Lung function of patients hospitalized with COVID-19 at 45 days after hospital discharge: first report of a prospective multicenter study in Brazil

Abstract

Objective: Because SARS-CoV-2 infection can severely affect the lungs and persistent functional changes can occur after severe disease, we aimed to determine lung function parameters of COVID-19 patients at 45 days after hospital discharge and compare changes according to the severity of the disease. Methods: This was a prospective descriptive analytical multicenter study. The participants were allocated into three groups: ward admission (WA) group; ICU admission not on mechanical ventilation (ICU/MV-) group; and ICU admission on MV (ICU/MV+) group. Lung volumes, DLco, MIP, MEP, and six-minute walk distance (6MWD) were measured 45 days after discharge. Results: The sample comprised 242 patients (mean age = 59.4 ± 14.8 years; 52.1% of males), and 232 (96%) had altered lung function. In the total cohort, restrictive disorder was observed in 96%, as well as reductions in DLco (in 21.2% of the patients), FEV1/FVC (in 39.7%), and PEmax (in 95.8%), with no differences between the groups. Comparing the groups, the ICU/MV+ group had reduced DLco in 50% of the patients (p < 0.001) and a lower mean 6MWD % of the predicted value (p = 0.013). Oxygen desaturation in the six-minute walk test was observed in 32.3% of the cohort and was less frequent in the IE group. Conclusions: This is the first South American study involving severe COVID-19 survivors whose lung function was assessed 45 days after hospital discharge. Changes were frequent, especially in those on MV, which highlights the importance of lung function evaluation after severe COVID-19.

Exercise intolerance in post-coronavirus disease 2019 survivors after hospitalisation

“…A low FVC has been reported in post-COVID19 patients as far as one year after the acute infection, and similar results have been demonstrated in SARS-COV1 survivors [29,33]. Considering that a low FVC might be related to the acute respiratory distress syndrome severity, it might indicate the development of restrictive ventilatory impairment secondary to lung interstitial sequelae [35]. This is in line with a tachypnea pattern, proven by high RR/VT.…”

“…Inspiratory muscle weakness and decreases in peripheral muscle strength have been described in post-COVID19 patients and were associated with reduced aerobic capacity [35][36][37]. However, our results did not identify a significant difference in maximal inspiratory pressure according to PEAKV'O2 severity (Table 2).…”

Oximetry at admission as a predictor of tomographic and functional impairment after 3–6 months in hospitalized patients with COVID-19

“…25 At hospital admission, most of the current patients exhibited severe CT involvement, with 42% showing impairment between 25 and 50%, and 30% of patients exhibiting greater than 50% involvement, similar to admission CT findings presented by another Brazilian prospective study. 26 Nevertheless, at follow-up CT after discharge, 32% of patients already had normal CT, regardless of the severity of initial tomographic involvement. This rate of resolution of CT involvement was similar to findings of two other prospective cohort studies that performed CT within 6 months of hospitalization and showed normal CTs in 30-38% of the scans.…”

Influência da composição corporal durante a hospitalização sobre a função pulmonar e força da musculatura inspiratória em pacientes com COVID-19: estudo transversal

“…In addition, approximately 80% of patients diagnosed with COVID-19 and hospitalized with clinical worsening, present alterations in lung function at the time of hospital discharge, which can predict the outcome of the COVID-19 disease [11,12]. Among these alterations, it is possible to observe a decrease in FVC and MIP [11,13].…”

“…It is probable that adequate body composition can improve clinical outcomes of the disease [14], such as lung function and MIP, and reduce the mortality rate. Some studies have investigated the occurrence of weight loss in patients with COVID-19 at different times; before, during, and after hospital treatment [13,15,16], suggesting the possibility that patients with COVID-19 may be susceptible to weight loss [3]. However, to date, no studies have been published to clarify whether there is an association between body composition and lung function, respiratory muscle strength, and mortality after hospital discharge in patients with COVID-19.…”