Severity of respiratory failure and computed chest tomography in acute COVID-19 correlates with pulmonary function and respiratory symptoms after infection with SARS-CoV-2: an observational longitudinal study over 12 months

Abstract

Background Prospective and longitudinal data on pulmonary injury over one year after acute coronavirus disease 2019 (COVID-19) are sparse. Research question: With this study, we aim to investigate pulmonary outcome following SARS-CoV-2 infection including pulmonary function, computed chest tomography, respiratory symptoms and quality of life over 12 months. Study design and Methods 180 patients after acute COVID-19 were enrolled into a single-centre, prospective observational study and examined 6 weeks, 3, 6 and 12 months after onset of COVID-19 symptoms. Chest CT-scans, pulmonary function and symptoms assessed by St. Georges Respiratory Questionnaire were used to evaluate objective and subjective respiratory limitations. Patients were stratified according to acute COVID-19 disease severity. Results Of 180 patients enrolled, 42/180 were not hospitalized during acute SARS-CoV-2 infection, 29/180 were hospitalized without need for oxygen, 43/180 with need for low-flow and 24/180 with high-flow oxygen, 26/180 required invasive mechanical ventilation and 16/180 were treated with ECMO. After acute COVID-19, pulmonary restriction and reduced carbon monoxide diffusion capacity was associated with disease severity after the acute phase and improved over 12 months except for those requiring ECMO treatment. Patients with milder disease showed a predominant reduction of ventilated area instead of simple restriction. The CT score of lung involvement in the acute phase increased significantly with COVID-19 severity and was associated with restriction and reduction in diffusion capacity in follow-up. Respiratory symptoms improved for patients in higher severity groups during follow-up, but not for patients with mild initially disease. Interpretation Severity of respiratory failure during COVID-19 correlates with the degree of pulmonary function impairment and respiratory quality of life in the year after acute infection. Patients with mild vs. severe disease show different patterns of lung involvement and symptom resolution.

Long-term outcomes of COVID-19 intensive care unit survivors and their family members: a one year follow-up prospective study

“…Interestingly, in this study, only 8 of 85 patients had persistent impairment of the diffusion capacity of the lungs for carbon monoxide (DLCO) at 1 year (11%) and, among these, only one was likely to have COVID-19-related DLCO alteration. However, other authors have shown that the severity of the CT scan and DCLO impairment was correlated to the severity of the acute disease (32). CT chest abnormalities in our cohort were found in 72% of patients, which was similar to the report by Eberst et al and higher than findings reported in COVID-19 non-ICU patients (33).…”

Evaluation of CT imaging biomarkers in the trachea and pulmonary vascular tree in patients Post-COVID-19

“…Finally, the authors point out that more research and studies are required to reveal whether the narrowings caused by the pathology in the different structures analyzed are permanent [9]. In research reported by Steinbeis and authors [20] they positively correlate the severity of respiratory failure during COVID-19 with the degree of lung function, deterioration and respiratory quality of life in a follow-up study of up to 12 months. The authors report that the pulmonary involvement score in the acute phase was associated with restriction and reduction of diffusion capacity.…”

“…Respiratory symptoms improved in patients in the higher severity groups during study follow-up, but not in patients with initially mild disease. A direct association with older age, male sex, and higher body mass index (BMI) with the severity of COVID-19 is also reported [20].…”

One-fourth of COVID-19 patients have an impaired pulmonary function after 12 months of disease onset

“…When compared with the HRQL of individuals without impaired pulmonary function, there was no significant difference. This observation can be a result of rehabilitation of patients with impaired pulmonary function [26]. However, the increase in HRQL over time seems not relate to all patients who were experiencing persistent symptoms one year after disease onset [27].…”