Interstitial lung disease increases susceptibility to and severity of COVID-19

Abstract

BackgroundThere are limited data regarding the relationship between interstitial lung disease (ILD) and the natural course of coronavirus disease 2019 (COVID-19). In this study, we investigate whether patients with ILD are more susceptible to COVID-19 than those without ILD and evaluate the impact of ILD on disease severity in patients with COVID-19.MethodsA nationwide cohort of patients with COVID-19 (n=8070) and a 1:15 age-, sex-, and residence-matched cohort (n=121 050) were constructed between January 1, 2020 and May 30, 2020 in Korea. We performed a nested case-control study to compare the proportions of patients with ILD between the COVID-19 cohort and the matched cohort. Using the COVID-19 cohort, we also evaluated the risk of severe COVID-19 in patients with ILD versus those without ILD.ResultsThe proportion of patients with ILD was significantly higher in the COVID-19 cohort than in the matched cohort (0.8% versus 0.4%, p<0.001). The odds ratio [OR] of having ILD was significantly higher in the COVID-19 cohort than in the matched cohort (adjusted OR=2.02, 95% confidence interval [CI]=1.54–2.61). Among patients in the COVID-19 cohort, patients with ILD were more likely to have severe COVID-19 than patients without ILD (49.3% versus 13.1%), including mortality (13.4% versus 2.8%) (all p<0.01). The risk of severe COVID-19 was significantly higher in patients with ILD than in those without ILD (adjusted OR=2.32, 95% CI=1.24–4.01).ConclusionThe risks of COVID-19 and severe presentation were significantly higher in patients with ILD than in those without ILD.

Angiotensin-Converting Enzyme 2 (ACE2), Transmembrane Peptidase Serine 2 (TMPRSS2), and Furin Expression Increases in the Lungs of Patients with Idiopathic Pulmonary Fibrosis (IPF) and Lymphangioleiomyomatosis (LAM): Implications for SARS-CoV-2 (COVID-19) Infections

“…We identified here that ACE2, TMPRSS2, and Furin are highly expressed on small airway epithelium and alveolar region in both IPF and LAM patients, especially high in IPF, which indicates that LAM and IPF patients could be more vulnerable to COVID-19 infections, and this could further exaggerate due to smoking history and comorbidities. Our findings provide the first histopathological evidence supporting the recent observational study from Lee et al [29] The study reported that patients with ILD had higher susceptibility to COVID-19 and had more severe clinical outcomes from COVID-19, especially patients with IPF [29]. However, the reason for this increased risk for COVID-19 in IPF patients was not provided at a tissue level.…”

How COVID-19 interacts with interstitial lung disease

“…Disease subtype appears to be important in disease susceptibility. In the study by LEE et al [11], patients with all subtypes of ILD examined demonstrated increased frequency of infection, with the exception of chronic hypersensitivity pneumonitis, and the effect was most pronounced in patients with IPF. In the study by ESPOSITO et al [12], usual interstitial pneumonitis pattern (typically seen in IPF) was more common in non-survivors, but this did not reach statistical significance.…”

“…It appears that patients with ILD are indeed more susceptible to contracting COVID-19. In a Korean study of patients with COVID-19 compared with age, sex and location matched controls, LEE et al [11] found that 0.8% of COVID-19 patients had an ILD diagnosis versus 0.4% of matched controls giving an adjusted OR for ILD of 2.02 (95% CI 1.54-2.61; p<0.001). LEE et al [11] also demonstrated that patients with ILD in the COVID-19 cohort were more likely to have severe disease compared with those without (49.3% versus 13.1%, adjusted OR 2.32, 95% CI 1.24-4.01) and patients with ILD are also more likely to succumb to infection.…”

“…In a Korean study of patients with COVID-19 compared with age, sex and location matched controls, LEE et al [11] found that 0.8% of COVID-19 patients had an ILD diagnosis versus 0.4% of matched controls giving an adjusted OR for ILD of 2.02 (95% CI 1.54-2.61; p<0.001). LEE et al [11] also demonstrated that patients with ILD in the COVID-19 cohort were more likely to have severe disease compared with those without (49.3% versus 13.1%, adjusted OR 2.32, 95% CI 1.24-4.01) and patients with ILD are also more likely to succumb to infection. In a study of 46 ILD patients who developed COVID-19 infection, ESPOSITO et al [12] found that the odds ratio for death was 3.2 (95% CI 1.3-7.3; p=0.01) when compared to age-and sex-matched controls, and this increased to 4.3 (95% CI 1.4-4.3; p=0.01) after adjustment for age, sex, race, smoking status, cardiovascular disease (congestive heart failure and/or coronary artery disease), and any chronic immunosuppression.…”

Pulmonary Fibrosis in the Time of COVID-19

“…They found that the proportion of patients with previous ILD was significantly higher in the COVID-19 cohort than in the control cohort (0.8% versus 0.4%; P < .001), indicating that they were more susceptible to becoming infected (oddas ratio [OR] = 2.02; 95% confidence interval [95% CI ], 1.54-2.61). 8 However, we do not currently know how this risk will change after vaccination in this group of patients.…”