Eight months follow-up study on pulmonary function, lung radiographic, and related physiological characteristics in COVID-19 survivors

Abstract

To describe the long-term health outcomes of patients with COVID-19 and investigate the potential risk factors. Clinical data during hospitalization and at a mean (SD) day of 249 (15) days after discharge from 40 survivors with confirmed COVID-19 (including 25 severe cases) were collected and analyzed retrospectively. At follow-up, severe cases had higher incidences of persistent symptoms, DLCO impairment, and higher abnormal CT score as compared with mild cases. CT score at follow-up was positively correlated with age, LDH level, cumulative days of oxygen treatment, total dosage of glucocorticoids used, and CT peak score during hospitalization. DLCO% at follow-up was negatively correlated with cumulative days of oxygen treatment during hospitalization. DLCO/VA% at follow-up was positively correlated with BMI, and TNF-α level. Among the three groups categorized as survivors with normal DLCO, abnormal DLCO but normal DLCO/VA, and abnormal DLCO and DLCO/VA, survivors with abnormal DLCO and DLCO/VA had the lowest serum IL-2R, IL-8, and TNF-α level, while the survivors with abnormal DLCO but normal DLCO/VA had the highest levels of inflammatory cytokines during hospitalization. Altogether, COVID-19 had a greater long-term impact on the lung physiology of severe cases. The long-term radiological abnormality maybe relate to old age and the severity of COVID-19. Either absent or excess of inflammation during COVID-19 course would lead to the impairment of pulmonary diffusion function.

Longitudinal Radiological Findings in Patients With COVID-19 With Different Severities: From Onset to Long-Term Follow-Up After Discharge

“…Lesions of COVID-19 induced pneumonia were distributed mainly in the subpleural region and progressed from patches to large patches with hardly noticeable pleural changes. With the progression of the disease, density changes were seen with a regular pattern of GGO-consolidation-GGO, which was aligned with previous reports ( 26 – 28 ). The pathological findings revealed that edema, proteinaceous exudate, and hyperplasia of pneumocytes with patchy inflammatory cellular infiltration and the absence of hyaline membranes were histological changes in the early stage of COVID-19 which presented as GGOs at the onset ( 26 , 29 ).…”

“…There were no patients with mild type recruited in this study. Patients in the severe group were older than those in the non-severe group (50.63 ± 13.29 vs. 42.89 ± 13.27 years old, respectively, p = 0.001) and were hospitalized for 23.5 (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30) days, longer than the hospitalization duration of non-severe patients [18 (15-23) days, p < 0.001]. Severe patients were more likely to have severe symptoms at onset.…”

Associations of Post-Acute COVID syndrome with physiological and clinical measures 10 months after hospitalization in patients of the first wave

“…This is consistent with data that shows that 12 months after COVID-19 values of spirometry and bodyplethysmography were <LLN in less than 10% of patients (except for a reduction of TLC in 42%), independently from the severity of the disease during inpatient treatment (WHO guideline severity scale) [40,67]. When assessed up to 8 months after hospitalization, some studies reported a significant relationship between the current functional impairment and the previous severity of the disease [25,29,31,33,36,37,66,68], while others did not [24,26,63,69]. The situation is complicated by a potential interplay between persistent symptoms and functional alterations that could be promoted by changes in behavior, for example regarding physical capacity or anxiety and depression.…”

“…We also found the symptom burden not to be related to characteristics of the previous hospital stay, particularly the severity of COVID-19, which goes along with data from shorter follow-up times in previous studies [36,61,[63][64][65]. In some studies, however, a positive correlation between the severity of the COVID-19 disease and the symptom burden at follow-up had been found [15,26,35,58,60,66]. This heterogeneity could be due to different classifications of disease severity or not yet specified subtypes of the virus or the fact that studies employed different tools, such as personal interview, phone interview and online survey.…”

Clinical and Laboratory Profile of Patients Visiting the Post-COVID-19 Clinic at a Tertiary Care Hospital: A Cross-Sectional Study

“…Since COVID-19 is primarily a respiratory infection, it can be anticipated that continued pulmonary opacities picked up on thoracic radiography render such individuals susceptible to experience residual respiratory symptoms. The lingering opacities may be indicative of fibrosis that some of the patients with COVID-19 pneumonia go on to develop [ 18 , 19 ]…”