Evolution and long‑term respiratory sequelae after severe COVID-19 pneumonia: nitric oxide diffusion measurement value

Núñez-Fernández, Marta; Ramos-Hernández, Cristina; García‐Río, Francisco; Pérez-González, Alexandre; Tilve-Gómez, Amara; Rodríguez-Fernández, Paula; Nodar-Germiñas, Andrés; Fernández-García, Alberto; Ruano-Raviña, Alberto; Villar, Alberto Fernández

doi:10.1186/s12931-023-02344-2

Cited by 8 publications

(7 citation statements)

References 32 publications

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“…A total of 2517 studies were identified, of which 43 met the inclusion (N = 8858 patients) ( Figure 1 ) [ 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 ]. The majority of studies were from China (14 studies [ 51 , 58 , 59 , 60 , 61 , 64 , 65 , …”

Section: Resultsmentioning

confidence: 99%

“…The median age of the patients was 60.3 years (57–63), with 61.5% being males and 37.8% being current/former smokers. Thirty-nine studies [ 47 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 65 , 66 , 67 , 68 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 ] reported outcomes stratified by disease severity; 17 for non-severe disease, 31 for severe disease, and 7 for mixed disease severity ( Table 1 ). The most common comorbidities were hypertension (35.8%), cardiovascular disease, (28%), and obesity (24.9%) ( Supplemental Table S1 ).…”

Section: Resultsmentioning

confidence: 99%

“…A total of 37 studies [ 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 56 , 57 , 60 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 ] reported chest-CT findings at 12 months, while only 3 studies [ 55 , 59 , 61 ] reported findings at 24 months. When comparing CT abnormalities between the 12- and 24-month follow-ups, consolidation (12 months: 3.6% vs. 24 months: 0.9%, p = 0.036) and interlobular septal thickening (12 months: 17.3% vs. 24 months: 7%, p = 0.043) significantly decreased over time.…”

Section: Resultsmentioning

confidence: 99%

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Short- and Long-Term Chest-CT Findings after Recovery from COVID-19: A Systematic Review and Meta-Analysis

Babar,

Jamil,

Mehta

et al. 2024

Diagnostics

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While ground-glass opacity, consolidation, and fibrosis in the lungs are some of the hallmarks of acute SAR-CoV-2 infection, it remains unclear whether these pulmonary radiological findings would resolve after acute symptoms have subsided. We conducted a systematic review and meta-analysis to evaluate chest computed tomography (CT) abnormalities stratified by COVID-19 disease severity and multiple timepoints post-infection. PubMed/MEDLINE was searched for relevant articles until 23 May 2023. Studies with COVID-19-recovered patients and follow-up chest CT at least 12 months post-infection were included. CT findings were evaluated at short-term (1–6 months) and long-term (12–24 months) follow-ups and by disease severity (severe and non-severe). A generalized linear mixed-effects model with random effects was used to estimate event rates for CT findings. A total of 2517 studies were identified, of which 43 met the inclusion (N = 8858 patients). Fibrotic-like changes had the highest event rate at short-term (0.44 [0.3–0.59]) and long-term (0.38 [0.23–0.56]) follow-ups. A meta-regression showed that over time the event rates decreased for any abnormality (β = −0.137, p = 0.002), ground-glass opacities (β = −0.169, p < 0.001), increased for honeycombing (β = 0.075, p = 0.03), and did not change for fibrotic-like changes, bronchiectasis, reticulation, and interlobular septal thickening (p > 0.05 for all). The severe subgroup had significantly higher rates of any abnormalities (p < 0.001), bronchiectasis (p = 0.02), fibrotic-like changes (p = 0.03), and reticulation (p < 0.001) at long-term follow-ups when compared to the non-severe subgroup. In conclusion, significant CT abnormalities remained up to 2 years post-COVID-19, especially in patients with severe disease. Long-lasting pulmonary abnormalities post-SARS-CoV-2 infection signal a future public health concern, necessitating extended monitoring, rehabilitation, survivor support, vaccination, and ongoing research for targeted therapies.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Short- and Long-Term Chest-CT Findings after Recovery from COVID-19: A Systematic Review and Meta-Analysis

Babar,

Jamil,

Mehta

et al. 2024

Diagnostics

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“…Finally, 46 studies with 8289 participants (3338 PASC and 4951 controls) were included in our pooled analysis (Table 1). 24–69 These included studies were all peer‐reviewed, published between 2020 and 2023; had data from 28 studies in Resp‐PASC, 10 studies in Neuro‐PASC, 5 studies in Cardio‐PASC, 2 studies in gastrointestinal‐PASC and as only 1 study was in Reno‐PASC. Thirty‐four studies were of cohort design, 11 were case control and 1 cross‐sectional.…”

Section: Resultsmentioning

confidence: 99%

Lactate dehydrogenase contribution to symptom persistence in long COVID: A pooled analysis

Udeh,

Utrero‐Rico,

Dolja‐Gore

et al. 2023

Reviews in Medical Virology

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There's critical need for risk predictors in long COVID. This meta‐analysis evaluates the evidence for an association between plasma lactate dehydrogenase (LDH) and long COVID and explores the contribution of LDH to symptoms persistent across the distinct post‐acute sequelae of COVID‐19 (PASC) domains. PubMed, EMBASE, Web of Science, and Google Scholar were searched for articles published up to 20 March 2023 for studies that reported data on LDH levels in COVID‐19 survivors with and without PASC. Random‐effect meta‐analysis was employed to estimate the standardized mean difference (SMD) with corresponding 95% confidence interval of each outcome. There were a total of 8289 study participants (3338 PASC vs. 4951 controls) from 46 studies. Our meta‐analysis compared to the controls showed a significant association between LDH elevation and Resp‐PASC [SMD = 1.07, 95%CI = 0.72, 1.41, p = 0.01] but not Cardio‐PASC [SMD = 1.79, 95%CI = −0.02, 3.61, p = 0.05], Neuro‐PASC [SMD = 0.19, 95%CI = −0.24, 0.61, p = 0.40], and Gastrointestinal‐PASC [SMD = 0.45, 95%CI = −1.08, 1.98, p = 0.56]. This meta‐analysis suggests elevated LDH can be used for predicting Resp‐PASC, but not Cardio‐PASC, Neuro‐PASC or gastrointestinal‐PASC. Thus, elevated plasma LDH following COVID infection may be considered as a disease biomarker.

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“…Finally, in our population the parenchymal involvement of CT scans is mild on average (about 10% vs 20% in the study by Barisione et al ). Núñez-Fernández and colleagues also assessed the role of DL NO in COVID-19 survivors, both at 3 and 12 months, showing a reduction in diffusion mainly explained by Dm reduction secondary to the damage and loss of alveolar units [ 11 ]. In their study VC and VA significantly improved over time, while DMCO increased less.…”

Section: Discussionmentioning

confidence: 99%

Gas exchange abnormalities in Long COVID are driven by the alteration of the vascular component

Imeri,

Conti,

Caroli

et al. 2024

Multidiscip Respir Med

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Background: There are uncertainties whether the impairment of lung diffusing capacity in COVID-19 is due to an alteration in the diffusive conductance of the alveolar membrane (Dm), or an alteration of the alveolar capillary volume (Vc), or a combination of both. The combined measurement DLNO and DLCO diffusion, owing to NO higher affinity and faster reaction rate with haemoglobin compared to CO, enables the simultaneous and rapid determination of both Vc and Dm. The aim of the present study was to better identify the precise cause of post-COVID-19 diffusion impairment.Methods: Using the combined NO and CO gas transfer techniques (DLNO and DLCO), it is possible to better understand whether gas exchange abnormalities are due to membrane or alveolar capillary volume components. The present study was aimed at evaluating pulmonary gas exchange one year after severe COVID-19. Results: The cohort included 33 survivors to severe COVID-19 (median age 67 years, 70% male) with no pre-existing lung disease, who underwent clinical, lung function and imaging assessments at 12 months due to persistence of respiratory symptoms or radiological impairment. The gas exchange abnormalities were mainly determined by the compromise of the vascular component as demonstrated by vascular pattern of gas exchange impairment (i.e., DLNO/DLCO≥110%, 76% of the sample), and by a reduction of the Vc (73%), while the Dm was reduced only in 9% of the entire sample. We did not find a correlation between the gas exchange impairment and the extent of the chest CT alterations (DLCO p = 0.059 and DLNO p = 0.054), which on average were found to be mild (11% of the parenchyma).Conclusion: In COVID-19 survivors who are still symptomatic or have minimal CT findings at one year, gas exchange abnormalities are determined by impairment of the vascular component, rather than the diffusive component of the alveolar membrane.

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Evolution and long‑term respiratory sequelae after severe COVID-19 pneumonia: nitric oxide diffusion measurement value

Cited by 8 publications

References 32 publications

Short- and Long-Term Chest-CT Findings after Recovery from COVID-19: A Systematic Review and Meta-Analysis

Short- and Long-Term Chest-CT Findings after Recovery from COVID-19: A Systematic Review and Meta-Analysis

Lactate dehydrogenase contribution to symptom persistence in long COVID: A pooled analysis

Gas exchange abnormalities in Long COVID are driven by the alteration of the vascular component

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