Organizing Pneumonia and COVID-19

Abstract

BACKGROUND: Potential sequelae of coronavirus disease 2019 (COVID-19) are still largely unknown. Here, we report, for the first time to our knowledge, the occurrence of an organizing pneumonia-like disease (OPLD) in patients with COVID-19 during hospital admission. METHODS: Observational, uncontrolled series of 53 patients hospitalized in our institution because of COVID-19 pneumonia (March-April 2020). Patients were referred to us by their attending physician because of computed tomography (CT) findings. The demographics, clinical, imaging and biological characteristics of these patients were obtained from their electronic medical records. FINDINGS: Mean age was 63±11 years, most patients were males (74%) and only a few (4%) were current smokers. As previously reported in COVID-19, on admission C-reactive protein (CRP), ferritin and D-Dimer levels were elevated. Pulmonary gas exchange was moderately impaired in most patients and chest X-ray mostly showed bilateral pulmonary opacities. Because persistence/worsening of radiological images and/or deterioration of pulmonary gas exchange, attending physicians ordered a CT scan that showed different degrees of groundglass opacities with peripheral, linear and perilobular consolidations, with reverse halo appearance, associated with bronchial dilatation and architectural distortion in all patients, compatible with organizing pneumonia. At CT time (10±5 days after admission), CRP levels were significantly lower and D-Dimer higher, than those determined on hospital admission. Most patients respond to systemic steroid treatment. INTERPRETATION: Patients with COVID-19 can develop an OPLD during hospitalization. Its long-term outcome remains to be determined. FUNDING STATEMENT: JS was partially supported by the Department of Health of Generalitat de Catalunya (SLT008/18/00176), in the call for grants 2019-2021, under a competitive regime, for the financing of different programs and instrumental actions included in the Strategic Research and Innovation Plan in Health 2016-2020. DECLARATION OF INTERESTS: Dr. Agusti reports grants and personal fees from GSK, Menarini, AstraZeneca and personal fees from Chiesi, outside the submitted work; Dr. Sellares reports grants and personal fees from Boehringer and Roche, personal fees from GSK, Chiesi and Gebro, outside the submitted work; R. Faner reports grants from GSK, grants from Menarini, outside the submitted work; the rest of authors have nothing to disclose. ETHICS APPROVAL STATEMENT: The Institutional Ethics Board of Hospital Clinic of Barcelona, Spain, approved this study and, due to the nature of retrospective chart review, waived the need for informed consent from individual patients (Comite Etic d´Investigacio Clinica; HCB/2020/0422).