Late unexpected consequences of COVID‐19 infection in survivors of acute hypoxic respiratory failure

Michele, Lucrezia De; Pierucci, Paola; Carpagnano, Giovanna Elisiana; Bonamonte, Domenico; Ambrogio, Francesca; Giovannetti, Guido; Dimitri, Michela; D’Agostino, Carlo

doi:10.1111/imj.15261

Cited by 3 publications

(3 citation statements)

References 6 publications

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“…( 24 , 25 ). Careful clinical evaluation of Post-COVID-related medical history included both current respiratory (self-reported PCED, coughing, chest pain/breathing discomfort) and non-respiratory (fatigue, joint/muscle pain, gustative sensory impairment, olfactory sensory impairment, fever, cephalalgia/headache/cognitive fog, tachycardia, alopecia, anxiety/depression) clinical symptoms ( 9 , 26 , 27 ). Clinical symptoms were collected upon semi-structured interview-based specific questions during clinical examination, by the visiting physician.…”

Section: Methodsmentioning

confidence: 99%

“…Clinical severity during the COVID-19 acute phase was classified as follows: (1) domiciliary course; (2) hospitalization in a General Medicine setting; (3) hospitalization in a Pulmonology/Semi-Intensive Care setting; (4) ICU admission. (24,25). Careful clinical evaluation of Post-COVID-related medical history included both current respiratory (self-reported PCED, coughing, chest pain/ breathing discomfort) and non-respiratory (fatigue, joint/muscle pain, gustative sensory impairment, olfactory sensory impairment, fever, cephalalgia/headache/cognitive fog, tachycardia, alopecia, anxiety/ depression) clinical symptoms (9,26,27).…”

Section: Data Collectionmentioning

confidence: 99%

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Significant burden of post-COVID exertional dyspnoea in a South-Italy region: knowledge of risk factors might prevent further critical overload on the healthcare system

Resta,

Cuscianna,

Pierucci

et al. 2023

Front. Public Health

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BackgroundExertional dyspnoea in post-COVID syndrome is a debilitating manifestation, requiring appropriate comprehensive management. However, limited-resources healthcare systems might be unable to expand their healthcare-providing capacity and are expected to be overwhelmed by increasing healthcare demand. Furthermore, since post-COVID exertional dyspnoea is regarded to represent an umbrella term, encompassing several clinical conditions, stratification of patients with post-COVID exertional dyspnoea, depending on risk factors and underlying aetiologies might provide useful for healthcare optimization and potentially help relieve healthcare service from overload. Hence, we aimed to investigate the frequency, functional characterization, and predictors of post-COVID exertional dyspnoea in a large cohort of post-COVID patients in Apulia, Italy, at 3-month post-acute SARS-CoV-2 infection.MethodsA cohort of laboratory-confirmed 318 patients, both domiciliary or hospitalized, was evaluated in a post-COVID Unit outpatient setting. Post-COVID exertional dyspnoea and other post-COVID syndrome manifestations were collected by medical history. Functional characterization of post-COVID exertional dyspnoea was performed through a 6-min walking test (6-mwt). The association of post-COVID exertional dyspnoea with possible risk factors was investigated through univariate and multivariate logistic regression analysis.ResultsAt medical evaluation, post-COVID exertional dyspnoea was reported by as many as 190/318 patients (59.7%), showing relatively high prevalence also in domiciliary-course patients. However, functional characterization disclosed a 6-mwt-based desaturation walking drop in only 24.1% of instrumental post-COVID exertional dyspnoea patients. Multivariate analysis identified five independent predictors significantly contributing to PCED, namely post-COVID-fatigue, pre-existing respiratory co-morbidities, non-asthmatic allergy history, age, and acute-phase-dyspnoea. Sex-restricted multivariate analysis identified a differential risk pattern for males (pre-existing respiratory co-morbidities, age, acute-phase-dyspnoea) and females (post-COVID-fatigue and acute-phase-dyspnoea).ConclusionOur findings revealed that post-COVID exertional dyspnoea is characterized by relevant clinical burden, with potential further strain on healthcare systems, already weakened by pandemic waves. Sex-based subgroup analysis reveals sex-specific dyspnoea-underlying risk profiles and pathogenic mechanisms. Knowledge of sex-specific risk-determining factors might help optimize personalized care management and healthcare resources.

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Section: Methodsmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Significant burden of post-COVID exertional dyspnoea in a South-Italy region: knowledge of risk factors might prevent further critical overload on the healthcare system

Resta,

Cuscianna,

Pierucci

et al. 2023

Front. Public Health

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“…At last, the severe hair loss described in this patients' population was Alopecia in three different forms: Telogen Effluvium, Androgenic Alopecia or a combination of the two. Among all potential hypothesis of pathophysiology mechanisms first, prophylactic or therapeutic doses of anticoagulants, dysthiroidisms, and emotional stress were described [3].…”

Section: Invasive Ventilatory Support (Nrs) Covid-19mentioning

confidence: 99%

Authors’ response to the Letter to the Editor regarding: Post severe COVID-19 infection lung damages study. The experience of early three months multidisciplinary follow-up

Michele¹,

Pierucci

Giovannetti

et al. 2022

Monaldi Arch Chest Dis

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Post severe COVID-19 infection lung damages study. The experience of early three months multidisciplinary follow-up

Michele¹,

Pierucci

Giovannetti

et al. 2022

Monaldi Arch Chest Dis

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The correct type and time of follow-up for patients affected by COVID19 ARDS is still unclear. The aim of this study was to evaluate at the survivors to COVID19 ARDS requiring non-invasive respiratory support (NRS) admitted to a Respiratory Intensive care unit (RICU) from March 8th till May 31th 2020 looking at all sequelae via a comprehensive follow up. All patients underwent a multi-disciplinary instrumental and clinical assessment within three months form admission to evaluate all infection related sequelae. Thirty-eight patients were enrolled Lung-Ultrasound (LUS) showed an outstanding discrimination ability (ROC AUC: 0.95) and a substantial agreement rate (Cohen’s K: 0.74) compared to chest CT-scan detecting improvement of lung consolidations. Youden’s test showed a cut-off pressure of 11 cmH2O ExpiratoryPAP-Continuous-PAP-max (EPAP-CPAP) applied at the airways during hospitalization to be significantly correlated (p value: 0.026) to the increased pulmonary artery common trunk diameter. A total of 8/38 patients (21.8%), 2 of whom during follow-up, were diagnosed with Pulmonary Emboli (PE) and started anticoagulant treatment. Patients with PE had a statistically significant shorter length of time of hospitalization, time to negative swab, CPAP/NIV duration, P/F ratio and D-dimers at follow-up compared to non PE. A comprehensive approach to patients with ARDS COVID19 requiring NRS is necessary. This study highlighted cardiopulmonary impairment related to the ARDS and to the high-EPAP-CPAP-max greater than 11mmHg provided during admission, the usefulness of LUS in monitoring post-infection recovery and the correct identification and treatment of patients with PE during follow up.

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Late unexpected consequences of COVID‐19 infection in survivors of acute hypoxic respiratory failure

Cited by 3 publications

References 6 publications

Significant burden of post-COVID exertional dyspnoea in a South-Italy region: knowledge of risk factors might prevent further critical overload on the healthcare system

Significant burden of post-COVID exertional dyspnoea in a South-Italy region: knowledge of risk factors might prevent further critical overload on the healthcare system

Authors’ response to the Letter to the Editor regarding: Post severe COVID-19 infection lung damages study. The experience of early three months multidisciplinary follow-up

Post severe COVID-19 infection lung damages study. The experience of early three months multidisciplinary follow-up

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