Follow up of patients with severe coronavirus disease 2019 (COVID-19): Pulmonary and extrapulmonary disease sequelae. (November 2020)

• Record Type: Journal Article
• Authors: Daher, Ayham; Balfanz, Paul; Cornelissen, Christian; Müller, Annegret; Bergs, Ingmar; Marx, Nikolaus; Müller-Wieland, Dirk; Hartmann, Bojan; Dreher, Michael; Müller, Tobias
• Is Part Of: Respiratory medicine. Volume 174(2020)
• Publication Date: 2020-11
• Subjects: COVID-19 -- Follow up -- Pulmonary functions -- Echocardiography -- Quality of life -- Fatigue; ABG arterial blood gas -- COVID-19 coronavirus disease 2019 -- DLco diffusing capacity for carbon monoxide -- FEV1 forced expiratory volume in 1 s -- FVC forced vital capacity -- GAD-7 Generalized Anxiety Disorder 7 -- IQR Interquartile range -- 6MWT 6-min walk test -- PaCO2 partial pressure of carbon dioxide -- PaO2 partial pressure of oxygen -- PFTs pulmonary function tests -- PHQ-9 Patient Health Questionnaire 9 -- SARS-CoV-2 severe acute respiratory syndrome coronavirus 2 -- SGRQ St. George's Respiratory Questionnaire -- SpO2 oxygen saturation on pulse oximeter -- TLC total lung capacity -- VC vital capacity -- VTE venous thromboembolism -- V/Q scan ventilation/perfusion scan; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2020.106197
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Background: Since December 2019 the novel coronavirus disease 2019 (COVID-19) has been burdening all health systems worldwide. However, pulmonary and extrapulmonary sequelae of COVID-19 after recovery from the acute disease are unknown. Material and methods: Hospitalized COVID-19 patients not requiring mechanical ventilation were included and followed 6 weeks after discharge. Body plethysmography, lung diffusion capacity (DLco), blood gas analysis (ABG), 6-min walk test (6MWT), echocardiography, and laboratory tests were performed. Quality of life (QoL), depression, and anxiety were assessed using validated questionnaires. Results: 33 patients with severe disease were included. Patients were discharged without prophylactic anticoagulation. At follow-up there were no thromboembolic complications in any patient. 11 patients (33%) had dyspnea, 11 (33%) had cough, and 15 (45%) suffered from symptoms of fatigue. Pulmonary function tests including ABG did not reveal any limitations (TLC: median=94% of predicted {IQR:85-105}; VC: 93% {78-101}; FEV1: 95% {72-103}; FEV1/FVC 79% {76-85}; PaO2: 72 mmHg {67-79}; PaCO2: 38 mmHg {35-38}), except for slightly reduced DLco (77% {69-95}). There were no echocardiographic impairments. 6MWT distance was reduced in most patients without oxygen desaturation. According to standardized questionnaires, patients suffered from reduced QoL, mainly due to decreased mobility (SGRQ activity score: 54 {19-78}). There were no indicators for depression or anxiety (PHQ-9: 7 {4-11}, GAD-7: 4 {1-9}, respectively). Conclusions: Hospitalized patients with severe COVID-19, who did not require mechanical ventilation, are unlikely to develop pulmonary long-term impairments, thromboembolic complications or cardiac impairments after discharge but frequently suffer from symptoms of fatigue. Highlights: Pulmonary impairment in hospitalized COVID-19 patients seems to be transient. COVID-19 patients are unlikely to develop pulmonary impairments on follow-up. Patients with COVID-19 often suffer from chronic fatigue following acute disease. Exercise capacity is reduced 6 weeks after COVID-19.