Epidemiological Profile of Hospitalized Patients with Cystic Fibrosis in Brazil Due to Severe Acute Respiratory Infection during the COVID-19 Pandemic and a Systematic Review of Worldwide COVID-19 in Those with Cystic Fibrosis

Abstract

Since the onset of the coronavirus disease, COVID-19 pandemic, concern arose for those who might be at higher risk of a worse COVID-19 prognosis, such as those with cystic fibrosis (CF). In this context, we evaluated the features of hospitalized patients with CF due to severe acute respiratory infection (SARI) in Brazil and we also performed a systematic review including all the studies published from the beginning of the first case of COVID-19 (17 November 2019) to the date of this search (23 May 2022) which included, concomitantly, patients with CF and COVID-19 in the worldwide population. In our Brazilian data, we evaluated the period from December 2019 to March 2022, and we included 33 demographical and clinical patients’ features. We classified the patients into groups: (G1) SARI due to another viral infection than severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (23; 5.4%), (G2) SARI due to an unknown etiological agent (286; 67.1%), and (G3) SARI due to SARS-CoV-2 infection (117; 27.5%). The individuals in G3 tended to be older, especially over 50 years old, and presented a higher prevalence of dyspnea, peripheral capillary oxygen saturation (SpO2) <95%, and cardiopathy. The highest prevalence for intensive care unit (ICU) treatment (52; 44.4%) and invasive mechanical ventilation (29; 24.8%) was for patients in G3. Almost half of the patients in G3 died (51; 43.6%); in contrast, none in G1 died. However, we observed 43 (15.0%) deaths in G2. In addition, 12 (4.2%) and one (0.9%) death not associated with SARI occurred, respectively, in the G2 and G3. The patients who died due to SARS-CoV-2 infection had a higher frequency of SpO2 <95% (46; 90.2%), ICU treatment (34; 66.7%), and invasive mechanical ventilation (27; 52.9%) when compared to those who recovered. The systematic review comprised a total of 31 papers published as observational studies. These studies comprised 661,386 patients in total, including children, adults, and elderly age groups. However, only 19,150 (2.9%) patients were diagnosed with CF and, from these patients, 2523 (0.4%) were diagnosed with both CF and COVID-19. It was observed that the most common outcome was the need for hospitalization (n = 322 patients with CF), and the need for oxygen support (n = 139 patients with CF). One hundred patients with CF needed intensive care units, fifty patients needed non-invasive mechanical ventilation support, and only three patients were described as receiving invasive mechanical ventilation support. Deaths were described in 38 patients with CF. Importantly, lung-transplanted patients with CF represented an increased risk of death in one publication; in accordance, another study described that lung transplantation and moderate to severe lung disease were independent risk factors for severe outcomes after SARS-CoV-2 infection. In contrast with the literature, in conclusion, Brazilian patients in G3 presented a severe phenotype, even though most of the other studies did not observe worse outcomes in patients with CF and COVID-19.

Occurrence of COVID-19 in cystic fibrosis patients: a review

“…According to a recent publication (Tedbury et al, 2023 ), CFTR may additionally affect the severity of SARS-CoV-2 infection and COVID-19 ailments in CF patients (Vitiello et al, 2023 ). Meanwhile, a literature evaluation (Marques et al, 2023 ) emphasizes the restricted understanding regarding the effects of COVID-19 on CF patients. The evaluation indicates that CF patients may be at a greater risk of intense infection from COVID-19 due to their underlying lung disease and other comorbidities (Marques et al, 2023 ).…”

“…Meanwhile, a literature evaluation (Marques et al, 2023 ) emphasizes the restricted understanding regarding the effects of COVID-19 on CF patients. The evaluation indicates that CF patients may be at a greater risk of intense infection from COVID-19 due to their underlying lung disease and other comorbidities (Marques et al, 2023 ). Additionally, an examination carried out in Brazil indicates using observational studies to assess the results of COVID-19 on individuals diagnosed with cystic fibrosis ( Table 1 ; Sorci et al, 2020 ).…”

Beyond Borders of the Cell: How Extracellular Vesicles Shape COVID-19 for People with Cystic Fibrosis

“…CFTR modulators were also associated with a significant decrease in hospitalization of PwCF requiring oxygen, and it was concluded that having lower lung function is linked to more severe outcomes in COVID-19 [26]. Other investigators found a higher incidence of SARS-CoV-2 infection in PwCF despite reports of less severe COVID-19 in this population [27,28]. Another study suggested that CFTR may facilitate the virus replication because IOWH-032, a small molecule CFTR inhibitor, suppressed SARS-CoV-2 replication [29].…”