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

Abstract

BackgroundCoronavirus disease 2019 (COVID-19) pandemic has caused substantial threats to people’s physical health and lives, claiming the lives of over 6 million people worldwide. Although the mortality rate of COVID-19 is very low, many survivors may have different degrees and various sequelae. Previous studies have shown that pulmonary fibrosis (PF) were common on discharged COVID-19 patients, and PF itself is a poor prognostic factor.Methods227 COVID-19 hospitalized patients’ clinical and laboratory data from the first 15 days following admission were collected in this retrospective study. Groups were based on with or without PF of COVID-19. Categorical variables were compared with the chi-square test or Fisher’s exact test. Continuous variables were tested by Wilcoxon rank-sum test for the non-normal distribution. Spearman correlations were used to assess the correlations between PF with clinic parameters of multiple time points. Univariate and multivariate logistic regression were used to analyze for risk factors of COVID-19 patients with pulmonary fibrosis.ResultsSixty cases of COVID-19 patients were diagnosed with PF. Compared with 167 non-PF patients, those with PF were older and had higher proportions of fever, shortness of breath, hemoptysis, abdominal pain, hypertension, cardiovascular, diabetes, high flow nasal cannula (HFNC), severe disease, and virus shedding duration. Furthermore, the correlation analysis between PF and clinic parameters showed that PF were positively related to the C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR), and negatively correlated with hemoglobin (HGB) and albumin (ALB) at all time points in the first 15 days after admission. Moreover, We found that PF were significantly correlated with coagulation indexes prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (Fib) and fibrinolysis index D-Dimer at some phases. In addition, Univariate logistic regression analyses showed that age, fever, shortness of breath, hemoptysis, hypertension, cardiovascular, diabetes, HFNC, severe disease were the risk factors of COVID-19 patients with PF. However, multivariate logistic regression showed that age was the risk factor of COVID-19 patients with PF.ConclusionCombining various factors, advanced age is an independent risk factor of COVID-19 patients with PF. PF was significantly related with clinic parameter of inflammation/coagulopathy/fibrinolysis.

Exploring the impact of ursodeoxycholic acid therapy on COVID‐19 in a real‐world setting

“…Regarding secondary outcomes, we found no reduction in the risk of ICU admissions for COVID‐19 or COVID‐19‐related deaths. While these findings, which argue against a protective role of UDCA against SARS‐CoV‐2 infection, challenge two previous multicenter retrospective cohort studies, both derived largely from the same US health data registry, as well as two other studies carried out China, 1‐4 they are, however, entirely consistent with more recent publications 5‐7…”

“…argue against a protective role of UDCA against SARS-CoV-2 infection, challenge two previous multicenter retrospective cohort studies, both derived largely from the same US health data registry, as well as two other studies carried out China, [1][2][3][4] they are, however, entirely consistent with more recent publications. [5][6][7] Several arguments can be advanced to explain the differences observed between these studies.…”

“…Regarding the study by John et al, it should be pointed out that it was based on a sample of cirrhotic patients among whom only 7.7% met the diagnostic criteria for PBC or PSC, thus including a majority of unusual indications for UDCA therapy. In the study by Li et al, the diagnosis of COVID‐19 was not medically validated and the UDCA‐exposed group included patients with hepatitis B “ associated with cholestasis or liver dysfunction ” who received UDCA for 1 month or more, again an unusual indication for long‐term treatment with this drug 3 . Finally, in the study by Hu et al, although UDCA proved to be a protective factor against SARS‐CoV‐2 infection in immunodeficient patients, no difference was found in the incidence of severe forms of COVID‐19 or in the duration of hospitalization with or without UDCA treatment 4 …”

“…1 In this study, an association between UDCA exposure and improved clinical outcomes following COVID-19 was also identified using retrospective registry data on a limited number of liver transplant (LT) recipients and patients with chronic liver disease (CLD). However, although this association was confirmed by other authors, 1,3,4 the supposed protective effect of UDCA treatment against SARS-CoV-2 infection and its complications has been called into question by several recent independent studies, in both adults and children. [5][6][7] Therefore, in this context of conflicting results, our aim was to evaluate, in a very large population of CLD patients, the association between UDCA exposure and the risk of hospitalization for COVID-19 as a primary endpoint.…”

“…There has been increasing interest in recent months in a potential therapeutic role for ursodeoxycholic acid (UDCA) in managing coronavirus disease-2019 (COVID-19). [1][2][3][4] Experimental evidence has shown that UDCA, a noncytotoxic bile acid mainly used to treat chronic cholestatic liver diseases such as primary biliary cholangitis (PBC) or primary sclerosing cholangitis (PSC), can reduce susceptibility to SARS-CoV-2 infection in vitro, in vivo, and in human lungs and livers perfused in situ, by inhibiting the farnesoid X receptor (FXR)-dependent expression of the spike (S) viral protein receptor angiotensin-converting enzyme 2. 1 In this study, an association between UDCA exposure and improved clinical outcomes following COVID-19 was also identified using retrospective registry data on a limited number of liver transplant (LT) recipients and patients with chronic liver disease (CLD).…”