reported on the outcome of coronavirus disease 2019 (COVID-19) in patients with pre-existing chronic obstructive pulmonary disease (COPD). A recent prospective cohort study published, assessed patients with both conditions to try and predict the mortality risk.
Study
The current observational cohort study included 165 patients with COPD who developed COVID-19. The aim was to identify biomarkers that could predict outcomes in these patients and whether a model could be created for this purpose using the identified markers.
Most patients were males, older than 65 years, and diagnosed with cardiovascular disease. About 25% of the study cohort required non-invasive ventilation, with 30% of these individuals eventually requiring mechanical ventilation. Of these 13 patients, nine died during the study period.
Patients with severe COVID-19, renal failure, diabetes, a history of ever or current smoking, and oxygen supplementation requirements at the time of admission were at an increased risk for ventilation or death. Likewise, those with high levels of lactate dehydrogenase (LDH) and C-reactive protein (CRP), or low lymphocyte and eosinophil counts, were also more likely to have a worse prognosis.
Patients who succumbed to the infection were more likely to have renal failure, more widespread lung disease, require oxygen treatment when first admitted to hospital, and have high LDH and low lymphocyte levels.
Patients with a non-invasive ventilation score of -4.5 or less were at a greater risk for non-invasive ventilation in 85% of cases. This score was based on the value obtained from the polymerase chain reaction (PCR) test for detecting SARS-CoV-2, the number of lung lobes affected, and presence of diabetes.
The invasive ventilation score predicting invasive ventilation risk was based on the number of affected pulmonary lobes, active smoking history, whether the patient required non-invasive ventilation, and already being prescribed lung medication. Those with a score of -7.15 or less were more likely in 75% of cases to be transferred to the ICU for mechanical ventilation.
The mortality score was calculated based on the presence of kidney failure or mechanical ventilation. A mortality score of -2.8 or less was predictive of death in over 85% of cases. However, the specificity was low, with less than 40% of the mortality variance explained by these markers.
The invasive ventilation score appeared to have the greatest prediction accuracy among all three scores.
Conclusion
Patients with COPD do not appear to be at a greater risk of mortality from COVID-19; however, COPD patients may be more likely to develop COVID-19, with the presence of this pulmonary disease potentially affecting the progression of COVID-19. The most important markers for poor outcomes were those related to the severity of COVID-19, which is similar to other patient groups.
The current study did not examine at how COVID-19 severity was graded; therefore, these conclusions must to be verified. The study findings contradict those reported in earlier studies that identify COPD as a risk factor for mortality from all causes in COVID-19 patients.
The wide disparity in the prevalence of lung disease among COVID-19 patients varied with the period of the pandemic, type of data collection method used, and study population. Medication compliance was not identified in the current study; however, this could also be an important factor for determining the outcome of COVID-19 in this patient population.
Source:
https://www.news-medical.net/news/20230808/Outcome-markers-in-COPD-patients-with-COVID-19.aspx