摘要：

Introduction and objectives Individuals with Chronic Obstructive Pulmonary Disease (COPD) have increased risk of severe pneumonia and poor outcomes when they develop severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (Hoffmann 2020). We hypothesised that there would be a difference in survival and length of stay between COPD phenotypes with SARS-CoV-2 infections requiring hospital admission. Methods Observational retrospective analysis of individuals admitted to a teaching hospital was performed on during the first peak of the SARS-CoV-2 pandemic (1st March to 30th June 2020). Individuals with COPD were identified and grouped into phenotypes; frequent exacerbators (≥2 severe exacerbations in the last 12 months), emphysema-predominant, chronic bronchitis (cough and sputum production) and eosinophilic-predominant (plasma eosinophil count ≥ 300 cells/L). Overall survival and length of stay for all phenotypes was compared using Kaplan-Meier methodology. Results 508 individuals were admitted to hospital with SARS-CoV-2 infection during this time period. 55 (11%) of these individuals had a diagnosis of COPD. Survival was significantly lower in all individuals with SARS-CoV-2 infection (34%) compared to individuals with SARS-CoV-2 infection and co-existing COPD (58%) (p = 0.0003). There was no difference between baseline characteristics (age, gender and smoking status) between all COPD phenotypes. There was no significant difference in survival between all 4 phenotypes; median survival for frequent exacerbators, emphysema-predominant, chronic bronchitis and eosinophilia-predominant (113 vs 7 vs 39 vs 36 respectively), X2 (2) = 3.9, p = 0.3; figure 1A. There was no difference in length of stay between all commers 13 days and individuals with COPD 12.5 days (p = 1.0). There was no significant difference in length of stay between all 4 phenotypes; median length of stay for frequent exacerbators, emphysema-predominant, chronic bronchitis and eosinophilia-predominant (12 vs 9 vs 13 vs 14 respectively), X2 (2) = 3.0, p = 0.4; figure 1B. Download figure Open in new tab Download powerpoint Abstract L11 Figure 1 Kaplan-Meier curve of survival and length of stay for COPD phenotypesPanel A. SurvivalA log rank test was run to determine if there were differences in the survival distribution for the different COPD phenotypes: Frequent Exacerbator, Emphysema, Chronic Bronchitis and Eosinophilic. The survival distributions for the four phenotypes were not statistically significantly different, X2 (2) = 3.9, p=0.3. There was a statistically significant difference in median survival between emphysema-predominant (113 days) vs Frequent Exacerbator (7 days) Odds Ratio 16.1 (95% CI 15.to 16.5); X2 (1) = 4.8, p=0.03. There was no statistically significant difference between Emphysema-Predominant and the other COPD phenotypes.Panel B. length of StayA log rank test was run to determine if there were differences in the length of stay distribution for the different COPD phenotypes: Frequent Exacerbator, Emphysema, Chronic Bronchitis and Eosinophilic. The survival distributions for the four phenotypes were not statistically significantly different, X2 (2) = 3.0, p=0.4.Abbreviations: FE - Frequent Exacerbator; EM - Emphysema-Predominant;CB - Chronic Bronchitis; EP-Eosinophilic-Predominant Conclusions These data do not support the hypothesis that COPD phenotype would result in a difference in a difference in survival and length of stay. Further study should investigate factors which predict survival of SARS-CoV-2 infection in individuals with co-existent COPD in a larger population.

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