Outcomes of Covid-19 organizing pneumonia in critically ill patients

Rocha, Ana Silva; Meireles, Mariana; Vilaça, Helena; Guimarães, Teresa; Martins, Marta Dalila; Santos, Lívia; Castro, Alexandra; Mesquita, Mari

doi:10.1016/j.jinf.2021.06.025

Cited by 8 publications

(8 citation statements)

References 9 publications

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“…In that study, OP was observed in 4.8% of these patients, with significant radiological and clinical improvement following steroid administration (28). In addition, in a study on respiratory intermediate care unit patients, 58% of patients that underwent a chest CT scan had a radiological pattern consistent with OP and a significantly decreased need for intubation and in-hospital mortality compared to those with a GGO pattern (29).…”

Section: Discussionmentioning

confidence: 86%

Radiologically suspected COVID‑19‑associated organizing pneumonia responding well to corticosteroids: A report of two cases and a review of the literature

et al. 2022

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Organizing pneumonia (OP) is a type of diffuse interstitial lung disease, which may be induced in the context of several clinical conditions, such as drug reactions, infections, autoimmune diseases and cancer. Coronavirus disease 2019 (COVID-19)-associated OP has been reported as a late-stage consequence of the infection or a histological form of COVID-19-associated pneumonia. Autopsies and postmortem lung biopsies have demonstrated that the majority of patients with COVID-19-associated pneumonia develop secondary OP, and COVID-19-associated pneumonia and OP have common radiological features. The diagnosis of COVID-19-associated OP should be suspected in patients with severe acute respiratory syndrome coronavirus 2 infection who exhibit clinical deterioration despite optimal care, or who have aggravating symptoms following an initial recovery. The use of corticosteroids is a typical treatment for OP. However, to date, at least to the best of our knowledge, there are a few reports regarding the role of corticosteroids in COVID-19-associated pneumonia; thus, the optimal time for administration, the dose and treatment duration have not yet been determined. The present study presents two cases of patients with COVID-19, who exhibited clinical deterioration following the initial phase of infection and with radiological characteristics of OP who received corticosteroids and had a favorable outcome. The early diagnosis of COVID-19-associated OP may lead to targeted treatment, decreased requirements for ventilatory support and an improved survival rate.

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Section: Discussionmentioning

confidence: 86%

Radiologically suspected COVID‑19‑associated organizing pneumonia responding well to corticosteroids: A report of two cases and a review of the literature

et al. 2022

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“…Additionally, if the worst OSCI = 4, the odds for OP are 2.722 times higher than having OSCI ≤ 3. After adjusting for other factors, no differences were found between groups for sex, frailty score, comorbidities, and the use of dexamethasone as a treatment for COVID- [12,13]. Both studies suggested that a more severe disease may be associated with progression to OP.…”

Section: Resultsmentioning

confidence: 91%

“…In that study, 83% of the patients diagnosed with OP previously required supplementary oxygen during the pneumonia phase of COVID-19, and half of them required ICU admission with 46% requiring invasive mechanical ventilation. Contrarily, among critically ill patients with COVID-19 pneumonia, admitted to an ICU, Rocha et al.de scribed a prevalence of OP that reached 58.0% [ 12 , 13 ]. Both studies suggested that a more severe disease may be associated with progression to OP.…”

Section: Discussionmentioning

confidence: 99%

“…As a retrospective study, there were variables with frequently missing data, including relevant data such as comorbidities and smoking habits. Variables of interest, such as procalcitonin, fibrinogen and IL-6, which literature suggests to be associated to COVID-19 disease severity, were not systematically collected and were, therefore, excluded from the multivariate analysis [ 13 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

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Secondary Organising Pneumonia Among COVID-19 Patients: A Retrospective Case-Control Study

Sinde¹,

Teixeira²,

Figueiredo³

et al. 2022

Cureus

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Coronavirus disease 2019 (COVID-19) is an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Secondary organising pneumonia (OP) induced by SARS-CoV-2 infection is a recently recognised complication of COVID-19. We aimed to evaluate the prevalence of OP among hospitalised patients with COVID-19 pneumonia and to assess whether disease severity and other clinical factors and comorbidities are correlated with OP development.We conducted a retrospective case-control study including hospitalised patients due to COVID-19 who performed a chest CT scan during hospitalisation and compared patients with clinical and radiological evidence of OP to patients without evidence of OP. Demographics, comorbidities, disease severity, dexamethasone/remdesivir treatment, laboratory results, and outcomes were compared between groups.One hundred fifteen patients were included, of whom 48 (41.7%) fulfilled clinical and imaging criteria for OP. Among OP patients, the most common chest CT-scan findings were consolidations, arciform condensations, and subpleural bands. OP patients had longer hospitalisation (19.5 vs 10 days, p=0.002) and more frequent ICU admission, but no significant differences in readmittance or mortality rates within 180 days compared to controls. In the adjusted effects model, the need for supplementary oxygen on the 21 st day after symptom onset, the presence of Ordinal Scale for Clinical Improvement (OSCI) = 4, when compared to OSCI ≤ 3, and higher C-reactive protein on admission, were significantly associated with higher odds for OP. No other differences were identified between OP and controls after adjusting for other factors. The use of remdesivir or dexamethasone did not impact the diagnosis of OP. Only 38% of OP patients required treatment with high-dose corticosteroids.In conclusion, SARS-CoV-2-induced OP may be more frequent than previously thought, especially among hospitalised patients and patients with a more severe disease, particularly those who fail to improve after the second week of disease or who present higher inflammatory markers on admission. It increases the length of stay, but not all patients require specific treatment and OP may improve despite the absence of high-dose corticosteroid treatment.

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“…The timing of developing organising pneumonia after COVID-19 infection is not well established, but may be related to the severity of the initial COVID-19 infection. While one study showed that CT changes suggestive of organising pneumonia occur as early as 3 weeks after the onset of COVID-19 infection,12 in severe COVID-19 infection, the diagnosis of organising pneumonia is often reached via CT scan at time of the initial COVID-19 infection 13. Organising pneumonia following severe COVID-19 infection also presents primarily with hypoxaemia.…”

Section: Discussionmentioning

confidence: 99%

Delayed organising pneumonia in an immunocompromised host after a mild COVID-19 infection

2023

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Organising pneumonia after a mild COVID-19 infection has been increasingly reported and poses a diagnostic challenge to physicians especially in immunocompromised patients. We report a patient with a background of lymphoma in remission on rituximab who presented with prolonged and persistent fever after recovering from a mild COVID-19 infection. The initial workup showed bilateral lower zone lung consolidation; however, the infective and autoimmune workup were unremarkable. Subsequently, a bronchoscopy with transbronchial lung biopsy confirmed the diagnosis of organising pneumonia. A tapering glucocorticoid regimen was commenced with prompt resolution of the patient’s clinical symptoms, and subsequent resolution of biochemical markers and radiological lung changes 3 months later. This case highlights the importance of early recognition of the diagnosis of organising pneumonia in immunocompromised populations after a mild COVID-19 infection as it shows promising response to glucocorticoid therapy.

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Outcomes of Covid-19 organizing pneumonia in critically ill patients

Cited by 8 publications

References 9 publications

Radiologically suspected COVID‑19‑associated organizing pneumonia responding well to corticosteroids: A report of two cases and a review of the literature

Radiologically suspected COVID‑19‑associated organizing pneumonia responding well to corticosteroids: A report of two cases and a review of the literature

Secondary Organising Pneumonia Among COVID-19 Patients: A Retrospective Case-Control Study

Delayed organising pneumonia in an immunocompromised host after a mild COVID-19 infection

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