Long-term impact of COVID-19 associated acute respiratory distress syndrome

Abstract

Objectives To determine the health status, exercise capacity, and health related quality of life (HRQoL) of COVID-19 associated acute respiratory distress syndrome (ARDS) survivors, 8 months after diagnosis. Methods All eligible patients were interviewed and underwent a physical examination, chest X-ray, and 6-minute walk test (6MWT). Scales to evaluate post-traumatic stress disorder, depression, anxiety, and HRQoL were applied. Results Of 1,295 patients, 365 suffered ARDS and 166 survived to hospital discharge. Five died after discharge and 48 were lost to follow-up. Of the 113 remaining patients, 81% had persistent symptoms. More than 50% of patients completed less than 80% of the theoretical distance on the 6MWT, 50% had an abnormal X-ray and 93% of patients developed psychiatric disorders. Mean SF-36 scores were worse than in the general population. After multivariate regression analysis, female sex, non-Caucasian race, and Charlson index>2 were independent risk factors for a worse mental health component summary score on the SF-36, and age was associated with a better prognosis. Female sex and chronic obstructive pulmonary disease were independently associated with a worse physical component summary score. Conclusion COVID-19 associated ARDS survivors have long-term consequences in health status, exercise capacity, and HRQoL. Strategies addressed to prevent these sequelae are needed.

Persistent Lung Injury and Prothrombotic State in Long COVID

“…As long as reduction of alveolar volume is compensated and thrombosis can be prevented or dissolved, the trend towards severe complications can be blocked. However, even if the criteria for discharge are met after effective treatment, the influence of impaired alveolar ventilation and pulmonary microcirculation in the course of COVID continues, and the pulmonary tissues are vulnerable to further damage ( 11 – 13 , 40 , 41 ). In another study, no significant differences in forced expiratory volume in 1s (FEV1), forced vital capacity (FVC), or their rates were observed nearly one month after discharge, regardless of the severity of COVID-19.…”

“…Chest computerized tomography (CT) scans showing GGO (55%) and fibrosis (19%) were common. Additionally, DLCO was less than 80% in 77.8% of patients ( 41 ).…”

Bone Marrow-Derived Mesenchymal Stromal Cell Therapy in Severe COVID-19: Preliminary Results of a Phase I/II Clinical Trial

“…The overall case fatality rate for mechanically ventilated patients is 40-45%, with even worse results in pooled analyses of elderly patients or those with comorbidities ( 30 ). In addition, among patients surviving after severe COVID-19, more than 50% experience a substantial reduction in activities of daily living and physical performance ( 31 , 32 ). The societal cost of ARDS was estimated in a recent systematic review to be approximately €70,000 per case ( 33 ).…”

Lung function and exercise capacity 6 months after hospital discharge for critical COVID-19

“…Persistent radiological abnormalities were common in 78% of our patients at 6 month follow up, with the most common abnormality being parenchymal bands. In previous studies, abnormalities on CXR have been reported up to 7 months after COVID-19 diagnosis [ 32 , 33 ]. However, in most COVID-19 studies, patients have undergone more in-depth imaging than CXRs.…”