Mortality and Risk Factors in Hospitalized Covid-19 Patients with Hypersensitivity Pneumonitis: An Observational Study of Thirty Cases.
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Keywords
COVID-19, hypersensitivity pneumonitis, interstitial lung disease, mortality, pulmonary function test, steroid, treatment
Abstract
Background and aim
During the Coronavirus Disease 2019(COVID-19) pandemic, it was shown that patients who had a comorbidity like interstitial lung disease had the worst prognosis and increased risk of death due to COVID-19 infection. There is not enough research investigating the effect of COVID-19 on patients with hypersensitivity pneumonitis(HP), a relatively common ILD. As a result, this paper aims to investigate the mortality and related risk factors in hospitalized patients for COVID-19 with HP.
Methods
Thirty patients(18female and 12male) with HP were hospitalized for COVID-19 pneumonia between June 1, 2020, and December 30, 2022, and were evaluated retrospectively at the tertiary pandemic hospital. The patients were recruited from the hospital information management system. COVID-19 was detected in patients' nasopharyngeal and throat swab samples using real-time Polymerase Chain Reaction.
Results
The median age of the HP patients was 58.9±11.6(range 34-81)years, and 18(60%) were female. The median follow-up period for HP was 31(IQR, 24) months. Bronchoalveolar lavage, transbronchial biopsy, criobiopsy, and Video-Assisted Thoracoscopic Surgery were used to diagnose HP. Before COVID-19 diagnosis, 27(90%) patients used immunosuppressive treatment, 27/30 used methylprednisolone, and 9/30 used other immunosuppressive. At admission, blood CRP, sedimentation rate, procalcitonin, lactate dehydrogenase, D-dimer, ferritin, and fibrinogen levels were higher than the normal range. The most common radiological findings in computed tomography in HP patients with COVID-19 pneumonia were consolidation and ground-glass opacities. Of the 30 HP cases, 9(30%) were intubated and died of COVID-19 infection. Non-survivors had lower FEV1%predicted, FVC%predicted, DLCO%,and 6MWT in the non-survivor group than in the survivor group. Furthermore, the blood neutrophil count, neutrophil/lymphocyte ratio, and CRP level were higher in non-survivors.
Conclusions
This study's mortality rate in HP patients with COVID-19 was 30%. Lower FEV1%predicted, FVC%predicted, DLCO% and 6MWT were also related to mortality in HP cases with COVID-19.
References
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1.World Health Organization. Statement on the fifteenth meeting of the IHR (2005) Emergency Committee on the COVID-19 pandemic. www.who.int/news Accessed December 16, 2023).
Running Title: Hypersensitivity pneumonitis with COVID-19
2. Dutt N, Shishir S, Chauhan NK, et al. Mortality and its predictors in COVID-19 patients with preexisting interstitial lung disease. Cureus 14(8): e27759. DOI 10.7759/cureus.27759.
3. Kondoh Y, Kataoka K, Ando M, et al. COVID-19 and acute exacerbation of interstitial lung disease. Respir Investig 2021;59:675-8. DOI: 10.1016/j.resinv.2021.06.007
4. Dessie ZG, Zewotir T. Mortality related risk factors of COVID-19: a systematic review and meta-analysis of 42 studies and 423,117 patients. BMC Infect Dis 2021;21:855 DOI: 10.1186/s12879-021-06536-
5. Yang B, Choi H, Lee SK, et al. Risk of coronavirus disease occurrence, severe presentation, and mortality in patients with lung cancer Cancer Res Treat 2021;53:678-684
6. Esposito AJ, Menon AA, Ghosh AJ, et al. Increased odds of death for patients with interstitial lung disease and COVID-19: A case-control study. Am J Respir Crit Care Med. 2020;202:1710-1713. DOI: 10.1164/rccm.202006-2441LE.].
7. Lee H, Hayoung C, Yang B, et al. Interstitial lung disease increases the susceptibility and severity of COVID-19. Eur Respir J 2021;58:2004125. DOI: 10.1183/13993003.04125-2020.
8. Dutt N, Shishir S, Chauhan NK, et al. Mortality and its predictors in COVID-19 patients with preexisting interstitial lung disease. Cureus 14(8): e27759. DOI 10.7759/cureus.27759).
9. Cilli A, Hanta I, Uzer F, et al. Characteristics and outcomes of COVID-19 patients with IPF: A multicenter retrospective study. Respir Med and Res 2022;81:100900 DOI: 10.1016/j.resmer.2022.100900.).
10. Hamblin M, Prosch H, Vasakova M. Diagnosis, course and management of hypersensitivity pneumonitis. Eur Respir Rev. ; 31:210169. DOI: 10.1183/16000617.0169-2021.).
11. Ministry of Health, Turkey. Covid-19 Algoritmalar (Online). Website https://www.covid19.saglik.gov.tr [Accessed December 21, 2020].
12. Gebhard C, Regitz-Zagrosek V, Neuhauser HK, Morgan R, Klein SL. Impact of sex and gender on COVID-19 outcomes in Europe. Biol Sec Differ. 2020;11:29. DOI:10.1186/s13293-020-00304-9.
Running Title: Hypersensitivity pneumonitis with COVID-19
13. Kokturk N, Babayigit C, Kul S, et al. The predictors of COVID-19 mortality in a nationwide cohort of Turkish patients. Respir Med 2021;183:106433. DOI:10.1016/j.rmed.2021.106433.
14. Afsin E, Demirkol ME. Factors affecting prognosis and mortality in severe COVID-19 pneumonia patients. Acta Clin Croat 2023;62:106-114.
15. Drake TM, Docherty AB, Harrison EM, et al. Outcome of hospitalization for COVID-19 in patients with intersitital lung disease. Am J Respir Crit Care Med. 2020;202(12):1656-1665. DOI:10.1164/rccm.202007-2794OC.
16. Golpe R, Blanco N, Castro-Anon O, et al. Factors associated with hospital admission in a care protocol in COVID-19. Arc Bronchoneumol (Engl Ed) 2020;56:676-7. DOI:10.1016/j.arbres.2020.05.038.)
17. Lohia P, Sreeram K, Nguyen P, et al. Preexisting respiratory diseases and clinical outcomes in COVID-19: a multihospital cohort study on predominantly African American population. Respir Res 2021;22:1-9.
18. Gallay L, Uzunhan Y, Borie R, et al. Risk factors for mortality after COVID-19 in patients with preexisting interstitial lung disease. Am J Respir Crit Care Med. 2021;203:245-9. DOI:10.1164/rccm.202007-2638LE.
19. Spagnolo P, Rossi G, Cavazza A, et al. Hypersensitivity pneumonitis: A Comprehensive Review. J Investing Allergol Clin Immunol. 2015;25(4):237-50.
20. Raghu G, Remy-Jardin M, Ryerson CJ, et al. Diagnosis of hypersensitivity pneumonitis in adults. An official ATS/JRS/ALAT Clinical Practice Guideline. Am J Respir Crit Care Med 2020; 202:e36-e69. DOI: 10.1164/rccm.202005-2032ST.
21. Li M, Li P, Zeng B, et al. Coronavirus disease (COVID-19): Spectrum of CT finding and temporal progression of the disease. Acad Radiol 2020;27:603-608. DOI: 10.1016/j.acra.2020.03.003.
22. Bernheim A, Mei X, Huang M, et al. Chest CT findings in coronavirus disease-19 (COVID-19):relationship to duration of infection. Radiology 2020: 200463. DOI: 10.1148/radiol.
Running Title: Hypersensitivity pneumonitis with COVID-19
23. Kanne JP. Chest CT findings in 2019 novel coronavirus (2019-nCoV) infections from Wuhan, China: key points for radiologist. Radiology 2020:200241. DOI: 10.1148/radiol.2020200241.
24. Kooraki S, Hosseiny M, Myers L, Gholamrezanezhad A. Coronavirus (COVID-19) outbreak What the department of radiology should know. J Am Coll Radiol 2020;17:447-451.
25. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single centered, retrospective, observational study. Lancet Respir Med 2020;8:475-81. DOI: 10.1016/S2213-2600(20)30079-5.
26. Graselli G, Zangrillo A, Zanella A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA 2020. DOI: 10.1001/jama.2020.5394.
27. Steinberg KP, Hudson LD, Goodman RB, et al. National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Efficacy and safety of corticosteroids for persistent acute respiratory distress syndrome. N Engl J Med. 2006;354(16):1671-1684. DOI: 10.1056/NEJMoa051693.
28. Villar J, Ferrando C, Marinez D, et al. Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomized controlled trial. The Lancet Respiratory Medicine 2020;8(3):267-276. Doi:10.1016/s2213-2600(19)30417-5.
29. Tomazini BM, Maia IS, Cavalcanti AB, et al. Effect of dexamethasone on days alive and ventilator-free in patients with moderate or severe acute respiratory distress syndrome and COVID-19. The CoDEX Randomized Clinical Trial. JAMA. 2020;324(13):1307-1316. DOI: 10.1001/jama.2020.17021.
30. Horby P, Lim WS, Emberson JR, RECOVERY Collaboraive Group, et al. Dexamethasone in hospitalized patients with Covid-19-Preliminary report. N Engl J Med. 2021; 384: 693-704. DOI:10.1056/NEJMoa2021436.
Running Title: Hypersensitivity pneumonitis with COVID-19
31. National Institutes of Health, Coronavirus Disease 2019 (COVID-19) Treatment Guidelines (Online). Website https://www.covid19treatmentguidelines.nih.gov/. [Accessed May 08, 2021].