B26-14 Clinical Features, Radiological Findings, and Mortality in Patients With E-Cigarette or Vaping Product Use-Associated Lung Injury (Evali): A Systematic Review and Meta-Analysis

Abstract Rationale The global expansion of e-cigarette and vaping product use has introduced a new clinical entity, EVALI (E-cigarette or Vaping Product Use-Associated Lung Injury). Since its first recognition in 2019, its clinical presentation has often mimicked other pulmonary diseases, resulting in underdiagnosis and delayed treatment. A comprehensive synthesis of the available evidence is essential to better characterize this condition and to guide early detection and management. Objective To synthesize evidence on the clinical manifestations, radiological findings, and mortality of EVALI and to quantify their pooled prevalence through meta-analysis. Methods This systematic review and meta-analysis followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD42024525011). Databases searched included Medline/PubMed, Scopus, Web of Science, Embase, and the Virtual Health Library through November 2024. Observational studies reporting clinical features, radiological findings, or outcomes in EVALI patients were included. Pooled prevalence estimates were calculated using a random-effects model with Freeman-Tukey double arcsine transformation. Study quality was evaluated using the Joanna Briggs Institute (JBI) checklist. Results Thirty-eight studies (36 U.S., 2 Canada) encompassing over 6,000 patients diagnosed between 2019 and 2022 were analyzed. Clinical symptoms: constitutional 87.3%, respiratory 87.1%, gastrointestinal 77.1%. Most frequent findings: dyspnea 82.7%, respiratory distress 81.2%, fever 79.9%, cough 77.4%, nausea/vomiting 75.0%. Hospitalization was required in 87.3% of patients; 87.1% required ICU admission. Overall mortality was 0.9% (95% CI 0.6-1.2%). Radiological findings: bilateral pulmonary involvement 98.1% and ground-glass opacities 94.9% were the hallmark CT patterns. Most cases involved adolescents and young adults, predominantly males, with vaping exposure exceeding three months. Figure 1. Pooled prevalence of clinical symptoms in EVALI (random-effects model, 95% CI).Presentation Conclusions EVALI represents a severe but potentially reversible form of acute lung injury characterized by respiratory and constitutional symptoms, bilateral ground-glass opacities, and high hospitalization and ICU admission rates. Despite its low mortality, its impact on adolescents and young adults underscores the need for early recognition, standardized diagnostic criteria, and stricter regulation of vaping products. Category: Clinical Epidemiology / Public Health Presentation Type: Poster This abstract is funded by: None