B44-43 Predicting Outcome in Hospitalized Chronic Obstructive Pulmonary Disease (COPD) Patients With Covid-19 Requiring Respiratory Support

Abstract Background COPD is the fourth leading cause of death globally and is associated with high morbidity and mortality. COVID-19 infection worsened outcomes, particularly in those with pre-existing lung disease. However, data on severe COVID-19 outcomes in patients with COPD—especially those requiring respiratory support—remain limited and conflicting. This study aimed to assess whether COPD patients had higher rates of composite outcome, including acute respiratory distress syndrome (ARDS per Berlin criteria), mechanical ventilation (MV), or death, compared to those without COPD. We hypothesized that COPD patients requiring respiratory support would have an increased risk of this composite outcome. Methods This retrospective study used a prospectively collected cohort from the South Texas Veterans Health Care System (San Antonio, TX), including patients ≥40 years old hospitalized with confirmed COVID-19 from March 13, 2020, to December 31, 2021. Only patients requiring respiratory support were included; those not hospitalized or not requiring oxygen therapy were excluded. Patients were stratified by COPD diagnosis and compared to those without COPD. The composite outcome was assessed at 30, 90, and 365 days. Results Of 2,042 patients, 788 (38.6%) were hospitalized with COVID-19 requiring respiratory support; 86 (10.9%) had COPD, and 702 (89.1%) did not. COPD patients were predominantly White non-Hispanic (59.3%), while non-COPD patients were Hispanic (53.4%). A total of 301 patients (38.2%) had a composite outcome at 365 days. Composite outcome observed between COPD and non-COPD patients at 30 days (26.7% vs. 31.2%; OR = 0.81, 95% CI = 0.49-1.33, p = 0.4), 90 days (32.6% vs. 33.6%; OR = 0.95, 95% CI = 0.59-1.53, p = 0.8), or 365 days (41.8% vs. 37.7%; OR = 1.19, 95% CI = 0.75 - 1.87, p = 0.5). COPD is independently associated with composite outcome after adjusted for age, race/ethnicity, and Charlson Comorbidity Index (CCI). There were no statistically significant differences between the two groups when the composite outcome was assessed at 30-, 90-, and 365-days. Conclusions Among patients with acute COVID-19 requiring respiratory support, those with COPD did not have a statistically significant risk compared to non-COPD patients for composite outcome. Further studies should evaluate the severity of COPD and treatments before assuming that there is no risk of poor clinical outcome. This abstract is funded by: University of Texas San Antonio, South Texas Veterans Health Care System San Antonio, GRECC San Antonio, TX