Integrative respiratory follow-up of severe COVID-19 reveals common functional and lung imaging sequelae. (May 2021)

• Record Type: Journal Article
• Authors: Froidure, Antoine; Mahsouli, Amin; Liistro, Giuseppe; De Greef, Julien; Belkhir, Leila; Gérard, Ludovic; Bertrand, Aurélie; Koenig, Sandra; Pothen, Lucie; Yildiz, Halil; Mwenge, Benny; Aboubakar, Frank; Gohy, Sophie; Pilette, Charles; Reychler, Gregory; Coche, Emmanuel; Yombi, Jean-Cyr; Ghaye, Benoit
• Is Part Of: Respiratory medicine. Volume 181(2021)
• Publication Date: 2021-05
• Subjects: COVID19 -- Follow-up -- Pulmonary function tests -- Lung fibrosis -- Lung HRCT -- Long COVID; 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.2021.106383
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: 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.