Severity does not impact on exercise capacity in COVID-19 survivors. (October 2021)

• Record Type: Journal Article
• Authors: Rinaldo, Rocco Francesco; Mondoni, Michele; Parazzini, Elena Maria; Baccelli, Andrea; Pitari, Federica; Brambilla, Elena; Luraschi, Simone; Balbi, Maurizio; Guazzi, Marco; Di Marco, Fabiano; Centanni, Stefano
• Is Part Of: Respiratory medicine. Volume 187(2021)
• Publication Date: 2021-10
• Subjects: Cardiopulmonary exercise test -- COVID-19 -- Pulmonary function testing; 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.2021.106577
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Background: current data on the impact of acute illness severity on exercise capacity and ventilatory efficiency of COVID-19 survivors, evaluated at cardiopulmonary exercise test (CPET), are limited. Methods: in this post-hoc analysis of our previous observational, prospective, cohort study on mechanisms of exercise intolerance in COVID-19 survivors, we aimed at evaluating the impact of acute COVID-19 severity on exercise capacity, pulmonary function testing (PFT) and chest computed tomography (CT) outcomes. Results: we enrolled 75 patients (18 with mild-to-moderate disease, 18 with severe disease, and 39 with critical disease). Mean (standard deviation – SD) follow-up time was 97 (26) days. Groups showed a similar PFT and CT residual involvement, featuring a mildly reduced exercise capacity with comparable mean (SD) values of peak oxygen consumption as percentage of predicted (83 (17) vs 82 (16) vs 84 (15), p = 0.895) among groups, as well as the median (interquartile range – IQR) alveolar-arterial gradient for O2 in mmHg at exercise peak (20 (15–28) vs 27 (18–31) vs 26 (21-21), p = 0.154), which was in the limit of normal. In addition, these patients featured a preserved mean ventilatory efficiency evaluated through the slope of the relation between ventilation and carbon dioxide output during exercise (27.1 (2.6) vs 29.8 (3.9) vs 28.3 (2.6), p = 0.028), without a clinically relevant difference. Conclusions: Disease severity does not impact on exercise capacity in COVID-19 survivors at 3 months after discharge, including a ventilatory response still in the limit of normal. Highlights: Severity of the acute disease does not affect exercise response in COVID-19 survivors. Functional impairment is present at rest and during exercise at mid-term follow-up. COVID-19 survivors exhibit a preserved exercise ventilatory response. CPET provides useful information that integrate resting functional evaluation.