Factors for severe outcomes following SARS-CoV-2 infection in people with cystic fibrosis in Europe.
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Jung Andreas, Orenti Annalisa, Dunlevy Fiona, Aleksejeva Elina, Bakkeheim Egil, Bobrovnichy Vladimir, Carr Siobhán B, Colombo Carla, Corvol Harriet, Cosgriff Rebecca, Daneau Géraldine, Dogru Deniz, Drevinek Pavel, Vukic Andrea Dugac, Fajac Isabelle, Fox Alice, Fustik Stojka, Gulmans Vincent, Harutyunyan Satenik, Hatziagorou Elpis, Kasmi Irena, Kayserová Hana, Kondratyeva Elena, Krivec Uroš, Makukh Halyna, Malakauskas Kestutis, McKone Edward F, Mei-Zahav Meir, de Monestrol Isabelle, Olesen Hanne Vebert, Padoan Rita, Parulava Tsitsino, Pastor-Vivero Maria Dolores, Pereira Luísa, Petrova Guergana, Pfleger Andreas, Pop Liviu, van Rens Jacqui G, Rodic Milan, Schlesser Marc, Storms Valérie, Turcu Oxana, Woz Niacki Lukasz, Yiallouros Panayiotis, Zolin Anna, Downey Damian G, Naehrlich Lutz
Аннотация
METHODS: In this observational study, the European Cystic Fibrosis Society Patient Registry collected data on pwCF and SARS-CoV-2 infection to estimate incidence, describe clinical presentation and investigate factors associated with severe outcomes using multivariable analysis.
RESULTS: Up to December 31, 2020, 26 countries reported information on 828 pwCF and SARS-CoV-2 infection. Incidence was 17.2 per 1000 pwCF (95% CI: 16.0-18.4). Median age was 24 years, 48.4% were male and 9.4% had lung transplants. SARS-CoV-2 incidence was higher in lung-transplanted (28.6; 95% CI: 22.7-35.5) versus non-lung-transplanted pwCF (16.6; 95% CI: 15.4-17.8) (p≤0.001).SARS-CoV-2 infection caused symptomatic illness in 75.7%. Factors associated with symptomatic SARS-CoV-2 infection were age >40 years, at least one F508del mutation and pancreatic insufficiency.Overall, 23.7% of pwCF were admitted to hospital, 2.5% of those to intensive care, and regretfully 11 (1.4%) died. Hospitalisation, oxygen therapy, intensive care, respiratory support and death were 2- to 6-fold more frequent in lung-transplanted versus non-lung-transplanted pwCF.Factors associated with hospitalisation and oxygen therapy were lung transplantation, cystic fibrosis-related diabetes (CFRD), moderate or severe lung disease and azithromycin use (often considered a surrogate marker for Pseudomonas aeruginosa infection and poorer lung function).
CONCLUSION: SARS-CoV-2 infection yielded high morbidity and hospitalisation in pwCF. PwCF with forced expiratory volume in 1 s <70% predicted, CFRD and those with lung transplants are at particular risk of more severe outcomes.