tetano
Editor, Senior Moderator
EClinicalMedicine
. 2022 Jul;49:101473.
doi: 10.1016/j.eclinm.2022.101473. Epub 2022 May 27.
Risk factors for impaired pulmonary diffusion function in convalescent COVID-19 patients: A systematic review and meta-analysis
Haopeng Zhi[SUP] 1 2 [/SUP], Xiaolong Ji[SUP] 1 2 [/SUP], Zifan Zhao[SUP] 3 [/SUP], Hanwen Liang[SUP] 1 [/SUP], Shuxin Zhong[SUP] 1 2 [/SUP], Yiting Luo[SUP] 1 2 [/SUP], Mingyu Zhong[SUP] 1 2 [/SUP], Chen Zhan[SUP] 1 2 [/SUP], Yi Gao[SUP] 1 [/SUP], Xilong Deng[SUP] 4 [/SUP], Shiyue Li[SUP] 1 [/SUP], Jing Li[SUP] 1 2 [/SUP], Nanshan Zhong[SUP] 1 5 [/SUP], Mei Jiang[SUP] 1 5 [/SUP], Ruchong Chen[SUP] 1 2 5 [/SUP]
Affiliations
Abstract
Background: The long-term prognosis of COVID-19 survivors remains poorly understood. It is evidenced that the lung is the main damaged organ in COVID-19 survivors, most notably in impairment of pulmonary diffusion function. Hence, we conducted a meta-analysis of the potential risk factors for impaired diffusing capacity for carbon monoxide (DLCO) in convalescent COVID-19 patients.
Methods: We performed a systematic search of PubMed, Web of Science, Embase, and Ovid databases for relevant studies from inception until January 7, 2022, limited to papers involving human subjects. Studies were reviewed for methodological quality. Fix-effects and random-effects models were used to pool results. Heterogeneity was assessed using I[SUP]2[/SUP]. The publication bias was assessed using the Egger's test. PROSPERO registration: CRD42021265377.
Findings: A total of eighteen qualified articles were identified and included in the systematic review, and twelve studies were included in the meta-analysis. Our results showed that female (OR: 4.011; 95% CI: 2.928-5.495), altered chest computerized tomography (CT) (OR: 3.002; 95% CI: 1.319-6.835), age (OR: 1.018; 95% CI: 1.007-1.030), higher D-dimer levels (OR: 1.012; 95% CI: 1.001-1.023) and urea nitrogen (OR: 1.004;95% CI: 1.002-1.007) were identified as risk factors for impaired DLCO.
Interpretation: Pulmonary diffusion capacity was the most common impaired lung function in recovered patients with COVID-19. Several risk factors, such as female, altered chest CT, older age, higher D-dimer levels and urea nitrogen are associated with impairment of DLCO. Raising awareness and implementing interventions for possible modifiable risk factors may be valuable for pulmonary rehabilitation.
Funding: This work was financially supported by Emergency Key Program of Guangzhou Laboratory (EKPG21-29, EKPG21-31), Incubation Program of National Science Foundation for Distinguished Young Scholars by Guangzhou Medical University (GMU2020-207).
Keywords: ACE2, angiotensin-converting enzyme 2; ARDS, acute respiratory distress syndrome; CIs, confidence intervals; COVID-19; COVID-19, Coronavirus Disease 2019; CT, computerized tomography; DLCO; DLCO, diffusing capacity for carbon monoxide; DLNO, diffusion capacity for nitric oxide; GRADE, Grading of Recommendations Assessment, Development, and Evaluation; HR, hazard ratio; MERS, Middle East Respiratory Syndrome; Meta-analysis; NOS, Newcastle-Ottawa scale; OR, odds ratio; PFTs, pulmonary function tests; Pulmonary diffusion function; RASI, renin-angiotensin system inhibitors; RR, relative risk; RT-PCR, reverse transcription-polymerase chain reaction; Risk factors; SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2; TSS, total severity score; WHO, World Health Organization.
. 2022 Jul;49:101473.
doi: 10.1016/j.eclinm.2022.101473. Epub 2022 May 27.
Risk factors for impaired pulmonary diffusion function in convalescent COVID-19 patients: A systematic review and meta-analysis
Haopeng Zhi[SUP] 1 2 [/SUP], Xiaolong Ji[SUP] 1 2 [/SUP], Zifan Zhao[SUP] 3 [/SUP], Hanwen Liang[SUP] 1 [/SUP], Shuxin Zhong[SUP] 1 2 [/SUP], Yiting Luo[SUP] 1 2 [/SUP], Mingyu Zhong[SUP] 1 2 [/SUP], Chen Zhan[SUP] 1 2 [/SUP], Yi Gao[SUP] 1 [/SUP], Xilong Deng[SUP] 4 [/SUP], Shiyue Li[SUP] 1 [/SUP], Jing Li[SUP] 1 2 [/SUP], Nanshan Zhong[SUP] 1 5 [/SUP], Mei Jiang[SUP] 1 5 [/SUP], Ruchong Chen[SUP] 1 2 5 [/SUP]
Affiliations
- PMID: 35663303
- PMCID: PMC9137275
- DOI: 10.1016/j.eclinm.2022.101473
Abstract
Background: The long-term prognosis of COVID-19 survivors remains poorly understood. It is evidenced that the lung is the main damaged organ in COVID-19 survivors, most notably in impairment of pulmonary diffusion function. Hence, we conducted a meta-analysis of the potential risk factors for impaired diffusing capacity for carbon monoxide (DLCO) in convalescent COVID-19 patients.
Methods: We performed a systematic search of PubMed, Web of Science, Embase, and Ovid databases for relevant studies from inception until January 7, 2022, limited to papers involving human subjects. Studies were reviewed for methodological quality. Fix-effects and random-effects models were used to pool results. Heterogeneity was assessed using I[SUP]2[/SUP]. The publication bias was assessed using the Egger's test. PROSPERO registration: CRD42021265377.
Findings: A total of eighteen qualified articles were identified and included in the systematic review, and twelve studies were included in the meta-analysis. Our results showed that female (OR: 4.011; 95% CI: 2.928-5.495), altered chest computerized tomography (CT) (OR: 3.002; 95% CI: 1.319-6.835), age (OR: 1.018; 95% CI: 1.007-1.030), higher D-dimer levels (OR: 1.012; 95% CI: 1.001-1.023) and urea nitrogen (OR: 1.004;95% CI: 1.002-1.007) were identified as risk factors for impaired DLCO.
Interpretation: Pulmonary diffusion capacity was the most common impaired lung function in recovered patients with COVID-19. Several risk factors, such as female, altered chest CT, older age, higher D-dimer levels and urea nitrogen are associated with impairment of DLCO. Raising awareness and implementing interventions for possible modifiable risk factors may be valuable for pulmonary rehabilitation.
Funding: This work was financially supported by Emergency Key Program of Guangzhou Laboratory (EKPG21-29, EKPG21-31), Incubation Program of National Science Foundation for Distinguished Young Scholars by Guangzhou Medical University (GMU2020-207).
Keywords: ACE2, angiotensin-converting enzyme 2; ARDS, acute respiratory distress syndrome; CIs, confidence intervals; COVID-19; COVID-19, Coronavirus Disease 2019; CT, computerized tomography; DLCO; DLCO, diffusing capacity for carbon monoxide; DLNO, diffusion capacity for nitric oxide; GRADE, Grading of Recommendations Assessment, Development, and Evaluation; HR, hazard ratio; MERS, Middle East Respiratory Syndrome; Meta-analysis; NOS, Newcastle-Ottawa scale; OR, odds ratio; PFTs, pulmonary function tests; Pulmonary diffusion function; RASI, renin-angiotensin system inhibitors; RR, relative risk; RT-PCR, reverse transcription-polymerase chain reaction; Risk factors; SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2; TSS, total severity score; WHO, World Health Organization.