Clinical Courses and Outcomes of Patients with Chronic Obstructive Pulmonary Disease During the COVID-19 Epidemic in Hubei, China

Figures & data

Figure 1 Flow chart of the follow-up design and process.

Table 1 Risk Factors Associated with Death of the Followed-Up Patients with COPD During the Epidemic (n = 489)

Parameters	Univariable OR (95% CI)	P value	Multivariable OR (95% CI)	P value
Male sex (vs female)	0.48 (0.10–2.22)	0.345	–	–
Age	1.10 (1.02–1.17)	0.011	1.11 (1.01–1.22)	0.045
No education (vs primary and above)	1.75 (0.22–14.05)	0.600
BMI	0.83 (0.70–0.97)	0.017	0.83 (0.68–1.03)	0.085
Neck circumference	0.87 (0.73–1.84)	0.127	–	–
COVID-19 (vs non-COVID-19)	0.03 (0.002–0.46)	0.013	0 (0–0)	1
Smoking (vs non-smoking)	2.17 (0.28–16.87)	0.458	-	-
Hypertension	1.27 (0.43–3.73)	0.659	-	-
Diabetes	0.77 (0.10–6.05)	0.806	-	-
CAD	0.83 (0.23–3.04)	0.784	-	-
CVD	2.66 (0.57–12.47)	0.214	-	-
FEV1%	0.96 (0.91–0.99)	0.034	0.96 (0.91–1.00)	0.064
AHI	0.99 (0.96–1.04)	0.966	-	-

Abbreviations: BMI, body mass index; CAD, coronary artery disease; CVD, cerebrovascular diseases; FEV₁, forced expiratory volume in one second; AHI, apnea-hypopnea index.

Table 2 Risk Factors Associated with Death of Confirmed COVID-19 Patients (n=821)

Parameters	Univariable OR (95% CI)	P value	Multivariable OR (95% CI)	P value
Sex, n (M vs F)	1.67 (1.20–2.32)	0.003	1.31 (0.73–2.37)	0.365
Age (years)	1.08 (1.06–1.09)	<0.0001	1.09 (1.06–1.12)	<0.0001
Hypertension	3.38 (2.27–5.02)	<0.0001	1.15 (0.57–2.31)	0.694
Diabetes	2.26 (1.38–3.70)	0.001	0.82 (0.34–1.97)	0.648
CAD	4.09 (2.32–7.18)	<0.0001	2.71 (0.98–7.53)	0.055
CVD	7.11 (3.35–15.08)	<0.0001	1.66 (0.50–5.49)	0.405
COPD	3.92 (1.98–7.74)	<0.0001	2.27 (0.64–7.97)	0.202
Malignancy	3.30 (1.45–7.47)	0.004	11.73 (2.44–56.36)	0.002
Chronic kidney disease	8.49 (2.98–24.17)	<0.0001	21.75 (2.67–177.29)	0.004
Chronic liver disease	0.74 (0.24–2.28)	0.598	–	–

Abbreviations: CAD, coronary artery disease; CVD, cerebrovascular diseases; COPD, chronic obstructive pulmonary disease.

Table 3 Comparison of COPD Patients Conditions During Periods of Epidemic and Non-Epidemic

Parameters	6 Months Between Oct.2018 and Mar. 2019	4 Months Between Dec.2019 and Mar. 2020	P value
Patients, n	307	489	–
AECOPD patients, n (%)	160 (52.12)	97 (19.84)	<0.0001
AE =1, n (%)	91 (29.64)	80 (16.40)	<0.0001
AE ≥2, n (%)	69 (22.48)	17 (3.48)	<0.0001
AE per person per month, events [median (IQR)]	0.17 (0, 0.17)	0 (0, 0)	<0.0001
Hospitalizations, n (%)	90 (29.32)	32 (6.54)	<0.0001
Hospitalization per person per month, events [median (IQR)]	0 (0, 0.17)	0 (0, 0)	<0.0001
Death, n (%)	2 (0.65)	14 (2.86)	0.023

Abbreviations: AE, acute exacerbation; COPD, chronic obstructive pulmonary disease.

Table 4 Baseline Data of the Followed-Up Patients with COPD (n = 489)

Parameters	Survival Group	Death Group	P-value
Number of patients, n (%)	475	14 (2.86)	-
Sex			0.335
Male, n (%)	440 (92.63)	12 (85.71)
Female, n (%)	35 (7.37)	2 (14.29)
Age, years	68.15±8.71	74.07±7.75	0.012
Education degree			1.000
No education, n (%)	20 (4.21)	1 (7.12)
Primary and above, n (%)	455 (95.79)	13 (92.86)
BMI, kg/m^2	22.91±3.85	20.40±4.99	0.017
Neck circumference, cm	37.78±3.08	36.50±4.36	0.130
COVID-19, n (%)	1 (0.22)	1 (7.14)	0.056
Hypertension, n (%)	176 (37.05)	6 (42.86)	0.658
Diabetes, n (%)	43 (9.05)	1 (7.14)	0.806
CAD, n (%)	117 (24.63)	3 (21.43)	0.784
CVD, n (%)	28 (5.89)	2 (14.29)	0.197
FVC, L	2.93±0.82	1.98±0.54	0.001
FVC%, %	92.01±21.57	63.44±18.57	<0.0001
FEV1, L	1.37±0.64	0.87±0.45	0.021
FEV1%, %	53.31±21.66	37.11±17.16	0.026
FEV1/FVC, %	45.95±13.56	43.89±16.38	0.654
AHI, events/hour	14.49±13.82	14.33±13.40	0.966
T90, %	13.51±24.34	20.12±33.43	0.323
Min SpO2, %	77.94±12.97	73.79±14.44	0.252
Mean SpO2, %	92.38±5.62	90.61±7.06	0.252
Tobacco use, n (%)	407 (85.68)	13 (92.86)	0.711
Current tobacco use, n (%)	90 (18.95)	2 (14.29)	0.490

Abbreviations: COPD, chronic obstructive pulmonary disease; BMI, body mass index; CAD, coronary artery disease; CVD, cerebrovascular diseases; FVC, forced vital capacity; FEV₁, forced expiratory volume in one second; AHI, apnea-hypopnea index; T90, percentage of sleep time with SpO₂ less than 90%; Min SpO₂, minimum oxygen saturation during sleep; mean SpO₂, mean oxygen saturation during sleep.

Table 5 Comorbidities and Deaths in 821 Patients with Confirmed COVID-19

Parameters	Total	Death	Death/Total (%)
Number, N	821	180	21.9
Hypertension, n (%)	224 (27.3)	92 (51.1)	41.1
Diabetes, n (%)	87 (10.6)	33 (18.3)	37.9
CAD, n (%)	60 (7.3)	32 (17.8)	53.3
CVD, n (%)	37 (4.5)	27 (15.0)	73.0
COPD, n (%)	37 (4.5)	19 (10.6)	51.4
Malignancy, n (%)	27 (3.3)	14 (7.8)	51.9
Chronic kidney disease, n (%)	19 (2.3)	14 (7.8)	73.7
Chronic liver disease, n (%)	19 (2.3)	4 (2.2)	21.1

Abbreviations: CAD, coronary artery disease; CVD, cerebrovascular diseases; COPD, chronic obstructive pulmonary disease.

Table 6 The First-Episode Syndromes and Comorbidities in Confirmed COVID-19 Deaths with or without COPD

Parameters	Death Cases (n=180)	With COPD (n =19)	Without COPD (n=161)	P value
Sex, M:F	101:79	11:8	90:71	0.868
Age, years (IQR)	71 (62–80)	74 (67–81)	70 (60–80)	0.139
Comorbidities
Diabetes, n	33	4	29	0.756
Hypertension, n	92	10	82	0.889
CAD, n	32	7	25	0.022
CVD, n	27	7	20	0.005
Chronic liver disease,n	4	0	4	1.000
Malignancy, n	14	2	12	0.646
Chronic kidney disease,n	14	1	13	1.000
First symptoms
Fever (T ≥37.0°C), n	157	16	141	0.715
Tmax,°C(IQR)	38.5 (38–39)	38.5 (38.1–38.6)	38.6 (38–39)	0.246
Dry cough, n	122	14	108	0.560
Expectoration, n	69	13	56	0.004
Chest tightness, n	107	12	95	0.727
Dyspnea, n	120	12	108	0.732
Myalgia, n	13	1	12	1.000
Nausea, n	5	1	4	0.431
Vomiting, n	7	1	6	0.548
Diarrhea, n	9	2	7	0.243
Severity on admission				0.654
Mild, n	0	0	0
Moderate, n	5	1	4
Severe, n	110	10	100
Critical, n	65	8	57
Death time after hospitalization, d (IQR)	8 (4–12)	7 (3–13)	8 (4–12)	0.794

Abbreviations: COPD, chronic obstructive pulmonary disease; CAD, coronary artery disease; CVD, cerebrovascular diseases.

Table 7 Laboratory Results in Confirmed COVID-19 Deaths with or without COPD

Parameters	Death Cases (n=180)		With COPD (n = 19)		Without COPD (n=161)		P value
	N	IQR or n/N	N	IQR or n/N	N	IQR or n/N
Age (years)	180	71 (62–80)	19	74 (67–81)	161	70 (60–80)	0.139
Sex, n (M:F)	180	101:79	19	11:8	161	90:71	0.868
WBC, ×10^9/L	174	7.26 (4.64–10.74)	19	7.35 (5.11–10.89)	155	7.17 (4.54–10.72)	0.589
<4	30		1		29		0.203
N,×10^9/L	174	6.1 (3.78–9.34)	19	6.48 (3.5–10.28)	155	6.07 (3.79–9.33)	0.692
L,×10^9/L	174	0.36 (0.25–0.56)	19	0.31 (0.25–0.5)	155	0.36 (0.25–0.57)	0.512
<1.0	164		19		145		0.604
Haemoglobin, g/L	174	106 (80–122)	19	97 (82–121)	155	107 (80–122)	0.817
Platelet count,×10^9/L	174	109 (48–166.75)	19	111 (76–156)	155	109 (42–172)	0.22
CRP, mg/L	152	144.85 (77.18–200)	16	199.85 (121.73–210.43)	136	123.1 (76.9–197.7)	0.019
Albumin, g/L	173	34.3 (31.6–37.2)	19	32.72 (29.7–34.85)	154	34.47 (31.9–37.48)	0.014
ALT, U/L	173	44 (25–97)	19	37 (17–63)	154	44.5 (25.75–104.25)	0.15
AST, U/L	173	62 (36–139)	19	47 (35–122)	154	63.5 (36–139.5)	0.291
Alkaline phosphatase, U/L	169	100 (67.95–157)	19	102.4 (67–150)	150	100 (67.98–160.25)	0.872
Bilirubin, mmol/L	173	20 (11.95–32.20)	19	16.2 (11.8–28)	154	21.05 (11.98–33.15)	0.334
Potassium, mmol/L	172	3.6 (3.2–4.06)	19	3.28 (2.8–3.78)	153	3.67 (3.2–4.125)	0.043
Sodium, mmol/L	172	138 (133.7–142)	19	138 (131–142)	153	138 (133.8–142)	0.885
Urea, mmol/L	173	13.9 (8.7–26.86)	19	11.91 (8.7–27.5)	154	13.9 (8.7–26.85)	0.732
Creatinine, umol/L	173	95 (67–192.5)	19	93 (71–168)	154	95.5 (66–197)	0.979
Creatine kinase, U/L	163	174 (71–512)	18	211.5 (61.5–441.5)	145	174 (74–565.5)	0.591
LDH, U/L	163	604 (420–909)	18	414 (326–537.75)	145	634 (438.5–963.5)	0.003
Ultra-TnI, ng/mL	156	0.42 (0.04–2.1)	17	0.16 (0.06–0.63)	139	0.46 (0.04–2.47)	0.287
D-dimer,mg/L	166	13.83 (3.56–64.19)	18	3.46 (2.04–30.36)	148	14.76 (4.37–65.42)	0.043
Fibrinogen, g/dL	166	2.95 (1.42–5.12)	18	4.42 (3–6.85)	148	2.79 (1.27–4.81)	0.006
Prothrombin time, s	166	14.4 (12.7–17.13)	18	14.2 (13.38–15.4)	148	14.45 (12.63–17.20)	0.848
APTT, s	166	32.65 (29.2–38.5)	18	34.85 (30.18–49.05)	148	32.5 (29.13–38.18)	0.177
Oximetry saturation, %	171	83 (70–90)	18	83.5 (70–89.25)	153	83 (70–91)	0.932
IgG for SARS-CoV-2, AU/mL	19	129.14 (56.12–176.56)	0	ND	19	129.14 (56.12–176.56)	ND
IgM for SARS-CoV-2, AU/mL	19	25.84 (12.4–73.08)	0	ND	19	25.84 (12.4–73.08)	ND
IL-2, pg/mL	23	4.05 (3.77–4.78)	3	4 (4-)	20	4.01 (3.76–4.73)	0.337
IL-4, pg/mL	23	4.03 (3.27–4.66)	3	5 (4-)	20	3.86 (3.27–4.30)	0.018
IL-6, pg/mL	50	122.79 (34.26–721.99)	5	171.53 (9.75-)	45	113.77 (40.55–648.11)	0.759
IL-10, pg/mL	23	18.71 (8361–36.04)	3	24 (14-)	20	16.41 (6.91–34.77)	0.411
TNF, pg/mL	23	3.58 (2.95–4.39)	3	4 (3-)	20	3.65 (2.89–4.32)	0.927
INF-γ, pg/mL	23	4.3 (3.64–6.04)	3	4 (4-)	20	4.29 (3.63–6.36)	0.855

Abbreviations: WBC, white blood cell; N, neutrophil; L, lymphocyte; CRP, C-reactive protein; ALT, alanine aminotransferase; AST, aspartate aminotransferase; LDH, lactate dehydrogenase; Ultra-TnI, hypersensitivity cardiac troponin I; APTT, activated partial thromboplastin time; SARS-CoV-2, 2019 novel coronavirus; IL, interleukin; TNF, tumor necrosis factor; INF-γ, interferon-γ; ND, no data.

Table 8 The Characteristics of COPD Deaths in Confirmed COVID-19 Cases and During the Followed-Up

Parameters	COVID-19 Confirmed Deaths with COPD^#	COPD Deaths During COVID-19 Pandemic	P-value
Number, N	20	13
Sex (M:F)	12:8	11:2	0.245
Age, years	74 (67–84)	71.5 (67.75–81)	0.691
BMI, kg/m^2	22.45 (18.75–24.53)	20.06 (16.56–22.95)	0.231
FEV1, L	1.96 (1.57-)*	0.69 (0.55–1.57)^§	0.034
FVC, L	3.06 (2.93-)*	2.11 (1.59–2.60)^§	0.014
FEV1/FVC, %	65 (51-)*	41 (32.5–64.25)^§	0.108
Hypertension, n (%)	10 (50.0)	3 (23.1)	0.159
Diabetes, n (%)	4 (20.0)	1 (7.7)	0.625
CAD, n (%)	7 (35.0)	3 (23.1)	0.701
CVD, n (%)	7 (35.0)	4 (30.8)	1.000
Malignancy, n (%)	2 (10.0)	2 (15.4)	1.000
Chronic kidney disease, n (%)	1 (5.0)	1 (7.7)	1.000
Chronic liver disease, n (%)	0 (0)	0 (0)	No data

Notes: ^#A male confirmed case with COVID-19 during followed-up was incorporated in group for statistics. *n=3; ^§n=10.

Abbreviations: COPD, chronic obstructive pulmonary disease; BMI, body mass index; FEV₁, forced expiratory volume in one second; FVC, forced vital capacity; CAD, coronary artery disease; CVD, cerebrovascular diseases.