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Crit Care Explor . Long-Term Cardiopulmonary Function After COVID-19-Associated Acute Respiratory Distress Syndrome: A Multicenter Case-Control Stu

tetano

Editor, Senior Moderator
Crit Care Explor


. 2025 Jul 10;7(7):e1286.
doi: 10.1097/CCE.0000000000001286. eCollection 2025 Jul 1. Long-Term Cardiopulmonary Function After COVID-19-Associated Acute Respiratory Distress Syndrome: A Multicenter Case-Control Study

Fernando Luis Scolari[SUP] 1 2 [/SUP], Marciane Maria Rover[SUP] 1 2 [/SUP], Geraldine Trott[SUP] 1 [/SUP], Mariana Motta Dias da Silva[SUP] 3 [/SUP], Denise de Souza[SUP] 1 [/SUP], Aline Paula Miozzo[SUP] 1 [/SUP], Jennifer Menna Barreto de Souza[SUP] 1 [/SUP], Gabrielle Nunes da Silva[SUP] 1 [/SUP], Raíne Fogliati De Carli Schardosim[SUP] 1 [/SUP], Emelyn de Souza Roldão[SUP] 1 [/SUP], Rosa da Rosa Minho Dos Santos[SUP] 1 [/SUP], Duane Mocellin[SUP] 1 [/SUP], Gabriela Soares Rech[SUP] 1 [/SUP], Carolina Rothmann Itaqui[SUP] 1 [/SUP], Lucas Gobetti da Luz[SUP] 4 [/SUP], Gabriel Beilfuss Rieth[SUP] 5 [/SUP], Thiago Costa Lisboa[SUP] 6 [/SUP], Ana Carolina Mardini[SUP] 6 [/SUP], Juliana Cardozo Fernandes[SUP] 7 [/SUP], Bruna Oliveira Lago[SUP] 7 [/SUP], Luciane Facchi[SUP] 8 [/SUP], Anderson Donelli da Silveira[SUP] 2 [/SUP], Igor Gorski Benedetto[SUP] 9 [/SUP], Marcelle Klein Draghetti[SUP] 5 [/SUP], Tiago Pacheco[SUP] 5 [/SUP], Debora Vaccaro Fogazzi[SUP] 1 [/SUP], Milena Soriano Marcolino[SUP] 10 [/SUP], Ana Carolina Peçanha Antonio[SUP] 6 [/SUP], Paulo Roberto Schvartzman[SUP] 2 [/SUP], Bruna Brandao Barreto[SUP] 11 [/SUP], Caroline Cabral Robinson[SUP] 1 [/SUP], Maicon Falavigna[SUP] 12 13 [/SUP], Luiz Antonio Nasi[SUP] 5 14 [/SUP], Cassiano Teixeira[SUP] 6 [/SUP], Carisi Anne Polanczyk[SUP] 2 3 [/SUP], Regis Goulart Rosa[SUP] 1 14 [/SUP]; Pos-COVID Brazil 3 Group Investigators



Affiliations
Abstract

Objectives: This study aimed to evaluate long-term pulmonary function, cardiopulmonary exercise capacity, chest CT findings, and health-related quality of life (HRQoL) in survivors of COVID-19 complicated by acute respiratory distress syndrome (ARDS).
Design, setting, and patients: This is a multicentric case-control study conducted from February 2023 to December of 2023. Pulmonary function tests, cardiopulmonary exercise testing (CPET), chest CT, and HRQoL (using EuroQol 5D three-level [EQ-5D-3L]) were performed at least 12 months after hospital discharge among cases (COVID-19 complicated by ARDS) and at the time of inclusion among controls (family members/friends matched for sex and age).
Interventions: None.
Measurements and main results: A total of 114 COVID-19 ARDS survivors and 115 controls were included. The mean age was 54 years and 52.4% of the participants were men. Time from hospital discharge to evaluation was 22 months (20.99-41.41 mo) among cases. Persistent symptoms, including memory loss (48.2%), fatigue (42.1%), and anxiety (31.6%), were reported by 73.6% of the COVID-19 ARDS survivors. Cases had significantly reduced pulmonary function, with lower diffusing capacity for carbon monoxide (DLCO) of 6.85 mmol/min/Kpa (5.44-8.37 mmol/min/Kpa) vs. 7.36 mmol/min/Kpa (6.43-8.96 mmol/min/Kpa; p = 0.012) and % of predicted DLCO of 81.0% (70.2-90.4%) vs. 89.3% (78.9-99.9%; p < 0.001), compared with controls, as well as a higher frequency of moderate to severe DLCO impairment (10.5% vs. 0.8%; p = 0.002). In CPET, cases demonstrated lower peak oxygen consumption (21.9 mL/kg/min [18.2-29 mL/kg/min] vs. 25.8 mL/kg/min [21.6-31.9 mL/kg/min]; p < 0.001). Chest CT revealed a greater prevalence of ground-glass opacities in cases (53.5% vs. 16.5%; p < 0.001) and emphysema (6.1% vs. 0%; p = 0.043). HRQoL, using EQ-5D-3L utility scores, were significantly lower in cases, with worse mobility (p < 0.001), self-care (p < 0.001), and anxiety/depression (p = 0.04) dimension scores compared with controls.
Conclusions: COVID-19 ARDS survivors exhibit significant long-term impairments in pulmonary function, exercise capacity, and quality of life and abnormal chest CT findings compared with family controls with same sex and age.

Keywords: COVID-19; exercise test; pulmonary function test; respiratory distress syndrome; severe acute respiratory syndrome coronavirus 2.

 
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