Respiration . Six-Month Pulmonary Impairment after Severe COVID-19: A Prospective, Multicentre Follow-Up Study

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Respiration


. 2021 Aug 19;1-10.
doi: 10.1159/000518141. Online ahead of print.
Six-Month Pulmonary Impairment after Severe COVID-19: A Prospective, Multicentre Follow-Up Study


Paola Faverio ¹ , Fabrizio Luppi ¹ , Paola Rebora ² , Sara Busnelli ¹ , Anna Stainer ¹ , Martina Catalano ¹ , Luca Parachini ¹ , Anna Monzani ¹ , Stefania Galimberti ² , Francesco Bini ³ , Bruno Dino Bodini ³ , Monia Betti ⁴ , Federica De Giacomi ⁴ , Paolo Scarpazza ⁵ , Elisa Oggionni ⁵ , Alessandro Scartabellati ⁶ , Luca Bilucaglia ⁶ , Paolo Ceruti ⁷ , Denise Modina ⁷ , Sergio Harari ⁸ , Antonella Caminati ⁹ , Maria Grazia Valsecchi ² , Giacomo Bellani ¹⁰ , Giuseppe Foti ¹⁰ , Alberto Pesci ¹



Affiliations

• PMID: 34515212
• DOI: 10.1159/000518141

Abstract

Background: Long-term pulmonary sequelae following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia are not yet confirmed; however, preliminary observations suggest a possible relevant clinical, functional, and radiological impairment.
Objectives: The aim of this study was to identify and characterize pulmonary sequelae caused by SARS-CoV-2 pneumonia at 6-month follow-up.
Methods: In this multicentre, prospective, observational cohort study, patients hospitalized 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," and "invasive mechanical ventilation") and followed up at 6 months from discharge. Pulmonary function tests and diffusion capacity for carbon monoxide (DLCO), 6-min walking test, chest X-ray, physical examination, and modified Medical Research Council (mMRC) dyspnoea score were collected.
Results: Between March and June 2020, 312 patients were enrolled (83, 27% women; median interquartile range age 61.1 [53.4, 69.3] years). The parameters that showed the highest rate of impairment were DLCO and chest X-ray, in 46% and 25% of patients, respectively. However, only a minority of patients reported dyspnoea (31%), defined as mMRC ≥1, or showed restrictive ventilatory defects (9%). In the logistic regression model, having asthma as a comorbidity was associated with DLCO impairment at follow-up, while prophylactic heparin administration during hospitalization appeared as a protective factor. The need for invasive ventilatory support during hospitalization was associated with chest imaging abnormalities.
Conclusions: DLCO and radiological assessment appear to be the most sensitive tools to monitor patients with the coronavirus disease 2019 (COVID-19) during follow-up. Future studies with longer follow-up are warranted to better understand pulmonary sequelae.

Keywords: COVID-19; Follow-up; Pneumonia; Pulmonary fibrosis; Radiology and other imaging; Respiratory function tests.