Fibrotic-Like Pulmonary Radiographic Patterns Are Not Associated With Adverse Outcomes in COVID-19 Chronic Critical Illness.

Pulmonary fibrosis is a feared complication of COVID-19. To characterize the risks and outcomes associated with fibrotic-like radiographic abnormalities in patients with COVID-19-related acute respiratory distress syndrome (ARDS) and chronic critical illness. Single-center prospective cohort study. We examined chest CT scans performed between ICU discharge and 30 days after hospital discharge using established methods to quantify nonfibrotic and fibrotic-like patterns. Adults hospitalized with COVID-19-related ARDS and chronic critical illness (> 21 d of mechanical ventilation, tracheostomy, and survival to ICU discharge) between March 2020 and May 2020. None. We tested associations of fibrotic-like patterns with clinical characteristics and biomarkers, and with time to mechanical ventilator liberation and 6-month survival, controlling for demographics, comorbidities, and COVID-19 therapies. A total of 141 of 616 adults (23%) with COVID-19-related ARDS developed chronic critical illness, and 64 of 141 (46%) had a chest CT a median (interquartile range) 66 days (42-82 d) after intubation. Fifty-five percent had fibrotic-like patterns characterized by reticulations and/or traction bronchiectasis. In adjusted analyses, interleukin-6 level on the day of intubation was associated with fibrotic-like patterns (odds ratio, 4.40 per quartile change; 95% CI, 1.90-10.1 per quartile change). Other inflammatory biomarkers, Sequential Organ Failure Assessment score, age, tidal volume, driving pressure, and ventilator days were not. Fibrotic-like patterns were not associated with longer time to mechanical ventilator liberation or worse 6-month survival. Approximately half of adults with COVID-19-associated chronic critical illness have fibrotic-like patterns that are associated with higher interleukin-6 levels at intubation. Fibrotic-like patterns are not associated with longer time to liberation from mechanical ventilation or worse 6-month survival.

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Dr. Capaccione received funding from Cardinal Health Advisor. Dr. Salvatore received funding from Genetech and Boehringer Ingelheim. Dr. Geleris’ institution received funding from the Department of Defense (DoD) (W81XWH2110217); he received funding from SmarterDx. Dr. Anderson received funding from the National Institutes of Health (NIH) (K23HL150280). Drs. Anderson, Zucker, Cummings, O’Donnell, Wei, and Baldwin received support for article research from the NIH. Dr. Zucker received funding from the NIH (K23AI150378). Dr. Brodie’s institution received funding from LivaNova; he received funding from LivaNova, Medtronic, Cellenkos, Inspira, Xenios, and Abiomed; he disclosed that he has been on the medical advisory boards for Abiomed, Xenios, Medtronic, Inspira, and Cellenkos. Dr. Cummings’ institution received funding from the National Institute of Allergy and Infectious Diseases; he received funding from the NIH (K23AI163364). Dr. McGroder received funding from the NIH (T32HL105323). Drs. Wei and Baldwin disclosed that this work was supported by the DoD (W81XWH2110217). Dr. Garcia’s institution received funding from the DoD (W81XWH2110216), the NIH, the Pulmonary Fibrosis Foundation, and Boehringer Ingelheim; she disclosed that this work was supported by the DoD (W81XWH2110216); disclosed that she consults for Rejuvenation Technologies. Drs. Garcia and Baldwin received support for article research from the DoD. Dr. Baldwin received funding from the NIH (UL1TR001873). The remaining authors have disclosed that they do not have any potential conflicts of interest.