Identification of factors impairing exercise capacity after severe COVID-19 pulmonary infection: a 3-month follow-up of prospective COVulnerability cohort

被引:19
作者
Baptista, Bruno Ribeiro [1 ]
D'Humieres, Thomas [1 ,2 ]
Schlemmer, Frederic [1 ,3 ]
Bendib, Ines [1 ,2 ,4 ]
Justeau, Gregoire [1 ]
Al-Assaad, Lara [2 ]
Hachem, Mouna [1 ,3 ]
Codiat, Rebecca [2 ]
Bardel, Benjamin [2 ]
Abou Chakra, Laure [2 ]
Belmondo, Thibaut [5 ]
Audureau, Etienne [6 ,7 ]
Hue, Sophie [1 ,5 ]
Mekontso-Dessap, Armand [1 ,4 ]
Derumeaux, Genevieve [1 ,2 ]
Boyer, Laurent [1 ,2 ]
机构
[1] Univ Paris Est Creteil UPEC, INSERM, IMRB, FHU SENEC, Creteil, France
[2] Hop Univ Henri Mondor, AP HP, Dept Physiol Explorat Fonctionnelles, Ave Marechal de Lattre de Tassigny, Creteil, France
[3] Hop Univ Henri Mondor, AP HP, Unite Pneumol, Serv Med Intens Reanimat, Creteil, France
[4] Hop Univ Henri Mondor, AP HP, Med Intens Reanimat, Creteil, France
[5] Hop Univ Henri Mondor, AP HP, Dept Hematol & Immunol Biol, Creteil, France
[6] Henri Mondor Hosp, AP HP, Biostat Dept, Creteil, France
[7] Univ Paris Est UPEC, FHU SENEC, CEpiA IMRB U955, Creteil, France
关键词
SARS-CoV-2; COVID-19; Cardiopulmonary exercise testing; Pulmonary function; Skeletal muscle; Sarcopenia; ACUTE RESPIRATORY SYNDROME; SARCOPENIA; IMPACT;
D O I
10.1186/s12931-022-01977-z
中图分类号
R56 [呼吸系及胸部疾病];
学科分类号
摘要
Background Patient hospitalized for coronavirus disease 2019 (COVID-19) pulmonary infection can have sequelae such as impaired exercise capacity. We aimed to determine the frequency of long-term exercise capacity limitation in survivors of severe COVID-19 pulmonary infection and the factors associated with this limitation. Methods Patients with severe COVID-19 pulmonary infection were enrolled 3 months after hospital discharge in COVulnerability, a prospective cohort. They underwent cardiopulmonary exercise testing, pulmonary function test, echocardiography, and skeletal muscle mass evaluation. Results Among 105 patients included, 35% had a reduced exercise capacity (VO(2)peak < 80% of predicted). Compared to patients with a normal exercise capacity, patients with reduced exercise capacity were more often men (89.2% vs. 67.6%, p = 0.015), with diabetes (45.9% vs. 17.6%, p = 0.002) and renal dysfunction (21.6% vs. 17.6%, p = 0.006), but did not differ in terms of initial acute disease severity. An altered exercise capacity was associated with an impaired respiratory function as assessed by a decrease in forced vital capacity (p < 0.0001), FEV1 (p < 0.0001), total lung capacity (p < 0.0001) and DLCO (p = 0.015). Moreover, we uncovered a decrease of muscular mass index and grip test in the reduced exercise capacity group (p = 0.001 and p = 0.047 respectively), whilst 38.9% of patients with low exercise capacity had a sarcopenia, compared to 10.9% in those with normal exercise capacity (p = 0.001). Myocardial function was normal with similar systolic and diastolic parameters between groups whilst reduced exercise capacity was associated with a slightly shorter pulmonary acceleration time, despite no pulmonary hypertension. Conclusion Three months after a severe COVID-19 pulmonary infection, more than one third of patients had an impairment of exercise capacity which was associated with a reduced pulmonary function, a reduced skeletal muscle mass and function but without any significant impairment in cardiac function.
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