Impact of Chronic Obstructive Pulmonary Disease and Emphysema on Outcomes of Hospitalized Patients with Coronavirus Disease 2019 Pneumonia

Abstract

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Risk of hospitalization in a sample of COVID-19 patients with and without chronic obstructive pulmonary disease

“…However, the simultaneous rise of the Akaike Information Criterion [ 37 ] indicates that the original model including HRU had a better fit. While few studies have examined the risk of hospitalization in COPD and COVID-19 [ 9 ], none has included this important variable in risk adjustment. We believe HRU is a relevant confounder in the association because patients with COPD could have a lower threshold to seek care, or they may require hospital-level care for reasons not captured in the Elixhauser Comorbidity Index or individual comorbidity variables.…”

“…Although several studies and meta-analyses have reported higher mortality rates among patients with COVID-19 who have COPD compared with those without COPD, these observations have generally been based on small sample sizes [ 6 , 8 , [48] , [49] , [50] ]. A propensity score–matched study was used to evaluate mortality, invasive mechanical ventilation, intensive care unit admission, and hospital length-of-stay among patients hospitalized for COVID-19 with or without COPD/emphysema using electronic health record data [ 9 ]. They used imaging findings, history of tobacco use, or long-acting bronchodilator prescription to flag a diagnosis of COPD/emphysema [ 9 ].…”

“…There is conflicting evidence about whether patients with COPD have a higher risk of COVID-19–related hospitalization, mortality, and other adverse outcomes [ [5] , [6] , [7] , [8] , [9] ]. Several meta-analyses have suggested that patients with COPD are at an increased risk of severe disease or death from COVID-19 [ [5] , [6] , [7] , [8] ].…”

“…However, many of the studies in these meta-analyses were small, including <200 patients each. One propensity score–matched analysis of hospitalized patients did not show any differences in mortality or need for invasive mechanical ventilation related to a history of COPD [ 9 ]. A brief report from an analysis of the National COVID Cohort Collaboration (N3C) suggested an increased risk of mortality in patients with COPD, but despite a large sample size, this study was not able to account for several important clinical factors such as smoking status or baseline supplemental oxygen use [ 10 ].…”

Explainable emphysema detection on chest radiographs with deep learning

“…Chest radiograph (CXR) is typically the first and most common imaging examination for patients presenting with respiratory symptoms. Especially with patients of COVID-19, emphysema detection is crucial in patient management, because it significantly increases the intensive care unit admission rates, increased respiratory support requirements and higher invasive mechanical ventilation frequencies [ 2 ]. This indicates the importance of detecting signs of emphysema in CXRs.…”