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

Author:

Hyams Catherine1ORCID,Qian George2,Nava George3,Challen Robert2,Begier Elizabeth4,Southern Jo4,Lahuerta Maria4,Nguyen Jennifer L4,King Jade5,Morley Anna6,Clout Madeleine7,Maskell Nick3,Jodar Luis4,Oliver Jennifer7,Ellsbury Gillian8,McLaughlin John M4,Gessner Bradford D4,Finn Adam9,Danon Leon2,Dodd James W10,

Affiliation:

1. Academic Respiratory Unit and Bristol Vaccine Centre, University of Bristol, Bristol, BS15, UK

2. Engineering Mathematics, University of Bristol, Bristol, Bristol, BS8, UK

3. Academic Respiratory Unit, University of Bristol, Southmead Hospital, Bristol, Bristol, BS15, UK

4. Vaccines Medical Development, Scientific and Clinical Affairs, Pfizer Inc., Collegeville, PA 19426, USA

5. Clinical Research and Imaging Centre, UHBW NHS Trust, Bristol, Bristol, BS2, UK

6. Academic Respiratory Unit, Southmead Hospital, Bristol, Bristol, BS15, UK

7. Bristol Vaccine Centre and Population Health Sciences, University of Bristol, Bristol, BS2, UK

8. Vaccines Medical Affairs, Pfizer Ltd, Tadworth, KT20, UK

9. Bristol Vaccine Centre, Cellular and Molecular Medicine and Population Health Sciences, University of Bristol, Bristol, BS2, UK

10. Academic Respiratory Unit and Population Health Sciences, University of Bristol, Southmead Hospital, Bristol, BS15, UK

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.

Funder

Pfizer Inc

Publisher

SAGE Publications

Subject

General Medicine

Reference30 articles.

1. National Institute for Health and Care Excellence. Chronic obstructive pulmonary disease in over 16s: diagnosis and management. NICE; 2019. See www.nice.org.uk/guidance/ng115/chapter/Recommendations#managing-exacerbations-of-copd (last checked 19 August 2022).

2. Terms and Definitions Used to Describe Recurrence, Treatment Failure and Recovery of Acute Exacerbations of COPD: A Systematic Review of Observational Studies

3. Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2022 report). 2022. See https://goldcopd.org/2022-gold-reports-2/ (last checked 18 August 2022).

4. Viral epidemiology of acute exacerbations of chronic obstructive pulmonary disease

5. Respiratory Viral Infections in Adults With and Without Chronic Obstructive Pulmonary Disease

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