PO:32:184 | Assessing the burden of Sars-Cov2 in systemic sclerosis-related interstitial lung disease patients: functional, clinical and therapeutic outcomes from an Italian cohort, a retrospective study

Andrea Cito¹, Greta Giulia Dipietrangelo¹, Daniele V. A. Sabella¹, Marco Fornaro¹, Fabio Cacciapaglia¹, Giuseppe Lopalco¹, Florenzo Iannone¹. | ¹AOUC Policlinico di Bari - Reumatologia Universitaria, Bari, Italy.

Background. Systemic sclerosis (SSc) is a rare immune condition mainly affecting connective tissues with interstitial lung disease (ILD) being a common feature of its clinical milieau. Among others, suffering from autoimmune systemic diseases (ASD) emerged as one of COVID-19 predisposing factors. Objective: the purpose of the present work was to assess the clinical, therapeutic and functional outcomes of a cohort of patients affected by SSc-related ILD (SSc-rILD).

Materials and Methods. We retrospectively analysed data from medical charts of 64 SSc-rILD patients from our Rheumatology Unit of Bari clustered into two groups depending on whether they experienced COVID-19 (35 patients) or not (29 patients). Baseline characteristic intended as the ones acquired at the very last visit before COVID infection or, in the other group, before SARS-CoV2 outbreak, included skin pattern, autoimmune features, ongoing medications, clinical manifestations, respiratory function as assessed through spirometry and radiographic appearance evaluated as TC-scans of the lungs. This information was then newly investigated at the latest available follow-up date as long as COVID-19 outcomes. Standard descriptive statistics were employed to evaluate demographic, clinical and functional characteristics. SPSS IBM was the software of choice in our work.

Results. The mean follow-up period was 46.3 (SD ±10.9) months for the non-COVID and 38.7 (±12.7) months for the COVID cohort. Diffuse cutaneous subset was found to be statistically more frequent in the COVID group (p=0.007) at baseline. The cohort resulted homogeneous when investigated for other demographical characteristics. The main highlight of our work comes from the evaluation of pulmonary functional index variations (Table 1): FVC and FEV1 showed a greater reduction in patients who experienced COVID, respectively -15.7% ±31.4% (vs -0.9%±14.8%, p=0.02) and -15.5% ±30.5% vs -1.7% ±13.9%, p=0.03. A similar trend was observed for DLCOc, -6.1% ±13.5% (vs -0.8% ±17.3%) despite not achieving statistical significance (Tab 1a). Same significance was found in COVID positive limited cutaneous subset subgroup for FVC and FEV1 reduction (p=0.01). In addition, in 2 of the 35 COVID cases (5.7%), the infection resulted in the death of the patients, with SARS-CoV2 being the only reason of death in both groups in the aforementioned follow-up period (Tab. 1b). No clear differences were noticed in ongoing or new onset treatment, while a trend of increasing percentage of digital ulcers, esophagophathy and pulmonary arterial hypertension was found, even if none of the aforementioned reached statistical significance.

Conclusions. Our work highlights the risks related to SARS-CoV2 infection in delicate patients as SSc-rILD ones. Global pulmonary function loss advocates for the necessity of shrewd preventive strategies (as with vaccinations) and careful monitoring of the disease course in those experiencing COVID infection.