tetano
Editor, Senior Moderator
PLoS One
. 2023 Jan 20;18(1):e0280567.
doi: 10.1371/journal.pone.0280567. eCollection 2023.
Long-term respiratory follow-up of ICU hospitalized COVID-19 patients: Prospective cohort study
Carlos Roberto Ribeiro Carvalho[SUP] 1 [/SUP], Celina Almeida Lamas[SUP] 1 [/SUP], Rodrigo Caruso Chate[SUP] 2 [/SUP], João Marcos Salge[SUP] 1 [/SUP], Marcio Valente Yamada Sawamura[SUP] 2 [/SUP], André L P de Albuquerque[SUP] 1 [/SUP], Carlos Toufen Junior[SUP] 1 [/SUP], Daniel Mario Lima[SUP] 3 [/SUP], Michelle Louvaes Garcia[SUP] 1 [/SUP], Paula Gobi Scudeller[SUP] 1 [/SUP], Cesar Higa Nomura[SUP] 2 [/SUP], Marco Antonio Gutierrez[SUP] 3 [/SUP], Bruno Guedes Baldi[SUP] 1 [/SUP]; HCFMUSP Covid-19 Study Group
Affiliations
Abstract
Background: Coronavirus disease (COVID-19) survivors exhibit multisystemic alterations after hospitalization. Little is known about long-term imaging and pulmonary function of hospitalized patients intensive care unit (ICU) who survive COVID-19. We aimed to investigate long-term consequences of COVID-19 on the respiratory system of patients discharged from hospital ICU and identify risk factors associated with chest computed tomography (CT) lesion severity.
Methods: A prospective cohort study of COVID-19 patients admitted to a tertiary hospital ICU in Brazil (March-August/2020), and followed-up six-twelve months after hospital admission. Initial assessment included: modified Medical Research Council dyspnea scale, SpO2 evaluation, forced vital capacity, and chest X-Ray. Patients with alterations in at least one of these examinations were eligible for CT and pulmonary function tests (PFTs) approximately 16 months after hospital admission. Primary outcome: CT lesion severity (fibrotic-like or non-fibrotic-like). Baseline clinical variables were used to build a machine learning model (ML) to predict the severity of CT lesion.
Results: In total, 326 patients (72%) were eligible for CT and PFTs. COVID-19 CT lesions were identified in 81.8% of patients, and half of them showed mild restrictive lung impairment and impaired lung diffusion capacity. Patients with COVID-19 CT findings were stratified into two categories of lesion severity: non-fibrotic-like (50.8%-ground-glass opacities/reticulations) and fibrotic-like (49.2%-traction bronchiectasis/architectural distortion). No association between CT feature severity and altered lung diffusion or functional restrictive/obstructive patterns was found. The ML detected that male sex, ICU and invasive mechanic ventilation (IMV) period, tracheostomy and vasoactive drug need during hospitalization were predictors of CT lesion severity(sensitivity,0.78±0.02;specificity,0.79±0. 01;F1-score,0.78±0.02;positive predictive rate,0.78±0.02; accuracy,0.78±0.02; and area under the curve,0.83±0.01).
Conclusion: ICU hospitalization due to COVID-19 led to respiratory system alterations six-twelve months after hospital admission. Male sex and critical disease acute phase, characterized by a longer ICU and IMV period, and need for tracheostomy and vasoactive drugs, were risk factors for severe CT lesions six-twelve months after hospital admission.
. 2023 Jan 20;18(1):e0280567.
doi: 10.1371/journal.pone.0280567. eCollection 2023.
Long-term respiratory follow-up of ICU hospitalized COVID-19 patients: Prospective cohort study
Carlos Roberto Ribeiro Carvalho[SUP] 1 [/SUP], Celina Almeida Lamas[SUP] 1 [/SUP], Rodrigo Caruso Chate[SUP] 2 [/SUP], João Marcos Salge[SUP] 1 [/SUP], Marcio Valente Yamada Sawamura[SUP] 2 [/SUP], André L P de Albuquerque[SUP] 1 [/SUP], Carlos Toufen Junior[SUP] 1 [/SUP], Daniel Mario Lima[SUP] 3 [/SUP], Michelle Louvaes Garcia[SUP] 1 [/SUP], Paula Gobi Scudeller[SUP] 1 [/SUP], Cesar Higa Nomura[SUP] 2 [/SUP], Marco Antonio Gutierrez[SUP] 3 [/SUP], Bruno Guedes Baldi[SUP] 1 [/SUP]; HCFMUSP Covid-19 Study Group
Affiliations
- PMID: 36662879
- DOI: 10.1371/journal.pone.0280567
Abstract
Background: Coronavirus disease (COVID-19) survivors exhibit multisystemic alterations after hospitalization. Little is known about long-term imaging and pulmonary function of hospitalized patients intensive care unit (ICU) who survive COVID-19. We aimed to investigate long-term consequences of COVID-19 on the respiratory system of patients discharged from hospital ICU and identify risk factors associated with chest computed tomography (CT) lesion severity.
Methods: A prospective cohort study of COVID-19 patients admitted to a tertiary hospital ICU in Brazil (March-August/2020), and followed-up six-twelve months after hospital admission. Initial assessment included: modified Medical Research Council dyspnea scale, SpO2 evaluation, forced vital capacity, and chest X-Ray. Patients with alterations in at least one of these examinations were eligible for CT and pulmonary function tests (PFTs) approximately 16 months after hospital admission. Primary outcome: CT lesion severity (fibrotic-like or non-fibrotic-like). Baseline clinical variables were used to build a machine learning model (ML) to predict the severity of CT lesion.
Results: In total, 326 patients (72%) were eligible for CT and PFTs. COVID-19 CT lesions were identified in 81.8% of patients, and half of them showed mild restrictive lung impairment and impaired lung diffusion capacity. Patients with COVID-19 CT findings were stratified into two categories of lesion severity: non-fibrotic-like (50.8%-ground-glass opacities/reticulations) and fibrotic-like (49.2%-traction bronchiectasis/architectural distortion). No association between CT feature severity and altered lung diffusion or functional restrictive/obstructive patterns was found. The ML detected that male sex, ICU and invasive mechanic ventilation (IMV) period, tracheostomy and vasoactive drug need during hospitalization were predictors of CT lesion severity(sensitivity,0.78±0.02;specificity,0.79±0. 01;F1-score,0.78±0.02;positive predictive rate,0.78±0.02; accuracy,0.78±0.02; and area under the curve,0.83±0.01).
Conclusion: ICU hospitalization due to COVID-19 led to respiratory system alterations six-twelve months after hospital admission. Male sex and critical disease acute phase, characterized by a longer ICU and IMV period, and need for tracheostomy and vasoactive drugs, were risk factors for severe CT lesions six-twelve months after hospital admission.