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1. CT predictors of outcomes in patients with connective tissue disease and progressive lung fibrosis.

Author

Shou AY and Salvatore MM

Subjects
Humans, Retrospective Studies, Fibrosis, Oxygen, Disease Progression, Tomography, X-Ray Computed methods, Lung diagnostic imaging, Lung Diseases, Interstitial diagnostic imaging, Lung Diseases, Interstitial complications, Connective Tissue Diseases complications, Connective Tissue Diseases diagnostic imaging, Idiopathic Pulmonary Fibrosis diagnostic imaging
Abstract

Purpose: Progressive fibrosing interstitial lung disease (PF-ILD) is a phenotype defined by rapid clinical progression towards respiratory failure. While idiopathic pulmonary fibrosis is the archetype of PF-ILD, connective tissue disease associated interstitial lung disease (CTD-ILD) can also manifest as PF-ILD. Few studies have described the value of serial computed tomography (CT) in predicting clinical progression of ILD. We explore which single and serial clinical and radiographic variables, in particular serial CT variables and a novel variable, the right lower lobe anterior bronchial angle (RLL-ABA), best predict mortality, oxygen requirement, hospital admissions, and lung transplant in CTD-ILD., Methods: This is a single-center retrospective study of 84 patients with a history of CTD-ILD. Cox survival analysis was used to predict two endpoints, all-cause mortality and composite negative outcomes (CNO): new oxygen requirement, respiratory admission, lung transplant, and death., Results: On serial CT, change in pulmonary artery (PA) size and RLL-ABA were predictive of mortality and CNO, and change in fibrosis was predictive of mortality alone. On single CT, the extent of fibrosis, PA size, and PA to aorta ratio were predictive of mortality and CNO. Among clinical variables, oxygen requirement, forced vital capacity (FVC), change in FVC, and worsening shortness of breath were predictive of mortality and CNO, and diffusing capacity for carbon monoxide was predictive of mortality alone., Conclusions: In addition to clinical and single CT variables, serial CT measurements such as change in extent of fibrosis, PA size, PA to aorta ratio, and RLL-ABA were predictive of mortality and CNO., Competing Interests: Declaration of competing interest Arthur Shou- No disclosures. Mary Salvatore- Speaker and consultant for Genentech, Boehriger Ingelheim. Grant support from Boehriger Ingelheim and Genentech., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Published
2023
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2. Characterization and clinical course of 1000 patients with COVID-19 in New York: retrospective case series.

Author

Argenziano MG, Bruce SL, Slater CL, Tiao JR, Baldwin MR, Barr RG, Chang BP, Chau KH, Choi JJ, Gavin N, Goyal P, Mills AM, Patel AA, Romney MS, Safford MM, Schluger NW, Sengupta S, Sobieszczyk ME, Zucker JE, Asadourian PA, Bell FM, Boyd R, Cohen MF, Colquhoun MI, Colville LA, de Jonge JH, Dershowitz LB, Dey SA, Eiseman KA, Girvin ZP, Goni DT, Harb AA, Herzik N, Householder S, Karaaslan LE, Lee H, Lieberman E, Ling A, Lu R, Shou AY, Sisti AC, Snow ZE, Sperring CP, Xiong Y, Zhou HW, Natarajan K, Hripcsak G, and Chen R

Abstract

Objective: To characterize patients with coronavirus disease 2019 (COVID-19) in a large New York City (NYC) medical center and describe their clinical course across the emergency department (ED), inpatient wards, and intensive care units (ICUs)., Design: Retrospective manual medical record review., Setting: NewYork-Presbyterian/Columbia University Irving Medical Center (NYP/CUIMC), a quaternary care academic medical center in NYC., Participants: The first 1000 consecutive patients with laboratory-confirmed COVID-19., Methods: We identified the first 1000 consecutive patients with a positive RT-SARS-CoV-2 PCR test who first presented to the ED or were hospitalized at NYP/CUIMC between March 1 and April 5, 2020. Patient data was manually abstracted from the electronic medical record., Main Outcome Measures: We describe patient characteristics including demographics, presenting symptoms, comorbidities on presentation, hospital course, time to intubation, complications, mortality, and disposition., Results: Among the first 1000 patients, 150 were ED patients, 614 were admitted without requiring ICU-level care, and 236 were admitted or transferred to the ICU. The most common presenting symptoms were cough (73.2%), fever (72.8%), and dyspnea (63.1%). Hospitalized patients, and ICU patients in particular, most commonly had baseline comorbidities including of hypertension, diabetes, and obesity. ICU patients were older, predominantly male (66.9%), and long lengths of stay (median 23 days; IQR 12 to 32 days); 78.0% developed AKI and 35.2% required dialysis. Notably, for patients who required mechanical ventilation, only 4.4% were first intubated more than 14 days after symptom onset. Time to intubation from symptom onset had a bimodal distribution, with modes at 3-4 and 9 days. As of April 30, 90 patients remained hospitalized and 211 had died in the hospital., Conclusions: Hospitalized patients with COVID-19 illness at this medical center faced significant morbidity and mortality, with high rates of AKI, dialysis, and a bimodal distribution in time to intubation from symptom onset., Competing Interests: Conflict of Interest Disclosures: All authors have completed the ICMJE uniform disclosure form and declare: no support from any organization for the submitted work; no competing interests with regards to the submitted work. MMS reports grants from Amgen, outside the submitted work. JJC reports personal fees from Allergan, outside the submitted work. RGB reports grants from Alpha1 Foundation and COPD Foundation, outside the submitted work. GH reports grants from Janssen Research, outside the submitted work. The remaining authors MGA, SLB, CLS, JRT, KN, RC, MRB, BPC, NG, PG, AMM, AAP, MSR, NWS, SS, MDS, KN, PAA, FMB, RB, MFC, MIC, LAC, JHD, LBD, SAD, KAE, ZPG, DTG, AAH, NH, SH, LEK, EL, AL, AYS, ACS, ZES, CPS, YX, HWZ, and RL have nothing to disclose.

Published
2020
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