Impact of SARS-CoV-2 infective exacerbation of chronic obstructive pulmonary disease on clinical outcomes in a prospective cohort study of hospitalised adults

Abstract

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.

Persistent Respiratory Failure and Re-Admission in Patients with Chronic Obstructive Pulmonary Disease Following Hospitalization for COVID-19

“…The baseline situation of patients with COPD, the severity of the process, prolonged stay, the treatment used, the presence of comorbidities, and SARS-CoV2 variant are some of the factors that will influence a patient's situation when the infection resolves. [1][2][3][4][5][6]14 Furthermore, COPD exacerbation due to SARS-COV2 seems to have a worse prognosis compared to other exacerbations not related to this…”

“…Figueira-Gonçalves et al Dovepress virus. Hyams et al 14 compared outcomes of patients hospitalized with SARS-CoV-2 infective exacerbation vs non-SARS-CoV-2 infective exacerbation and found that SARS-CoV-2 exacerbation was associated with worse outcomes than for those admitted with non-SARS-CoV2 infective exacerbation, with a 55% and 26% and 35% increased risk of positive pressure support, hospitalization length and 30-day mortality, respectively, when controlling for potential confounders such as age, chronic medical conditions and vaccination status. The rate of re-admission in the 12 months following hospitalization for COVID-19 is estimated to be ≈ 10%, 15,16 being higher in the elderly and in subjects with multiple comorbidities like COPD or cardiovascular disease.…”

“…Current evidence suggesting that outcomes have improved over time for patients with COPD hospitalized with SARS-CoV-2 based on circulating and dominant variants, vaccination rates, healthcare pressure and COVID-19 treatments is varied. 14,22,[24][25][26][27][28] Taking into account these aspects, more studies will be required to confirm our results in the current health situation, especially with regard to these patients' evolution after hospital discharge, evaluating the clinical impact of new dominant SARS-CoV2 variants, treatments and vaccination on this group of patients.…”