Integrative respiratory follow-up of severe COVID-19 reveals common functional and lung imaging sequelae

被引:76
作者
Froidure, Antoine [1 ,6 ]
Mahsouli, Amin [2 ,6 ]
Liistro, Giuseppe [1 ,6 ]
De Greef, Julien [3 ,6 ]
Belkhir, Leila [3 ,6 ]
Gerard, Ludovic [4 ,6 ]
Bertrand, Aurelie [5 ]
Koenig, Sandra [1 ]
Pothen, Lucie [3 ,6 ]
Yildiz, Halil [3 ,6 ]
Mwenge, Benny [1 ,6 ]
Aboubakar, Frank [1 ,6 ]
Gohy, Sophie [1 ,6 ]
Pilette, Charles [1 ,6 ]
Reychler, Gregory [1 ,6 ]
Coche, Emmanuel [2 ,6 ]
Yombi, Jean-Cyr [3 ,6 ]
Ghaye, Benoit [2 ,6 ]
机构
[1] Catholic Univ Louvain, Pulmonol Dept, Clin Univ St Luc, Ave Hippocrate 10, B-1200 Brussels, Belgium
[2] Catholic Univ Louvain, Radiol Dept, Clin Univ St Luc, Brussels, Belgium
[3] Catholic Univ Louvain, Gen Internal Med & Infect Dis Dept, Clin Univ St Luc, Brussels, Belgium
[4] Catholic Univ Louvain, Intens Care Dept, Clin Univ St Luc, Brussels, Belgium
[5] Catholic Univ Louvain, Support Methodol & Calcul Stat SMCS, Brussels, Belgium
[6] Catholic Univ Louvain, Inst Rech Expt & Clin IREC, Brussels, Belgium
关键词
COVID19; Follow-up; Pulmonary function tests; Lung fibrosis; Lung HRCT; Long COVID;
D O I
10.1016/j.rmed.2021.106383
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: COVID-19 pandemic resulted in an unprecedented number of hospitalizations in general wards and intensive care units (ICU). Severe and critical COVID-19 patients suffer from extensive pneumonia; therefore, long-term respiratory sequelae may be expected. Research question: We conducted a cohort study to determine respiratory sequelae in patients with severe and critical COVID-19. We aimed at evaluating the proportion of patients with persisting respiratory symptoms and/ or abnormalities in pulmonary function tests (PFT) or in lung imaging. Study design: and methods: This is a single center cohort study including COVID-19 survivors who underwent a three-month follow-up with clinical evaluation, PFT and lung high-resolution computed tomography (HRCT). All clinical, functional, and radiological data were centrally reviewed. Multiple linear regression analysis was performed to identify factors associated with residual lesions on HRCT. Results: Full clinical evaluation, PFT and lung HRCT were available for central review in 126, 122 and 107 patients, respectively. At follow-up, 25% of patients complained from dyspnea and 35% from fatigue, lung diffusion capacity (DLCO) was decreased in 45%, 17% had HRCT abnormalities affecting more than 5% of their lung parenchyma while signs of fibrosis were found in 21%. In multiple linear regression model, number of days in ICU were related to the extent of persisting lesions on HRCT, while intubation was associated with signs of fibrosis at follow-up (P = 0.0005, Fisher's exact test). In contrast, the severity of lung imaging or PFT changes were not predictive of fatigue and dyspnea. Interpretation: Although most hospitalized COVID-19 patients recover, a substantial proportion complains from persisting dyspnea and fatigue. Impairment of DLCO and signs suggestive of fibrosis are common but are not strictly related to long-lasting symptoms.
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页数:6
相关论文
共 24 条
[1]   Ventilation management and clinical outcomes in invasively ventilated patients with COVID-19 (PRoVENT-COVID): a national, multicentre, observational cohort study [J].
Botta, Michela ;
Tsonas, Anissa M. ;
Pillay, Janesh ;
Boers, Leonoor S. ;
Algera, Anna Geke ;
Bos, Lieuwe D. J. ;
Dongelmans, Dave A. ;
Hollmann, Marcus W. ;
Horn, Janneke ;
Vlaar, Alexander P. J. ;
Schultz, Marcus J. ;
Neto, Ary Serpa ;
Paulus, Frederique .
LANCET RESPIRATORY MEDICINE, 2021, 9 (02) :139-148
[2]   Mechanical Ventilation-associated Lung Fibrosis in Acute Respiratory Distress Syndrome A Significant Contributor to Poor Outcome [J].
Cabrera-Benitez, Nuria E. ;
Laffey, John G. ;
Parotto, Matteo ;
Spieth, Peter M. ;
Villar, Jesus ;
Zhang, Haibo ;
Slutsky, Arthur S. .
ANESTHESIOLOGY, 2014, 121 (01) :189-198
[3]   Long term outcomes in survivors of epidemic Influenza A (H7N9) virus infection [J].
Chen, Jiajia ;
Wu, Jie ;
Hao, Shaorui ;
Yang, Meifang ;
Lu, Xiaoqing ;
Chen, Xiaoxiao ;
Li, Lanjuan .
SCIENTIFIC REPORTS, 2017, 7
[4]  
Das Karuna M, 2017, Indian J Radiol Imaging, V27, P342, DOI 10.4103/ijri.IJRI_469_16
[5]   Features of 20133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study [J].
Docherty, Annemarie B. ;
Harrison, Ewen M. ;
Green, Christopher A. ;
Hardwick, Hayley E. ;
Pius, Riinu ;
Norman, Lisa ;
Holden, Karl A. ;
Read, Jonathan M. ;
Dondelinger, Frank ;
Carson, Gail ;
Merson, Laura ;
Lee, James ;
Plotkin, Daniel ;
Sigfrid, Louise ;
Halpin, Sophie ;
Jackson, Clare ;
Gamble, Carrol ;
Horby, Peter W. ;
Nguyen-Van-Tam, Jonathan S. ;
Ho, Antonia ;
Russell, Clark D. ;
Dunning, Jake ;
Openshaw, Peter Jm ;
Baillie, J. Kenneth ;
Semple, Malcolm G. .
BMJ-BRITISH MEDICAL JOURNAL, 2020, 369
[6]   Nintedanib in Progressive Fibrosing Interstitial Lung Diseases [J].
Flaherty, K. R. ;
Wells, A. U. ;
Cottin, V ;
Devaraj, A. ;
Walsh, S. L. F. ;
Inoue, Y. ;
Richeldi, L. ;
Kolb, M. ;
Tetzlaff, K. ;
Stowasser, S. ;
Coeck, C. ;
Clerisme-Beaty, E. ;
Rosenstock, B. ;
Quaresma, M. ;
Haeufel, T. ;
Goeldner, R-G ;
Schlenker-Herceg, R. ;
Brown, K. K. .
NEW ENGLAND JOURNAL OF MEDICINE, 2019, 381 (18) :1718-1727
[7]   Short telomeres increase the risk of severe COVID-19 [J].
Froidure, Antoine ;
Mahieu, Manon ;
Hoton, Delphine ;
Laterre, Pierre-Francois ;
Yombi, Jean Cyr ;
Koenig, Sandra ;
Ghaye, Benoit ;
Defour, Jean-Philippe ;
Decottignies, Anabelle .
AGING-US, 2020, 12 (20) :19911-19922
[8]   Multicenter Assessment of CT Pneumonia Analysis Prototype for Predicting Disease Severity and Patient Outcome [J].
Homayounieh, Fatemeh ;
Bezerra Cavalcanti Rockenbach, Marcio Aloisio ;
Ebrahimian, Shadi ;
Doda Khera, Ruhani ;
Bizzo, Bernardo C. ;
Buch, Varun ;
Babaei, Rosa ;
Karimi Mobin, Hadi ;
Mohseni, Iman ;
Mitschke, Matthias ;
Zimmermann, Mathis ;
Durlak, Felix ;
Rauch, Franziska ;
Digumarthy, Subba R. ;
Kalra, Mannudeep K. .
JOURNAL OF DIGITAL IMAGING, 2021, 34 (02) :320-329
[9]   Magnitude, demographics and dynamics of the effect of the first wave of the COVID-19 pandemic on all-cause mortality in 21 industrialized countries [J].
Kontis, Vasilis ;
Bennett, James E. ;
Rashid, Theo ;
Parks, Robbie M. ;
Pearson-Stuttard, Jonathan ;
Guillot, Michel ;
Asaria, Perviz ;
Zhou, Bin ;
Battaglini, Marco ;
Corsetti, Gianni ;
McKee, Martin ;
Di Cesare, Mariachiara ;
Mathers, Colin D. ;
Ezzati, Majid .
NATURE MEDICINE, 2020, 26 (12) :1919-1928
[10]  
Lindsell C.J., 2020, MMWR MORB MORTAL WKL, V69