Characteristics and clinical outcomes of COVID‐19 patients with pulmonary disorders: A single‐center, retrospective observational study

Abstract Introduction Mortality rates and clinical characteristics of patients with coronavirus disease 2019 (COVID‐19) admitted to the intensive care unit (ICU) vary significantly. Objectives To describe the data of patients with pulmonary comorbidities who were admitted to the ICU with COVID‐19 in Qatar in terms of demographic characteristics, coexisting conditions, imaging findings, and outcomes. Methods We conducted a retrospective study of the outcomes with regard to mortality and requirement of invasive ventilation, demographic characteristics, coexisting conditions, secondary infections, and imaging findings for critical care patients with COVID‐19 in Qatar who had pulmonary comorbidities between March and June 2020. Results A total of 923 patients were included, 29 (3.14%) were found to have pulmonary disease. All these 29 patients' respiratory disease was noted to be asthma. Among these, three patients (10.3%) died in the ICU within 28 days of ICU admission. They were all above 50 years old. Nineteen (66%) patients required intubation and mechanical ventilation. Twenty‐one (72.4%) patients were males. The most common comorbidities included diabetes mellitus (55.1%) and hypertension (62%). Eighteen (62%) patients developed secondary infections in the ICU. Five (17.24%) patients developed renal impairment. Twenty (69%) patients received tocilizumab as part of their COVID‐19 management, and out of these 16 (80%) patients developed a coinfection. Conclusion Patients with pulmonary disorders had higher mortality rates than other patients admitted to ICU during the same time frame with similar comorbidities; these patients require extra consideration and care to avoid disease progression and death.


| INTRODUCTION
Since coronavirus disease 2019 (COVID- 19) was discovered, which is caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). It swiftly spread, resulting in an epidemic throughout the globe. 1,2 While most patients have mild symptoms, some people experience acute respiratory distress syndrome (ARDS), possibly triggered by septic shock, multiorgan failure, cytokine storm, and blood vessels thrombosis. 3,4 Disease outcomes varied across various regions and countries. While increasing age was considered a significant risk factor, 3 comorbidities and coexisting medical conditions proved critical other factors in determining the severity of the disease and mortality outcomes. [5][6][7] It subsequently and steadily became more relevant and essential to determine the effect of various diseases on COVID-19 outcomes. Over the course of the pandemic, evidence emerged that certain medical conditions could influence the outcomes more than the other disease. In relation to this, we focused on outcomes in COVID-19 patients who have known respiratory conditions-we conducted a retrospective study of the outcomes with regard to mortality and requirement of invasive ventilation, demographic characteristics, coexisting conditions, secondary infections, and imaging findings for critical care patients with COVID-19 in Qatar who had pulmonary comorbidities between March 21, 2020, and June 14, 2020. Out of three patients who died, two of them had hypertension (Table 2), and all three have developed secondary infections during their stay in the ICU (Figures 1 and 2).

| MATERIALS AND METHODS
T A B L E 1 28-day mortality and invasive ventilation requirement of laboratory-confirmed COVID-19 patients with known pulmonary disease, by age, and gender thresholds for hospitalization, the robustness of a regional healthcare system, and availability of ICU beds, are various important factors. 8,9 Comorbidities such as diabetes mellitus, 6 hypertension, 10  Pulmonary disease has been identified to affect the outcomes of patients with COVID-19. In particular, COPD has been identified to be associated with poor outcomes. [13][14][15] Smoking is also noted to be related to poor outcomes. 14  Interestingly, we note that in all of our 29 patients, the respiratory disease was asthma, and there were no patients who had COPD.
Asthma, being the diagnosis in all our patients, is likely multifactorial.
In the Gulf States, asthma has a higher prevalence. In addition, as the diagnosis was mostly clinical and lacked adequate objective assessment, our patients were likely overdiagnosed and overpresented.
Furthermore, anecdotal data suggest that overdiagnosis of asthma universally is approximately 30%. 16,17 Asthma has also been noted as In addition, as the diagnosis requires an objective assessment by spirometry, it is likely an underdiagnosed condition in our cohort of patients.
Although a multicenter retrospective study from the United States pertaining to hospitalized patients reported comparable mortality of 13.5% in asthmatic patients with COVID-19, it did not find any significant mortality difference between their asthmatics and nonasthmatics patients. 19 However, our study only included ICU patients whose mortality is expected to be high. The lower mortality in our cohort of patients is likely multifactorial, including our patients' younger age.
As observed in other studies, 8,18 44 diabetes mellitus (n = 18, 62%) and hypertension (n = 16, 55%) were also noted to be the commonest comorbidities among our patients (Table 3). Among the three patients in our study who died, in addition to asthma, two also had hypertension, and one had chronic kidney disease.
The need for invasive ventilation remained common throughout the pandemic. Numerous factors, including the healthcare system's robustness and variation in the threshold for ICU admission and intubation, can cause wide variation in the number of patients subjected to intubation and mechanical ventilation across various countries. In    Mortality n (%) 0 (0%) 2 (12.5%) 0 (0%) 1 (33.3%) 0 (0%)

ACKNOWLEDGMENTS
The publication of this article was funded by the Qatar National Library.

FUNDING
This study was funded by the MRC IRB in Hamad Medical Corporation (MRC-01-20-532).

CONFLICT OF INTEREST
The authors declare that they have no competing interests.

AUTHORS' CONTRIBUTIONS
Conceptualization: Abdulqadir Nashwan, Amna Ahmed, Wasim Jamal. All authors read and approved the final manuscript. The first author confirm that he had full access to all of the data in the study and takes complete responsibility for the integrity of the data and the accuracy of the data analysis.

ETHICS APPROVAL AND CONSENT TO PARTICIPATE
The project has been approved (exempted) by the Medical Research Center (MRC) IRB in Hamad Medical Corporation (MRC-01-20-532).
The study has been conducted in accordance with the ethical standards noted in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards. No consents were obtained due to the retrospective nature of the study.

TRANSPARENCY STATEMENT
I would like to confirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

DATA AVAILABILITY STATEMENT
All data generated or analyzed during this study are included in this published article. ORCID