The long-term pulmonary outcomes of coronavirus disease 2019 (COVID-19) are unknown. We aimed to describe self-reported dyspnoea, quality of life, pulmonary function, and chest CT findings three months following hospital admission for COVID-19. We hypothesised outcomes to be inferior for patients admitted to intensive care units (ICU), compared with non-ICU patients.Discharged COVID-19-patients from six Norwegian hospitals were consecutively enrolled in a prospective cohort study. The current report describes the first 103 participants, including 15 ICU patients. Modified Medical Research Council dyspnoea scale (mMRC), EuroQol Group's Questionnaire, spirometry, diffusion capacity (DLCO), six-minute walk test, pulse oximetry, and low-dose CT scan were performed three months after discharge.mMRC was >0 in 54% and >1 in 19% of the participants. The median (25th–75th percentile) forced vital capacity and forced expiratory volume in one second were 94% (76, 121) and 92% (84, 106) of predicted, respectively. DLCO was below the lower limit of normal in 24%. Ground-glass opacities (GGO) with >10% distribution in ≥1 of 4 pulmonary zones were present in 25%, while 19% had parenchymal bands on chest CT. ICU survivors had similar dyspnoea scores and pulmonary function as non-ICU patients, but higher prevalence of GGO (adjusted odds ratio [95% confidence interval] 4.2 [1.1, 15.6]) and performance in lower usual activities.Three months after admission for COVID-19, one fourth of the participants had chest CT opacities and reduced diffusion capacity. Admission to ICU was associated with pathological CT findings. This was not reflected in increased dyspnoea or impaired lung function.

The association between pulmonary sequelae and markers of disease severity, as well as pro-fibrotic mediators, were studied in 108 patients 3 months after hospital admission for COVID-19. The COPD assessment test (CAT-score), spirometry, diffusion capacity of the lungs (DLCO), and chest-CT were performed at 23 Norwegian hospitals included in the NOR-SOLIDARITY trial, an open-labelled, randomised clinical trial, investigating the efficacy of remdesivir and hydroxychloroquine (HCQ). Thirty-eight percent had a CAT-score ≥ 10. DLCO was below the lower limit of normal in 29.6%. Ground-glass opacities were present in 39.8% on chest-CT, parenchymal bands were found in 41.7%. At admission, low pO2/FiO2 ratio, ICU treatment, high viral load, and low antibody levels, were predictors of a poorer pulmonary outcome after 3 months. High levels of matrix metalloproteinase (MMP)-9 during hospitalisation and at 3 months were associated with persistent CT-findings. Except for a negative effect of remdesivir on CAT-score, we found no effect of remdesivir or HCQ on long-term pulmonary outcomes. Three months after hospital admission for COVID-19, a high prevalence of respiratory symptoms, reduced DLCO, and persistent CT-findings was observed. Low pO2/FiO2 ratio, ICU-admission, high viral load, low antibody levels, and high levels of MMP-9 were associated with a worse pulmonary outcome.

Hallgeir Tveiten er spesialist i indremedisin og i lungesykdommer og overlege og seksjonsleder ved Lungemedisinsk avdeling ved Oslo universitetssykehus, Ullevål sykehus. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. PÅL AUKRUST Pål Aukrust er spesialist i indremedisin og i infeksjonssykdommer, overlege og seksjonsleder ved Seksjon for klinisk immunologi og infeksjonsmedisin ved Oslo universitetssykehus, Rikshospitalet, og professor ved Universitetet i Oslo. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. GUSTAV LEHNE Gustav Lehne er dr.med., spesialist i onkologi og i klinisk farmakologi og overlege ved Seksjon for lymfom og indremedisin ved Oslo universitetssykehus, Radiumhospitalet. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. JEZABEL R. RODRIGUEZ Jezabel R. Rodriguez er spesialist i radiologi og overlege ved Seksjon for thorax-, kar-og intervensjonsradiologi ved Oslo universitetssykehus, Ullevål. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. OLE HENNING SKJØNSBERG Ole Henning Skjønsberg er spesialist i indremedisin og i lungesykdommer, overlege og seksjonsleder ved Lungemedisinsk avdeling ved Oslo universitetssykehus, Ullevål sykehus, og professor ved Universitetet i Oslo. Forfatteren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. Kan hemofagocytisk lymfohistiocytose vaere en faktor ved alvorlig koronavirussykdom?

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