Dynamic changes of serum SARS-Coronavirus IgG, pulmonary function and radiography in patients recovering from SARS after hospital discharge

Abstract

Objective: The intent of this study was to examine the recovery of individuals who had been hospitalized for severe acute respiratory syndrome (SARS) in the year following their discharge from the hospital. Parameters studied included serum levels of SARS coronavirus (SARS-CoV) IgG antibody, tests of lung function, and imaging data to evaluate changes in lung fibrosis. In addition, we explored the incidence of femoral head necrosis in some of the individuals recovering from SARS. Methods:The subjects of this study were 383 clinically diagnosed SARS patients in Beijing, China. They were tested regularly for serum levels of SARS-CoV IgG antibody and lung function and were given chest X-rays and/or high resolution computerized tomography (HRCT) examinations at the Chinese PLA General Hospital during the 12 months that followed their release from the hospital. Those individuals who were found to have lung diffusion abnormities (transfer coefficient for carbon monoxide [D L CO] < 80% of predicted value [pred]) received regular lung function tests and HRCT examinations in the follow-up phase in order to document the changes in their lung condition. Some patients who complained of joint pain were given magnetic resonance imaging (MRI) examinations of their femoral heads. Findings:Of all the subjects, 81.2% (311 of 383 patients) tested positive for serum SARS-CoV IgG. Of those testing positive, 27.3% (85 of 311 patients) were suffering from lung diffusion abnormities (D L CO < 80% pred) and 21.5% (67 of 311 patients) exhibited lung fibrotic changes. In the 12 month duration of this study, all of the 40 patients with lung diffusion abnormities who were examined exhibited some improvement of lung function and fibrosis detected by radiography. Of the individuals receiving MRI examinations, 23.1% (18 of 78 patients) showed signs of femoral head necrosis. Interpretation:The lack of sero-positive SARS-CoV in some individuals suggests that there may have been some misdiagnosed cases among the subjects included in this study. Of those testing positive, the serum levels of SARS-CoV IgG antibody decreased significantly during the 12 months after hospital discharge. Additionally, we found that the individuals who had lung fibrosis showed some spontaneous recovery. Finally, some of the subjects developed femoral head necrosis.

The 1-Year Impact of Severe Acute Respiratory Syndrome on Pulmonary Function, Exercise Capacity, and Quality of Life in a Cohort of Survivors

“…The serial results suggest an increase of the intra-alveolar diffusion pathway, which might be the result of diffuse alveolar damage and/or BOOP initially, 38 -41 followed by postinflammatory changes such as atelectasis, ongoing alveolitis, and parenchymal fibrosis later in the course of the disease. Our results are similar to a long-term follow-up study 44 in Beijing that reported that 27.3% of their SARS survivors (85 of 311 patients) had impaired Dlco, whereas 21.5% exhibited radiographic evidence of lung fibrotic changes at 1 year. Several studies [45][46][47] on ARDS survivors have shown that their pulmonary function generally returns to normal or near normal by 6 to 12 months, but Dlco may remain abnormal in up to 80% of patients at 1 year after recovery.…”

Clinical Features of Pneumonia Caused by 2009 Influenza A(H1N1) Virus in Beijing, China

“…19 In survivors of severe acute respiratory syndrome (SARS) followed for 1 year, marked improvements in pulmonary fi brosis have been seen, but some patients still had residual changes. 20 Because this kind of fi brosis was reversible, it has been suggested that these fi ndings were partially caused by postinflammatory atelectasis rather than by genuine fi brosis alone. 21 The resolution of lung abnormalities in patients with A(H1N1) viral pneumonia seemed better than that seen in patients with SARS and infl uenza A(H5N1) infection.…”

The long‐term impact of severe acute respiratory syndrome on pulmonary function, exercise capacity and health status

“…[4][5][6][7][8] As SARS is a disease that has recently emerged, the long-term sequelae are largely unclear. Studies on the lung function outcome of SARS survivors have been reported; [9][10][11][12][13][14][15][16][17][18][19] however, the longest duration of follow up was around 3 years and small numbers of subjects were studied. 18,19 We have previously reported the 6 month 12 and 1 year outcomes 13 from the Prince of Wales Hospital SARS patient cohort, based on the available normative lung function data collected in the 1960s.…”