Severe COVID-19 Infection, Death Risk Higher in Comorbid Interstitial Lung Disease

coronavirus pneumonia image
Coronavirus pneumonia
Patients with interstitial lung disease have an increased risk of severe disease and death associated with COVID-19.

Patients with interstitial lung disease (ILD) have an increased risk of severe disease and death associated with coronavirus disease 2019 (COVID-19), according to findings from a multicenter case-control study published in the American Journal of Respiratory and Critical Care Medicine.

A total of 46 adults with preexisting ILD and a diagnosis of COVID-19 were identified through electronic health record data from 6 Mass General Brigham hospitals. All patients tested either positive for COVID-19 by real-time polymerase chain reaction (RT-PCR) or negative with RT-PCR but positive with immunoglobulin M and/or G serology between March 1 and June 8, 2020. Using the same clinical data registry, the researchers also identified a matched control group of 92 patients with COVID-19 but without ILD.

Death, censored on June 8, 2020, was the primary outcome of interest. Secondary outcomes included hospital admission, intensive care unit (ICU) admission, and hospital discharge either to home or a skilled nursing facility.

More patients with COVID-19 and ILD died compared with control individuals (33% vs 13%, respectively; odds ratio [OR], 3.2; 95% CI, 1.3-7.3; P =.01). The association between COVID-19 and comorbid ILD with increased mortality persisted in an analysis adjusted for age, sex, race, smoking status, cardiovascular disease, and any chronic immunosuppression (OR, 4.3; 95% CI, 1.4-14.0; P =.01).

In the ILD cohort, patients who died were significantly older compared with survivors (76 vs 67 years, respectively; P =.02). In addition, patients with ILD and COVID-19 were more likely to be admitted to the hospital and require care in the ICU. These patients were also less likely to be discharged, specifically to home.

Study limitations included the small sample size as well as the potential of false negative RT-PCR test results in the cohort.

The researchers noted “patients with ILD should be counseled of their increased risk” of severe disease and death associated with COVID-19 “with an emphasis on public health measures to prevent infection in this susceptible population.”


Esposito AJ, Menon AA, Ghosh AJ, et al. Increased odds of death for patients with interstitial lung disease and COVID-19: a case-control study. Am J Respir Crit Care Med. Published online September 8, 2020. doi:10.1164/rccm.202006-2441LE