Clinical course and risk factors for severe COVID-19 among Italian patients with cystic fibrosis: a study within the Italian Cystic Fibrosis Society

Abstract

Purpose To describe the clinical course of COVID-19 in patients with cystic fibrosis (CF) and to identify risk factors for severe COVID-19. Methods We conducted a prospective study within the Italian CF Society. CF centers collected baseline and follow-up data of patients with virologically confirmed SARS-CoV-2 infection between March 2020 and June 2021. Odds ratios (ORs) for severe SARS-CoV-2 (as defined by hospital admission) were estimated by logistic regression models. Results The study included 236 patients with positive molecular test for SARS-CoV-2. Six patients died, 43 patients were admitted to hospital, 4 admitted to intensive care unit. Pancreatic insufficiency was associated with increased risk of severe COVID-19 (OR 4.04, 95% CI 1.52; 10.8). After adjusting for age and pancreatic insufficiency, forced expiratory volume in one second (FEVp) < 40% (OR 4.54, 95% CI 1.56; 13.2), oxygen therapy (OR 12.3, 95% CI 2.91–51.7), underweight (OR 2.92, 95% CI 1.12; 7.57), organ transplantation (OR 7.31, 95% CI 2.59; 20.7), diabetes (OR 2.67, 95% CI 1.23; 5.80) and liver disease (OR 3.67, 95% CI 1.77; 7.59) were associated with increased risk of severe COVID-19, while use of dornase alfa was associated with a reduced risk (OR 0.34, 95% CI 0.13–0.88). No significant changes were observed in FEVp from baseline to a median follow-up of 2 months (median difference: 0, interquartile range: − 4; 5, P = 0.62). Conclusion Clinical features indicative of severe form of CF are associated with increased risk of COVID-19 hospitalization. SARS-CoV-2 infected patients do not experience a deterioration of respiratory function. Supplementary Information The online version contains supplementary material available at 10.1007/s15010-021-01737-z.

First Case of COVID-19 Treated with Monoclonal Anti-Spike Antibodies in a Patient with Cystic Fibrosis in Romania

“…However, the course of COVID-19 disease in patients with CF appears to be favorable [ 1 , 2 , 12 ]. Nevertheless, recent studies have shown that lung and pancreatic impairment are risk factors for severe COVID-19 in these patients [ 4 , 12 ]. Therefore, any CF patient with SARS-CoV-2 infection requires a comprehensive evaluation, taking into account all associated comorbidities, in order to tailor a personalized management plan.…”

“…For patients with cystic fibrosis (CF), less information is available in field literature, and some studies point to an overall lower incidence of SARS-CoV-2 infection in this patient population [ 1 , 2 ], but a higher rate of hospitalization among them [ 3 ]. Furthermore, once infection does occur, the patient is considered to be at risk of severe COVID-19 and this risk may be dependent on the underlying degree of lung damage, and also the degree of pancreatic or liver damage [ 4 ].…”

A year in review: Real world evidence, functional monitoring and emerging therapeutics in 2021

“…A history of transplantation was associated with higher rates of hospitalization (82% versus 53%) and intensive care support (26% versus 5.6%) than those PwCF without transplants [1] . Other studies have shown that PwCF with lower lung function, lower body mass index (BMI), and with comorbidities such as diabetes or liver disease were also more likely to have severe infection [ 2 , 3 ]. The Cystic Fibrosis Registry Global Harmonization Group reported data on 105 children with SARS-CoV-2 infection from 13 countries over a 6-month period [3] .…”

“…Thirty-seven percent of children were treated with oral antibiotics and 46% received intravenous (IV) antibiotics. Overall, studies showed the majority of PwCF with SARS-CoV-2 infection maintain their lung function and were managed with antibiotics either at home or in the community [1] , [2] , [3] .…”

Poor Respiratory Health Following Relapsing SARS-CoV-2 Infection in Children with Cystic Fibrosis: Authors’ Reply

“…Though initial reports of COVID-19 in CF patients suggested that the disease may not be as severe as expected, these reports were from developed countries and before the period of delta variant [ 5 ]. A recent large prospective series of Italian cohort of 236 CF patients had 18% hospitalizations and 2.5% mortality, which is significantly higher than the general population of similar age group (median age 25 y) [ 6 ]. Risk factors of severe COVID-19 amongst the cohort were low FEV 1 predicted (< 40%), home oxygen support, underweight, organ transplant, diabetes, and liver disease; while the use of dornase alpha and long-term azithromycin were associated with reduced risk [ 6 ].…”