Patients With Impaired Lung Function May Have Higher Risk of Severe COVID-19

People with sarcoidosis who have impaired lung function seem to be at greater risk for severe COVID-19 disease, a new study suggests.

The study, “Moderate or Severe Impairment in Pulmonary Function is Associated with Mortality in Sarcoidosis Patients Infected with SARS‑CoV‑2,” was published in the journal Lung.

COVID-19 is caused by the virus SARS-Cov-2. Available data so far have indicated that the risk of serious disease is highest in people who are older and in those with other underlying health conditions.

“These outcome data prompted us to ask whether sarcoidosis is an underlying condition that predisposes patients infected with SARS‑CoV‑2 to adverse disease outcomes,” the authors of the new study wrote.

According to them, this study “is the first to evaluate sarcoidosis patients infected with SARS‑CoV‑2.”

Patient data were collected from five hospitals in the Mount Sinai Health System, in New York, from March 1 to July 29, and then analyzed by the team. In total, the researchers identified data for 7,337 people who tested positive for COVID-19; of these, 37 (0.5%) had sarcoidosis.

“The number of patients with sarcoidosis was small,” the researchers wrote. “While sarcoidosis is a rare disease, we expected that our cohort [patient group] would be larger.”

The team speculated that the relatively low number of infected sarcoidosis patients identified could be related to the disease’s underlying biology — sarcoidosis is characterized by an overactive immune system, which could theoretically help fight infections — or by other factors, such as reduced access to testing.

“Additional studies are needed to explore these hypotheses,” the researchers wrote, noting that the small number of sarcoidosis patients is an inherent limitation of their study.

The rates of various outcomes between COVID-19 patients with or without sarcoidosis were compared for this analysis.

COVID patients with the disease were significantly more likely to be African-American, to be obese, to be past or present smokers, or to have chronic obstructive pulmonary disease (COPD), compared with those without sarcoidosis.

No statistically significant differences were found in terms of hospital admission rates, rates of requiring a ventilator, or mortality rates.

Based on the available data, 14 of the sarcoidosis patients were determined to have a moderate-to-severe impairment in lung function. Of these, nine (64.3%) developed severe COVID-19 disease — defined as disease that resulted in the need for mechanical ventilation or in death.

In contrast, three out of 23 people with sarcoidosis who did not have lung impairment (13.0%) developed severe disease. This difference was statistically significant.

Additional statistical analyses indicated that there was no significant difference in the risk of severe disease between people with or without a diagnosis of sarcoidosis. However, relative to the rest of the study population, those with sarcoidosis who had impaired lung function were nearly eight times more likely to develop severe disease.

“Our results did not show a significant association between sarcoidosis and mortality. Yet, the risk of intubation and mechanical ventilation or in-hospital mortality was highest in patients with moderately and/or severely impaired pulmonary function,” the researchers wrote.

Further statistical analyses showed that age, male sex, heart disease, diabetes mellitus, chronic kidney disease, COPD, and obesity were associated with an increased risk of severe disease in the overall study population (with or without sarcoidosis). These findings are largely in accordance with other published reports on COVID-19.

Of note, the team recognized that this study does not have the statistical power — referring to the minimum number of people that need to be included in an analysis for the results to be mathematically meaningful — to make assessments as to whether sarcoidosis treatments affected COVID-19 outcomes.

Overall, the data indicated “that sarcoidosis patients with COVID-19 are more likely to require mechanical ventilation and die if they have pre-existing moderate and/or severe impairment in pulmonary function,” the researchers wrote.

“The results of our study may provide a foundation for future prospective studies, which further examine outcomes in sarcoidosis patients infected with SARS‑CoV‑2,” they added.