Predictors of Poor Outcomes in Chronic Obstructive Pulmonary Disease (COPD) Patients Admitted to the Emergency Department With COVID-19: A Prospective Study

Objectives Long-term consequences of COVID-19 in the post-pandemic era are still being investigated. Despite the growing data on COVID-19, there remains a lack of information regarding predictors of poor outcomes among chronic obstructive pulmonary disease (COPD) patients with COVID-19. Methods A single-center prospective cohort study was conducted with a total of 172 adult COPD patients with COVID-19 pneumonia included. Univariable and multivariable analyses were conducted to define independent factors associated with ICU admission, need for mechanical ventilation, or all-cause mortality in 30 days following COVID-19 pneumonia. receiver operating characteristic (ROC) analyses evaluated the diagnostic performance of the independent predictors. Results Out of all the patients, 73 (42.4%) experienced poor outcomes. Lower forced expiratory volume in the first second (FEV1) (OR= 0.949, p= 0.004), higher radiological severity score (OR= 1.15, p= 0.004), and lower respiratory rate oxygenation (ROX) index (OR= 0.867, p<0.001) were independently associated with poor outcomes. ROX index was found a better predictor of poor outcome than oxygen saturation (SaO2)/fraction of inspired oxygen (FiO2) and partial pressure of oxygen (PaO2)/FiO2 ratio (area under the curve (AUC)=0.80 vs. 0.73, p=0.01; AUC= 0. 80 vs. 0.63 p=0.001). A significant decline in FEV1 values compared to baseline values was observed (55.9 ±12.9 vs. 62.1±10.0; p<0.001). Conclusion Lower baseline FEV1, higher COVID-19 radiological severity score, and lower ROX index are strongly associated with poor outcomes in COPD patients with COVID-19.