Clinical Characteristics and Prognosis of COPD Patients Hospitalized with SARS-CoV-2

Figures & data

Table 1 Characteristics of People with Coronavirus Disease 2019 with or without COPD. Demographic Data and Comorbidity

Characteristics	Values are Indicated as the Number (Percentage) or Median (Interquartile Range)
	Overall (n=10,420)	N (%)	Non-COPD (n=9674)	COPD (n=746)	P value
Median (IQR) age (years)	10,385	69 (55–79)	68 (54–79)	77 (71–84)	-
Age (years):
<45 years	10,385	1130 (10.9)	1130 (11.7)	0 (0.0)	-
45–55 years		1325 (12.8)	1316 (13.7)	9 (1.2)	<0.001
55–65 years		1884 (18.1)	1798 (18.7)	86 (11.6)	<0.001
65–75 years		2258 (21.7)	2049 (21.3)	209 (28.1)	0.596
75–85 years		2263 (21.8)	1973 (20.5)	290 (39)	0.004
>85 years		1525 (14.7)	1376 (14.3)	149 (20.0)	omitted
Men	10,401	5893 (56.7)	5281 (54.7)	612 (82.2)	<0.001
Smoking status
Never	9904	6890 (69.6)	6783 (74)	107 (14.7)	-
Former		2482 (25.0)	1968 (21.4)	514 (70.7)	<0.001
Current		532 (5.4)	426 (4.6)	106 (14.6)	0.46
Alcohol use disorder	10,112	470 (4.7)	384 (4.0)	86 (11.8)	<0.001
Obesity (BMI>30)	4597	1537 (33.4)	1415 (33.6)	122 (32.1)	0.57
Hypertension	10,404	5242 (50.4)	4729 (48.9)	513 (69.1)	<0.001
Hyperlipidemia	10,401	4078 (39.2)	3682 (38.1)	396 (53.4)	<0.001
Diabetes Mellitus	10,379	1936 (18.7)	1745 (18.1)	191 (25.8)	<0.001
Anxiety disorder	10,377	842 (8.1)	779 (8.0)	63 (8.5)	0.71
Depression	10,376	1092 (10.5)	1014 (10.5)	78 (10.5)	0.99
Atrial fibrillation	10,395	1175 (11.3)	1000 (10.4)	175 (23.6)	<0.001
Myocardial infarction	10,410	619 (5.6)	521 (5.4)	98 (13.2)	<0.001
Heart failure	10,406	775 (7.5)	643 (6.7)	132 (17.8)	<0.001
Transient ischemic attack	10,377	747 (7.2)	657 (6.8)	90 (12.2)	<0.001
Dementia	10,403	1066 (10.3)	987 (10.2)	79 (10.6)	0.74
Neurodegenerative disease	10,401	979 (9.4)	908 (9.4)	71 (9.5)	0.89
Peripheral arterial disease	10,397	503 (4.8)	414 (4.3)	89 (12.0)	<0.001
Mild chronic liver disease	10,393	294 (2.8)	255 (2.6)	39 (5.2)	<0.001
Moderate–severe chronic liver disease	10,401	110 (1.0)	90 (0.9)	20 (2.7)	<0.001
Chronic kidney disease	10,399	631 (6.1)	549 (5.7)	82 (11.0)	<0.001
Dialysis	10,352	16 (0.2)	14 (0.2)	2 (0.3)	0.64
Cancer	10,388	845 (8.1)	740 (7.7)	105 (14.1)	<0.001
Obstructive Sleep Apnea Syndrome	10,337	654 (6.3)	524 (5.5)	130 (17.6)	<0.001
Dependency status
Independent	10,250	8519 (83.1)	7960 (83.7)	559 (76.7)	–
Moderate dependency		984 (9.6)	856 (9.0)	128 (17.4)	<0.001
Severe dependency		747 (7.3)	700 (7.4)	47 (6.4)	0.76
Charlson Comorbidity Index	10,084	1 (0–2)	1 (0–2)	2 (1–4)	<0.001
Charlson Comorbidity Index, age corrected	10,048	3 (1–5)	3 (1–5)	6 (4–8)	<0.001

Table 2 Characteristics of People with Coronavirus Disease 2019 with or without COPD. Clinical Data and Evolution

Characteristics	Values are Indicated as the Number (Percentage) or Median (Interquartile Range)
	Overall (n=10,420)	N (%)	Non-COPD (n=9674)	COPD (n=746)	P value
Habitual treatment
Immunosuppressants	10,383	362 (3.5)	335 (3.5)	27 (3.6)	0.82
Systemic corticosteroids	10,392	450 (4.3)	395 (4.0)	55 (7.4)	<0.001
Inhaled corticosteroids	10,340	1031 (10.0)	683 (7.1)	348 (47.2)	<0.001
Anticoagulants
None	10,338	9148 (88.5)	8582 (89.4)	566 (76.4)	-
Antivitamin K		653 (6.3)	552 (5.8)	101 (13.6)	<0.001
DOACs		456 (4.4)	388 (4.0)	68 (9.2)	<0.001
LMWH		81 (0.8)	75 (0.8)	6 (0.8)	0.65
Antiplatelet drugs	10,319	1591 (15.4)	1393 (14.5)	198 (26.9)	<0.001
Statins	10,319	3302 (32.0)	2928 (30.6)	374 (50.6)	<0.001
ACE inhibitors	10,330	1757 (17.0)	1590 (16.6)	167 (22.6)	<0.001
Angiotensin-renin blockers	10,334	2014 (19.5)	1829 (19)	185 (25)	<0.001
Symptoms and vital signs
Temperature >38 ºC	10,369	6581 (63.5)	6181 (64.2)	400 (53.8)	<0.001
Low-grade fever	10,369	2195 (21.2)	2025 (21)	170 (22.9)	<0.001
Dyspnea	10,369	5939 (53.4)	5402 (56.2)	537 (72.3)	<0.001
Dry cough	10,368	6084 (58.7)	5724 (59.5)	360 (48.5)	<0.001
Cough with expectoration		1652 (15.9)	1452 (15.1)	200 (26.9)	<0.001
Fatigue	10,157	4493 (44.2)	4193 (44.5)	300 (41.2)	0.088
Anorexia	10,102	2045 (20.2)	1903 (20.3)	142 (19.6)	0.68
Myalgia	10,198	3146 (30.9)	2969 (31.4)	177 (24.2)	<0.001
Headache	10,160	1192 (11.7)	1152 (12.2)	40 (5.5)	<0.001
Diarrhea	10,287	2339 (22.7)	2239 (23.5)	100 (13.6)	<0.001
Nausea	10,121	1274 (12.6)	1233 (13.1)	41 (5.7)	<0.001
Vomiting	10,249	759 (7.4)	740 (7.8)	19 (2.6)	<0.001
Abdominal pain	10,235	683 (6.7)	649 (6.8)	34 (4.6)	0.022
Ageusia	9971	656 (6.6)	632 (6.8)	24 (3.4)	<0.001
Anosmia	9967	584 (5.9)	563 (6.1)	21 (3.0)	0.001
Sore throat	10,147	994 (9.8)	926 (9.8)	68 (9.4)	0.68
Vital signs at triage
Temperature >38 °C	9978	1611 (16.2)	1516 (16.4)	95 (13.3)	0.029
Temperature, median (IQR) ºC	9978	37 (36.4–37.8)	36.9 (36.2–37.7)	37 (36.4–37.8)	0.004
Sat <90%	10,084	2211 (21.9)	1928 (20.6)	283 (38.8)	<0.001
Sat02% Median (IQR)	10,084	94 (91–97)	95 (91–97)	92 (88–95)	<0.001
Respiratory rate >20 breaths/min	10,097	3145 (31.2)	2797 (29.9)	348 (47.9)	<0.001
Heart rate >100 beats/min	9990	2181 (21.8)	2036 (22.0)	145 (20.0)	0.22
Heart rate Median (IQR)	9990	87 (76–100)	87 (76–100)	85 (75–98)	0.08
SBP, median (IQR) mmHg	9870	127 (114–141)	127 (115–140)	127 (113–144)	0.96
DBP, median (IQR) mmHg	9860	74 (65–82)	74 (65–82)	72 (61–80)	<0.001
Confusion	10,270	1227 (12.0)	1100 (11.5)	127 (17.3)	<0.001
Wheezing	10,105	625 (6.2)	501 (5.3)	124 (17.3)	<0.001
Rhonchi	10,097	1088 (10.8)	890 (9.5)	198 (27.6)	<0.001
Crackles	10,107	5324 (52.7)	4937 (52.6)	387 (53.9)	0.49
Evolution
Non-invasive mechanical ventilation	10,327	503 (4.9)	429 (4.5)	74 (10.1)	<0.001
High-flow nasal cannula	10,264	832 (8.1)	736 (7.7)	96 (13.2)	<0.001
Invasive mechanical ventilation	10,326	663 (6.4)	627 (6.5)	36 (4.9)	0.083
Prone position	10,307	1020 (9.9)	938 (9.8)	82 (11.2)	0.21
ICU admission	10,400	841 (8.1)	788 (8.2)	53 (7.1)	0.31
Hospital stay in days, median (IQR)	9 (5–14)		9 (5–14)	10 (6–16)	0.80
Mortality	2142 (20.6)		1856 (19.2)	286 (38.3)	<0.0001

Table 3 Mortality of COPD Patients with Coronavirus Disease 2019 According to Demographic Data and Antecedents

Values are Indicated as the Number (Percentage) or Median (Interquartile Range)
Characteristics	Overall (n=746)	Survivors (n=460)	Deceased (n=286)	Odds Ratio (95% CI)	P value
Age (years)	77 (71–84)	75 (66–82)	79 (74–86)	1.06 (1.04–1.08)	<0.001
Men	612 (82.2)	365 (79.4)	247 (86.7)	1.69 (1.12–2.55)	0.012
Comorbidities
FEV1
<30	21 (5.8)	11 (4.9)	10 (7.3)	1.74 (0.58–5.26)	0.33
30–49	84 (23.1)	52 (22.9)	32 (23.4)	1.18 (0.52–2.69)	0.70
50–79	224 (61.5)	141 (62.1)	83 (60.6)	1.13 (0.53–2.39)	0.75
≥80	35 (9.6)	23 (10.1)	12 (8.8)	Ref. (1)	-
FEV1 <50	105 (28.8)	63 (27.8)	42 (30.7)	1 (ref.)	-
FEV1 >50	259 (71.2)	164 (72.2)	95 (69.3)	0.87 (0.55–1.38)	0.55
Smoking status
Never	107 (14.8)	59 (13.3)	48 (17.0)	1 (ref.)	-
Former	514 (70.7)	316 (71.0)	198 (70.2)	0.77 (0.51–1.17)	0.22
Current	106 (14.6)	70 (15.7)	36 (12.8)	0.63 (0.36–1.1)	0.12
Obesity (BMI>30)	122 (32.1)	73 (30.7)	49 (34.5)	1.19 (0.77–1.85)	0.44
Hypertension	513 (69.1)	298 (65.0)	215 (75.7)	1.67 (1.2–2.3)	0.002
Hyperlipidemia	396 (53.4)	239 (52.2)	157 (55.3)	1.13 (0.84–1.52)	0.41
Diabetes mellitus	191 (25.8)	119 (26.1)	72 (25.4)	0.96 (0.69–1.35)	0.82
Atrial fibrillation	175 (23.6)	103 (22.5)	72 (25.4)	1.18 (0.83–1.66)	0.36
Myocardial infarction	98 (13.2)	52 (11.3)	46 (16.1)	1.51 (0.98–2.32)	0.059
Heart failure	132 (17.8)	58 (12.7)	74 (26.1)	2.43 (1.65–3.56)	< 0.001
Transient ischemic attack	90 (12.2)	48 (10.5)	42 (15.1)	1.52 (0.97–2.37)	0.066
Dementia	79 (10.6)	36 (7.8)	43 (15.0)	2.08 (1.3–3.33)	0.002
Neurodegenerative disease	71 (9.5)	34 (7.4)	37 (12.9)	1.85 (1.13–3.03)	0.014
Peripheral arterial disease	89 (12.0)	51 (11.1)	38 (13.4)	1.24 (0.79–1.94)	0.35
Chronic kidney disease	82 (11.0)	41 (8.9)	41 (14.4)	1.71 (1.08–2.72)	0.022
Cancer	105 (14.1)	60 (13.1)	45 (15.8)	1.25 (0.82–1.89)	0.30
Obstructive Sleep Apnea Syndrome	130 (17.6)	83 (18.1)	47 (16.9)	0.92 (0.62–1.34)	0.66
Dependency status
Independent	559 (76.2)	377 (82.7)	182 (65.5)	1 (ref.)	-
Moderate dependency	128 (17.4)	61 (13.4)	67 (24.1)	2.28 (1.54–3.36)	< 0.001
Severe dependency	47 (6.4)	18 (4.0)	29 (10.4)	3.34 (1.81–6.17)	< 0.001
Charlson Comorbidity Index	2 (1–4)	2 (1–4)	3 (2–5)	1.17 (1.09–1.26)	< 0.001
Charlson Comorbidity Index, age corrected	6 (4–8)	5 (4–7)	6 (5–9)	1.23 (1.15–1.32)	< 0.001
Habitual treatment
Immunosuppressants	27 (3.6)	19 (4.1)	8 (2.8)	0.68 (0.29–1.56)	0.36
Systemic corticosteroids	55 (7.4)	27 (5.9)	28 (9.9)	1.75 (1.01–3.04)	0.046
Inhaled corticosteroids	348 (47.2)	216 (47.2)	132 (47.1)	1 (0.74–1.35)	0.996
Antivitamin K	101 (13.6)	48 (10.5)	53 (18.7)	1.94 (1.27–2.98)	0.002
Antiplatelet Drugs	198 (26.9)	105 (23.0)	93 (33.2)	1.67 (1.20–2.32)	0.002
Statins	374 (50.6)	237 (51.8)	137 (48.8)	0.89 (0.66–1.19)	0.43
ACE In	167 (22.6)	101 (22.1)	66 (23.5)	1.09 (0.76–1.54)	0.65
Angiotensin-renin blockers	185 (25)	107 (23.3)	78 (27.7)	1.26 (0.90–1.77)	0.19

Table 4 Mortality of COPD Patients with Coronavirus Disease 2019 According to Clinical Data and Treatment

Values are Indicated as the Number (Percentage) or Median (Interquartile Range)
Characteristics	Overall (n=746)	Survivors (n=460)	Deceased (n=286)	Odds Ratio (95% CI)	P value
Symptoms and vital signs
Dyspnea	537 (72.3)	304 (66.1)	233 (82.3)	2.39 (1.67–3.43)	<0.001
Temperature >38 ºC	95 (13.3)	47 (10.6)	48 (17.5)	1.78 (1.15–2.74)	0.009
Oxygen saturation <90%	283 (38.8)	131 (29.1)	152 (54.3)	0.35 (0.25–0.47)	<0.001
Oxygen saturation % Median (IQR)	92 (88–95)	93 (90–96)	90 (86–94)	0.91 (0.88–0.93)	<0.001
Respiratory rate >20 breaths/min	348 (47.9)	169 (37.6)	179 (64.6)	3.03 (2.22–4.13)	<0.001
Heart rate
>100 beats/min	145 (20.0)	80 (17.9)	65 (23.4)	1.40 (0.97–2.02)	0.073
Median (IQR)	85 (75–98)	85 (74–98)	86 (76–100)	1.01 (0.99–1.01)	0.18
SBP, median (IQR) mmHg	127 (113–144)	129 (116–144)	125 (110–141)	0.99 (0.99–1)	0.09
DBP, median (IQR) mmHg	72 (61–80)	73 (64–81)	70 (60–80)	0.99 (0.98–0.99)	0.008
Confusion	127 (17.3)	53 (11.7)	74 (26.3)	2.71 (1.83–4)	<0.001
Radiological findings
At admission
Bilateral condensation	203 (27.7)	107 (23.7)	96 (33.9)	1.8 (1.29–2.6)	0.001
Bilateral interstitial infiltrates	359 (48.9)	202 (44.7)	157 (55.7)	1.6 (1.13–2.15)	0.006
Progress (7 days)
Bilateral condensation	198 (36.5)	114 (30.7)	84 (49.1)	2.38 (1.58–3.57)	< 0.001
Bilateral interstitial infiltrates	316 (58.1)	201 (53.9)	115 (67.3)	1.55 (1.03–2.32)	0.035
Radiological worsening	277 (50.8)	147 (39.6)	130 (74.7)	4.5 (3.02–6.72)	< 0.001
Treatment
Lopinavir/ritonavir	421 (56.9)	267 (58.4)	154 (54.4)	0.85 (0.63–1.45)	0.29
Interferon-beta	94 (12.8)	41 (9.0)	53 (19.0)	2.36 (1.52–3.66)	< 0.001
Remdesivir	4 (0.6)	2 (0.4)	2 (0.7)	1.66 (0.23–11.85)	0.61
Hydroxychloroquine	610 (82.4)	398 (87.1)	212 (74.9)	0.44 (0.3–0.65)	< 0.001
Chloroquine	26 (3.5)	16 (3.5)	10 (3.6)	1.02 (0.46–2.29)	0.96
Colchicine	10 (1.4)	4 (0.9)	6 (2.2)	2.5 (0.7–8.9)	0.16
Tocilizumab	50 (6.8)	23 (5.0)	27 (9.6)	1.99 (1.12–3.56)	0.019
Immunoglobulin	2 (0.3)	1 (0.2)	1 (0.4)	1.7 (0.1-26-6)	0.72
Anakinra	4 (0.6)	3 (0.7)	1 (0.4)	0.54 (0.06–5.24)	0.60
Systemic corticosteroids	364 (49.3)	215 (47.1)	149 (53.0)	1.27 (0.94–1.71)	0.12
Beta-lactams	561 (76.3)	329 (72.3)	232 (82.9)	1.85 (1.28–2.69)	0.001
Macrolides	400 (55.0)	263 (57.9)	137 (50.0)	0.73 (0.54–0.98)	0.037
Quinolones	134 (18.5)	78 (17.2)	56 (20.5)	1.24 (0.85–1.82)	0.27
Non-invasive mechanical ventilation	74 (10.1)	34 (7.5)	40 (14.4)	2.09 (1.29–3.40)	0.003
High-flow nasal cannula	96 (13.2)	46 (10.2)	50 (18.0)	1.93 (1.25–2.97)	0.003
Invasive mechanical ventilation	36 (4.9)	8 (1.8)	28 (10.1)	6.27 (2.82–13.97)	<0.001
Prone position	82 (11.2)	25 (5.5)	57 (20.6)	4.44 (2.70–7.29)	<0.001
Hospital stay in days, median (IQR)	10 (6–16)	12 (7–17)	7 (3–12)	0.95 (0.93–0.96)	<0.001

Table 5 Comorbidity and mortality of COPD Patients with Coronavirus Disease 2019

Characteristics	Overall (n=746)	Survivors (n=460)	Deceased (n=286)	Odds Ratio (95% CI)	P value
Comorbidity - CVRF^a
No	169 (22.6)	111 (24.1)	58 (20.3)	1 (ref.)	–
Yes	577 (77.4)	349 (75.9)	228 (79.7)	1.25 (0.87–1.79)	0.22
Comorbidity - NRL^b
No	583 (78.2)	373 (81.1)	210 (73.4)	1 (ref.)	–
Yes	163 (21.9)	87 (18.9)	76 (26.6)	1.55 (1.09–2.20)	0.014
Comorbidity - Cardio^c
No	406 (54.4)	266 (57.8)	140 (49.0)	1 (ref.)	–
Yes	340 (45.6)	194 (42.2)	146 (52.0)	1.43 (1.06–1.92)	0.018
Comorbidity – K.L^d
No	614 (82.3)	387 (84.1)	227 (79.4)	1 (ref.)	–
Yes	132 (17.7)	73 (15.9)	59 (20.6)	1.38 (0.94–2.02)	0.10
Comorbidity - Onco^e
No	623 (83.5)	392 (85.2)	231 (80.8)	1 (ref.)	–
Yes	123 (16.5)	68 (14.8)	55 (19.2)	1.37 (0.93–2.03)	0.11
Comorbidity^f
No	64 (8.6)	51 (11.1)	13 (4.5)	1 (ref.)	–
Yes	682 (91.4)	409 (88.9)	273 (95.5)	2.62 (1.40–4.91)	0.003

Notes: ^aComorbidity-CVRF: Considering as comorbidity the presence of any of the following Cardiovascular Risk Factors: HBP, Dyslipidemia, Diabetes Mellitus (with or without target organ injury) or Obesity. ^bComorbidity-NRL: We consider as comorbidity the presence of any of the following pathologies: Dementia, Neurodegenerative disease, Transient ischemic attack, Acute cerebrovascular accident, Hemiplegia. ^cComorbidity-Cardio: We consider as comorbidity the presence of any of the following pathologies: Atrial fibrillation, myocardial infarction, Angor, CHF, Peripheral vascular disease. ^dComorbidity-K.L: We consider as comorbidity the presence of any of the following pathologies: chronic kidney disease or Hemodialysis, mild or moderate–severe chronic liver disease. ^eComorbidity-Onco: We consider as comorbidity the presence of any of the following pathologies: solid neoplasia with or without metastasis, leukemia or lymphoma. ^fComorbidity: In this case we consider as comorbidity the presence of any of the pathologies included in the previous ones.

Figure 1 Mortality according to smoking status in COPD with COVID-19.