Severe COVID-19 Associated With ILD in Patients Without Cancer

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Should patients without cancer who have recovered from severe COVID-19 infection be referred to post-COVID clinics based on their risk for interstitial lung disease?

Patients without cancer hospitalized with severe COVID-19 infection have a higher risk of developing interstitial lung disease (ILD) at 3 months following discharge than patients with cancer, according to research presented at the American College of Chest Physicians (CHEST) 2022 Annual Meeting, held from October 16 to 19, in Nashville, Tennessee.

Patients hospitalized for COVID-19 infection are thought to be at high risk for ILD after discharge. It is unclear whether having cancer, which may affect the course of COVID-19 infection, also affects the risk for ILD. Investigators sought to determine the incidence of ILD in patients hospitalized for COVID-19 infection with and without cancer at 3 and 6 months after hospitalization.

The investigators analyzed 173 patients (with cancer, n=98; without cancer, n=75) who have been discharged after COVID-19 hospitalization and have subsequently presented to post-COVID clinics. Logistic regression was used to measure severity of COVID-19 infection, measured by the radiologic severity index (RSI) based on a computed tomography scan completed on admission, and ILD at 3 months.

Study participants were classified into 4 groups:

  • Group 1: Patients without ILD who were asymptomatic (with cancer, 20% [n=20] vs without cancer, 3% [n=2]);
  • Group 2: Patients without ILD who were symptomatic (with cancer, 8% [n=8] vs without cancer, 4% [n=3]);
  • Group 3: Patients diagnosed with ILD who showed spontaneous improvement by 6 months (with cancer, 43% [n=42] vs without cancer, 35% [n=26]); and
  • Group 4: Patients with persistent ILD at 6 months (with cancer, 25% [n=24] vs without cancer, 19% [n=14]).

Postdischarge imaging was unavailable in 5% of patients with cancer and in 40% of patients without cancer. Overall, the study investigators noted ILD in 68% of patients at 3 months, and 25% of patients at 6 months.

The logistic regression analysis found that a higher RSI upon COVID-19 hospitalization was associated with an increased risk of ILD at 3 months in patients without cancer (odds ratio [OR], 1.03; 95% CI, 1.00-1.07; P =.054) but not in patients with cancer (OR, 1.3; 95% CI, 0.4-4.5).

The researchers concluded that “ILD is common in survivors of COVID-19 hospitalization, particularly in noncancer patients hospitalized for severe infection.” While referral to post-COVID clinics was the standard of care for study participants with cancer, participants without cancer came to post-COVID clinics only through self-referral. “These data may guide patient selection for referral to post-COVID clinics,” said the investigators.

Reference

Noh S, Bertini CD, Mira-Avendano IC, et al. Interstitial lung disease after COVID-19 in patients with cancer and without: a prospective cohort study. Presented at: CHEST 2022 Annual Meeting; October 16-19, 2022; Nashville, TN.

This article originally appeared on Pulmonology Advisor