Dataset Information

Integrative respiratory follow-up of severe COVID-19 reveals common functional and lung imaging sequelae.

ABSTRACT:

Background

COVID-19 pandemic resulted in an unprecedented number of hospitalizations in general wards and intensive care units (ICU). Severe and critical COVID-19 patients suffer from extensive pneumonia; therefore, long-term respiratory sequelae may be expected.

Research question

We conducted a cohort study to determine respiratory sequelae in patients with severe and critical COVID-19. We aimed at evaluating the proportion of patients with persisting respiratory symptoms and/or abnormalities in pulmonary function tests (PFT) or in lung imaging.

Study design

and methods: This is a single center cohort study including COVID-19 survivors who underwent a three-month follow-up with clinical evaluation, PFT and lung high-resolution computed tomography (HRCT). All clinical, functional, and radiological data were centrally reviewed. Multiple linear regression analysis was performed to identify factors associated with residual lesions on HRCT.

Results

Full clinical evaluation, PFT and lung HRCT were available for central review in 126, 122 and 107 patients, respectively. At follow-up, 25% of patients complained from dyspnea and 35% from fatigue, lung diffusion capacity (DLCO) was decreased in 45%, 17% had HRCT abnormalities affecting more than 5% of their lung parenchyma while signs of fibrosis were found in 21%. In multiple linear regression model, number of days in ICU were related to the extent of persisting lesions on HRCT, while intubation was associated with signs of fibrosis at follow-up (P = 0.0005, Fisher's exact test). In contrast, the severity of lung imaging or PFT changes were not predictive of fatigue and dyspnea.

Interpretation

Although most hospitalized COVID-19 patients recover, a substantial proportion complains from persisting dyspnea and fatigue. Impairment of DLCO and signs suggestive of fibrosis are common but are not strictly related to long-lasting symptoms.

SUBMITTER: Froidure A

PROVIDER: S-EPMC8019490 | biostudies-literature | 2021 May

REPOSITORIES: biostudies-literature

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Publications

Integrative respiratory follow-up of severe COVID-19 reveals common functional and lung imaging sequelae.

Froidure Antoine A Mahsouli Amin A Liistro Giuseppe G De Greef Julien J Belkhir Leila L Gérard Ludovic L Bertrand Aurélie A Koenig Sandra S Pothen Lucie L Yildiz Halil H Mwenge Benny B Aboubakar Frank F Gohy Sophie S Pilette Charles C Reychler Gregory G Coche Emmanuel E Yombi Jean-Cyr JC Ghaye Benoit B

Respiratory medicine 20210404

<h4>Background</h4>COVID-19 pandemic resulted in an unprecedented number of hospitalizations in general wards and intensive care units (ICU). Severe and critical COVID-19 patients suffer from extensive pneumonia; therefore, long-term respiratory sequelae may be expected.<h4>Research question</h4>We conducted a cohort study to determine respiratory sequelae in patients with severe and critical COVID-19. We aimed at evaluating the proportion of patients with persisting respiratory symptoms and/or ...[more]

PMID: 33839588

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Project description:Background Severe acute respiratory syndrome (SARS) broke out in China and spread to all over the world in 2003. Without comprehensive protection, during a severe hospital outbreak in the Peking University People's Hospital (PKUPH), there were 78 patients diagnosed with SARS and two deaths. During treatment, most patients received large doses of steroid shock therapy, which may result in complications of femoral head necrosis and pulmonary fibrosis. We aimed to follow up the condition of lung and bone in those patients. Methods We did an observational cohort study of patients with SARS from 2003 to 2018. We carried out pulmonary CT scans, hip joint MRI tests, pulmonary function tests, and hip joint functional assessment to evaluate the recovery condition of lung damage and femoral head necrosis according to patients' willingness. We used linear regression, and mixed-model repeated-measures analysis to measure the change of lung interstitial and femoral head necrosis volume. This study was authorised by the Ethics Committee of Peking University People's Hospital (2018PHB010-01). All recruited SARS patients signed informed consent for the study. This study is registered with ClinicalTrials.gov, number NCT03443102. Findings There were 80 medical staff patients with SARS altogether in Peking University People's Hospital. Two patients died of SARS in 2003 and 78 patients were enrolled in this study from August, 2003, to March, 2018. 71 patients completed the 15 years' follow-up and seven patients were missing. Pulmonary injury scope on lung CT improved from 2003 (9·40%, SD 7·83) to 2004 (3·20%, 4·78; p≤0·001), and thereafter remained steady to 2018 (4·60%, 6·37). Pulmonary function items in patients with SARS did not differ between 2006 and 2018. The recovery extent of pulmonary function items between 2006 and 2018 in patients with lung interstitial change (n=13), was less than that without lung interstitial changes (n=23), especially in one-second ratio (FEV1/FVC, t=2·21, p=0·04) and mid-flow of maximum expiration (FEF25–75%, t=2·76, p=0·01). The volume of femoral head necrosis decreased significantly from 2003 (38·83%, SD 21·01) to 2005 (30·38%, 20·23; p=0·0002), then decreased slowly from 2005 to 2013 (28·99%, 20·59) and thereafter remained steady to 2018 (25·52%, 15·51)%. Interpretation Damaged lung interstitial and functional decline induced by SARS mainly recovered in the next 1–2 years after rehabilitation. The natural process of femoral head necrosis caused by large doses of steroid shock therapy in SARS patients was not progressive, while partially reversible. Funding Chinese National Ministry of Science and Technology 973 Project (number 2014CB542201), Beijing science and technology new star cross subject (2018019), Fund for Fostering Young Scholars of Peking University Health Science Center (BMU2017PY013), National Natural Science Foundation (numbers 31771322,31571235, 31571236, 31271284).

Project description:Background Since the beginning of the SARS-CoV-2 pandemic, over 550 million people have been infected worldwide. Despite these large numbers, the long-term pulmonary consequences of COVID-19 remain unclear. Aims The aim of this single-center observational cohort study was to identify and characterize pulmonary sequelae of COVID-19 at 12 months from hospitalization and to reveal possible predictors for the persistence of long-term lung consequences. Methods Based on the persistence or absence of radiological changes after 12 months from hospitalization, the whole population was categorized into NOT-RECOVERED (NOT-REC) and RECOVERED (REC) groups, respectively. Clinical and pulmonary function data tests and clinical data were also collected and compared in the two groups. In the NOT-REC group, high resolution computed tomography (HRCT) images were semiquantitatively scored analyzing ground-glass opacities (GGO), interstitial thickening (IT), consolidations (CO), linear and curvilinear band opacities, and bronchiectasis for each lung lobe. Logistic regression analyses served to detect the factors associated with 12-month radiological consequences. Results Out of the 421 patients followed after hospitalization for SARS-CoV-2 pneumonia, 347 met inclusion and exclusion criteria and were enrolled in the study. The NOT-REC patients (n = 24; 6.9%) were significantly older [67 (62–76) years vs. 63 (53–71) years; p = 0.02], more frequently current smokers [4 (17%) vs. 12 (4%); p = 0.02], and with more severe respiratory failure at the time of hospitalization [PaO2/FiO2 at admission: 201 (101–314) vs. 295 (223–343); p = 0.01] compared to REC group (n = 323; 93.1%). On multivariable analysis, being a current smoker resulted in an independent predictor for lung sequelae after 12 months from hospitalization [5.6 OR; 95% CI (1.41–22.12); p = 0.01]. Conclusion After 12 months from hospital admission, a limited number of patients displayed persistent pulmonary sequelae with minimal extension. Being a current smoker at the time of SARS-CoV-2 infection is an independent predictive factor to lung consequences, regardless of the disease severity.

Dataset Information

Integrative respiratory follow-up of severe COVID-19 reveals common functional and lung imaging sequelae.

Background

Research question

Study design

Results

Interpretation

Publications

Integrative respiratory follow-up of severe COVID-19 reveals common functional and lung imaging sequelae.

Similar Datasets

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