Mortality due to COVID-19 elevated in patients with preexisting ILD

Mortality due to COVID-19 was higher in patients with preexisting fibrotic idiopathic interstitial lung disease compared with other interstitial lung diseases, researchers reported in a new study.

“Patients with preexisting ILD may be at high risk for severe COVID-19 disease due to impaired lung function, propensity to develop acute exacerbation of pulmonary fibrosis or immunomodulatory medications that may interact with viral clearance or pathogenesis,” Laure Gallay, MD, PhD, of the National Coordinating Reference Centre for Rare Pulmonary Diseases at Claude Bernard University Lyon 1 in France, and colleagues wrote in the American Journal of Respiratory and Critical Care Medicine. “However, whether the type of ILD may influence the outcome of COVID-19 is unknown.”

Researchers conducted a multicenter, observational survey of specialized centers to analyze the survival rate in patients with COVID-19 and ILDs. Researchers reported data from 123 patients (median age, 64 years; 66% men) with COVID-19 and ILDs. Cases were collected from the outset of the COVID-19 outbreak in France through May.

Thirty-nine percent of patients had fibrotic idiopathic ILD, including idiopathic pulmonary fibrosis (n = 20), idiopathic nonspecific pneumonia (n = 8) and other fibrotic idiopathic ILDs (n = 20), the researchers reported. The other patients had connective tissue disease-associated ILD (n = 27), systemic vasculitis (n = 7), sarcoidosis (n = 16) and other ILDs (n = 25).

Eighty-four percent of patients required hospital admission, with 21% being admitted to ICUs.

The primary outcome of the study was death at 30 days after COVID-19 infection. At 30 days, 35% of patients with fibrotic idiopathic ILD had died compared with 19% of those with other ILDs (P = .04). The median time from diagnosis to death was 8 days, the researchers reported. In all cases, death was related to COVID-19 infection, including in four patients who had an acute IPF exacerbation.

“Of note, the mortality among subjects with an ILD other than fibrotic ILD was comparable to that reported in the global French population hospitalized for COVID-19,” the researchers wrote.

On the univariable analysis and multivariable analysis, male sex (P = .03), older age (P < .01) and chronic use of home oxygen supplementation (P < .01) were independent predictors of mortality among these patients, according to the study.

“The potential long-term impact of COVID-19 on the course of ILD remains to be determined,” the researchers wrote.