自从冠状病毒病发作以来,COVID-19大流行,人们对那些可能有更高的COVID-19预后更差风险的人感到担忧,例如囊性纤维化(CF)。在这种情况下,我们评估了巴西严重急性呼吸道感染(SARI)引起的CF住院患者的特征,我们还进行了系统评价,包括从第一例COVID-19(2019年11月17日)开始到此次搜索之日(2022年5月23日)发表的所有研究,其中包括,同时,全球人群中患有CF和COVID-19的患者。在我们的巴西数据中,我们对2019年12月至2022年3月期间进行了评估,纳入了33例人口统计学和临床特征.我们将患者分为几组:(G1)SARI由于另一种病毒感染而不是严重急性呼吸道综合症冠状病毒2(SARS-CoV-2)(23;5.4%),(G2)由未知病原体引起的SARI(286;67.1%),和(G3)SARS-CoV-2感染引起的SARI(117;27.5%)。G3中的个体往往年龄较大,尤其是50岁以上,呼吸困难的患病率更高,外周毛细血管氧饱和度(SpO2)<95%,和心脏病。重症监护病房(ICU)治疗(52;44.4%)和有创机械通气(29;24.8%)的患病率最高的是G3患者。G3中几乎一半的患者死亡(51;43.6%);相反,G1中没有人死亡。然而,我们观察到G2中有43例(15.0%)死亡。此外,发生12例(4.2%)和1例(0.9%)与SARI无关的死亡,分别,在G2和G3。因SARS-CoV-2感染而死亡的患者SpO2<95%(46;90.2%)的频率更高,ICU治疗(34;66.7%),与康复者相比,有创机械通气(27;52.9%)。该系统综述共包括31篇作为观察性研究发表的论文。这些研究共包括661,386名患者,包括孩子,成年人,和老年人群。然而,只有19,150(2.9%)患者被诊断为CF,从这些病人身上,2523例(0.4%)被诊断为CF和COVID-19。观察到最常见的结果是需要住院治疗(n=322例CF患者),和氧气支持的需要(n=139例CF患者)。一百名CF患者需要重症监护病房,50名患者需要无创机械通气支持,只有3例患者接受有创机械通气支持.在38例CF患者中描述了死亡。重要的是,在一份出版物中,患有CF的肺移植患者的死亡风险增加;根据,另一项研究描述肺移植和中重度肺部疾病是SARS-CoV-2感染后严重结局的独立危险因素.与文献相反,总之,G3中的巴西患者表现出严重的表型,尽管大多数其他研究没有观察到CF和COVID-19患者的预后较差.
Since the onset of the coronavirus disease, COVID-19 pandemic, concern arose for those who might be at higher risk of a worse COVID-19 prognosis, such as those with cystic fibrosis (CF). In this context, we evaluated the features of hospitalized patients with CF due to severe acute respiratory infection (SARI) in Brazil and we also performed a systematic
review including all the studies published from the beginning of the first case of COVID-19 (17 November 2019) to the date of this search (23 May 2022) which included, concomitantly, patients with CF and COVID-19 in the worldwide population. In our Brazilian data, we evaluated the period from December 2019 to March 2022, and we included 33 demographical and clinical patients\' features. We classified the patients into groups: (G1) SARI due to another viral infection than severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (23; 5.4%), (G2) SARI due to an unknown etiological agent (286; 67.1%), and (G3) SARI due to SARS-CoV-2 infection (117; 27.5%). The individuals in G3 tended to be older, especially over 50 years old, and presented a higher prevalence of dyspnea, peripheral capillary oxygen saturation (SpO2) <95%, and cardiopathy. The highest prevalence for intensive care unit (ICU) treatment (52; 44.4%) and invasive mechanical ventilation (29; 24.8%) was for patients in G3. Almost half of the patients in G3 died (51; 43.6%); in contrast, none in G1 died. However, we observed 43 (15.0%) deaths in G2. In addition, 12 (4.2%) and one (0.9%) death not associated with SARI occurred, respectively, in the G2 and G3. The patients who died due to SARS-CoV-2 infection had a higher frequency of SpO2 <95% (46; 90.2%), ICU treatment (34; 66.7%), and invasive mechanical ventilation (27; 52.9%) when compared to those who recovered. The systematic
review comprised a total of 31 papers published as observational studies. These studies comprised 661,386 patients in total, including children, adults, and elderly age groups. However, only 19,150 (2.9%) patients were diagnosed with CF and, from these patients, 2523 (0.4%) were diagnosed with both CF and COVID-19. It was observed that the most common outcome was the need for hospitalization (n = 322 patients with CF), and the need for oxygen support (n = 139 patients with CF). One hundred patients with CF needed intensive care units, fifty patients needed non-invasive mechanical ventilation support, and only three patients were described as receiving invasive mechanical ventilation support. Deaths were described in 38 patients with CF. Importantly, lung-transplanted patients with CF represented an increased risk of death in one publication; in accordance, another study described that lung transplantation and moderate to severe lung disease were independent risk factors for severe outcomes after SARS-CoV-2 infection. In contrast with the literature, in conclusion, Brazilian patients in G3 presented a severe phenotype, even though most of the other studies did not observe worse outcomes in patients with CF and COVID-19.