One-year pulmonary impairment after severe COVID-19: a prospective, multicenter follow-up study

Abstract

Background Long-term pulmonary sequelae following hospitalization for SARS-CoV-2 pneumonia is largely unclear. The aim of this study was to identify and characterise pulmonary sequelae caused by SARS-CoV-2 pneumonia at 12-month from discharge. Methods In this multicentre, prospective, observational study, patients hospitalised for SARS-CoV-2 pneumonia and without prior diagnosis of structural lung diseases were stratified by maximum ventilatory support (“oxygen only”, “continuous positive airway pressure (CPAP)” and “invasive mechanical ventilation (IMV)”) and followed up at 12 months from discharge. Pulmonary function tests and diffusion capacity for carbon monoxide (DLCO), 6 min walking test, high resolution CT (HRCT) scan, and modified Medical Research Council (mMRC) dyspnea scale were collected. Results Out of 287 patients hospitalized with SARS-CoV-2 pneumonia and followed up at 1 year, DLCO impairment, mainly of mild entity and improved with respect to the 6-month follow-up, was observed more frequently in the “oxygen only” and “IMV” group (53% and 49% of patients, respectively), compared to 29% in the “CPAP” group. Abnormalities at chest HRCT were found in 46%, 65% and 80% of cases in the “oxygen only”, “CPAP” and “IMV” group, respectively. Non-fibrotic interstitial lung abnormalities, in particular reticulations and ground-glass attenuation, were the main finding, while honeycombing was found only in 1% of cases. Older patients and those requiring IMV were at higher risk of developing radiological pulmonary sequelae. Dyspnea evaluated through mMRC scale was reported by 35% of patients with no differences between groups, compared to 29% at 6-month follow-up. Conclusion DLCO alteration and non-fibrotic interstitial lung abnormalities are common after 1 year from hospitalization due to SARS-CoV-2 pneumonia, particularly in older patients requiring higher ventilatory support. Studies with longer follow-ups are needed.

Cluster analysis unveils a severe persistent respiratory impairment phenotype 3-months after severe COVID-19

“…Given the design of our study, the patients were not systematically rescheduled for long-term reassessment, which represents a major limitation. Interestingly, two recent studies decribed 1-year follow-up features of severe hospitalized COVID-19 patients, showing frequent persistent fatigue, dyspnea, and quality of life impairment [ 36 ] and also DLCO alteration and persistent interstitial lung abnormalities especially in older patients requiring ventilatory support [ 37 ]. Our study is also limited by its single-center design, the potential selection bias of patients who consented to a 3-month assessment, the relatively low number of patients, the absence of pre-COVID-19 data regarding respiratory symptoms, pulmonary function, CT scan, sarcopenia and psychological symptoms, and the absence of systematic assessment of pulmonary arterial hypertension by echography.…”

Pulmonale Manifestationen bei Long-COVID

“…So wurden in einer Studie 12 Monate nach einer COVID-19-Erkrankung mit Hospitalisierung nur bei 1 % der Patienten fibrotische Folgeerscheinungen (im Sinne von "honeycombing") in der hochauflösenden Computertomographie (HR-CT) gefunden. In den meisten Fällen dieser Studie (66 % der Patienten) wurden nichtfibrotische Veränderungen mit eingeschränkter anatomischer Ausdehnung beobachtet [11]. Ähnliche Befunde ergaben sich im 2-Jahres-Verlauf nach COVID-19 [19].…”

“…Auch andere Studien zeigten eine leichte Einschränkung der TLC und DLCO nach mildem bis schwerem COVID-19-Verlauf (TLC 78-102 % des Soll, DLCO 61-81 % des Soll 4 Monate nach einer COVID-19-Erkrankung; [24]). Die lungenfunktionellen Befunde korrelieren mit der Schwere des initialen Verlaufs und bessern sich im Lauf der Zeit, wobei insbesondere die Einschränkung der DLCO über einen längeren Beobachtungszeitraum bis zu einem Jahr persistieren kann [3,11,16,18,32,34]. Bei Patienten nach sehr schwerem COVID-19-Verlauf zeigten sich im 2-Jahres-Verlauf signifikant häufiger Zeichen einer restriktiven Ventilationsstörung und Lungendiffusionsstörung als bei Kontrollpatienten [19] [14].…”

“…Die Patienten zeigen häufig radiologische Auffälligkeiten sowie typische restriktive lungenfunktionelle Veränderungen mit verminderter TLC und Einschränkung der Diffusionskapazität. Diese Befunde bessern sich im Verlauf der Rekonvaleszenz, wobei die Diffusionskapazität aber auch im Verlauf bis zu einem Jahr nach der COVID-19-Erkrankung noch eingeschränkt sein kann [3,11,16,18,32,34].…”

Case Report: Pirfenidone in the Treatment of Post-COVID-19 Pulmonary Fibrosis

“…Several long-term longitudinal follow-up cohorts of patients recovered from COVID-19 have shown that although most patients recover well, up to 57.7–100% of patients still have persistent lung structural abnormalities and pulmonary function impairment ( 4 – 6 ). The common pattern of pulmonary interstitial lesions, also known as post-COVID-19 pulmonary fibrosis or COVID-19 pulmonary fibrosis-like ( 7 ), were ground glass opacities (GGOs), ground-glass attenuation and reticular abnormalities ( 8 ). At the same time, chest imaging showed bilateral diffuse interstitial lung disease among patients who complicated acute respiratory distress syndrome (ARDS) during acute phase ( 9 ).…”