Patients with idiopathic pulmonary fibrosis have poor clinical outcomes with COVID-19 disease: a propensity matched multicentre research network analysis

Abstract

IntroductionOutcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in patients with pre-existing idiopathic pulmonary fibrosis (IPF) remain understudied, and it is unknown if IPF is an independent predictor of worse disease course. Herein, we report the clinical outcomes in a large cohort of 251 patients with COVID-19 in the setting of known IPF. Outcomes were compared with a propensity matched cohort of patients with COVID-19 without IPF.MethodsAnalysis of a federated multicentre research network TriNetX was performed including patients more than 16 years of age diagnosed with SARS-CoV-2 infection. Outcomes in patients diagnosed as positive for SARS-CoV-2 infection with concurrent IPF were compared with a propensity matched cohort of patients without IPF.ResultsA total of 311 060 patients with SARS-CoV-2 infection on the research network were identified, 251 patients (0.08%) carried a diagnosis of IPF. Mean age of patients with IPF was 68.30±12.20 years, with male predominance (n=143, 56.97%). Comorbidities including chronic lower respiratory diseases, diabetes mellitus, ischaemic heart disease and chronic kidney disease were more common in patients with IPF when compared with the non-IPF cohort. After propensity matching, higher rates of composite primary outcome (death or mechanical ventilation) at 30 and 60 days, as well as need for hospitalisation, critical care, and acute kidney injury were observed in the IPF cohort.ConclusionPoor outcomes of COVID-19 disease were observed in patients with IPF after robust matching of confounders. Our data confirm that patients with IPF constitute a high-risk cohort for poor outcomes related to COVID-19 disease.

Pulmonary fibrosis in patients with COVID-19: A retrospective study

“…Moreover, it was reported that the major risk factors for severe COVID-19 are shared with PF (George et al, 2020). Comparable to what was said in a previous research, COVID-19 patients with pre-existing PF have been thought to have worse outcomes (Naqvi et al, 2021), which also proved by an international multicenter study (Drake et al, 2020). Most recently, a study reported that chronic COVID-19 patients who received anti-fibrotic therapy obtained a better response in pulmonary function (Kerget et al, 2022).…”

“…PF is thought to be one of the most serious complications in patients recovered from Previous studies suggested that most post-discharge COVID-19 patients have PF sequelae (Sun et al, 2020;Li et al, 2021). COVID-19 patients with pre-existing idiopathic pulmonary fibrosis (IPF) have been thought to have worse outcomes (Naqvi et al, 2021). IPF as a type of PF, is demonstrated to be associated with poor prognosis in non-COVID-19 patients (Lederer and Martinez, 2018).…”

COVID‐19 immunopathology: From acute diseases to chronic sequelae

“…Of note, patients with pre‐existing idiopathic pulmonary fibrosis (IPF) are at high risk for COVID‐19‐related pathology and clinical outcomes. 31 , 32 Additionally, as the gene signatures from COVID‐19 lungs resemble patients who have IPF, antifibrotic therapy may improve outcomes for COVID‐19 patients with an increased risk of development of fibrosis. 27 …”

Antibody responses and risk factors associated with impaired immunological outcomes following two doses of BNT162b2 COVID-19 vaccination in patients with chronic pulmonary diseases

“…While there have been conflicting reports on the risk of SARS-CoV-2 infection in patients with chronic pulmonary diseases, especially in asthma patients, 34 35 their increased risk of severe outcomes after infection is well established. [1][2][3][4] Several industrialised countries have introduced additional third and fourth doses to their COVID-19 vaccination schedules in light of the waning immunity after vaccination, which is highly relevant for patients with chronic pulmonary diseases. 35 The identified risk factors for being a low responder have not been extensively characterised for other groups than severely immunocompromised patients.…”

“…Patients with chronic pulmonary diseases, including chronic obstructive pulmonary disease (COPD), interstitial lung disease (ILD), severe asthma and bronchiectasis, are at increased risk of severe and critical COVID-19. [1][2][3][4] In addition, several retrospective cohort studies and case…”