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Zhao LM, Lancaster AC, Patel R, Zhang H, Duong TQ, Jiao Z, Lin CT, Healey T, Wright T, Wu J, Bai HX. Association of clinical and imaging characteristics with pulmonary function testing in patients with Long-COVID. Heliyon 2024; 10:e31751. [PMID: 38845871 PMCID: PMC11153179 DOI: 10.1016/j.heliyon.2024.e31751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 05/20/2024] [Accepted: 05/21/2024] [Indexed: 06/09/2024] Open
Abstract
Purpose The purpose of this study is to identify clinical and imaging characteristics associated with post-COVID pulmonary function decline. Methods This study included 22 patients recovering from COVID-19 who underwent serial spirometry pulmonary function testing (PFT) before and after diagnosis. Patients were divided into two cohorts by difference between baseline and post-COVID follow-up PFT: Decline group (>10 % decrease in FEV1), and Stable group (≤10 % decrease or improvement in FEV1). Demographic, clinical, and laboratory data were collected, as well as PFT and chest computed tomography (CT) at the time of COVID diagnosis and follow-up. CTs were semi-quantitatively scored on a five-point severity scale for disease extent in each lobe by two radiologists. Mann-Whitney U-tests, T-tests, and Chi-Squared tests were used for comparison. P-values <0.05 were considered statistically significant. Results The Decline group had a higher proportion of neutrophils (79.47 ± 4.83 % vs. 65.45 ± 10.22 %; p = 0.003), a higher absolute neutrophil count (5.73 ± 2.68 × 109/L vs. 3.43 ± 1.74 × 109/L; p = 0.031), and a lower proportion of lymphocytes (9.90 ± 4.20 % vs. 21.21 ± 10.97 %; p = 0.018) compared to the Stable group. The Decline group also had significantly higher involvement of ground-glass opacities (GGO) on follow-up chest CT [8.50 (4.50, 14.50) vs. 3.0 (1.50, 9.50); p = 0.032] and significantly higher extent of reticulations on chest CT at time of COVID diagnosis [6.50 (4.00, 9.00) vs. 2.00 (0.00, 6.00); p = 0.039] and follow-up [5.00 (3.00, 13.00) vs. 2.00 (0.00, 5.00); p = 0.041]. ICU admission was higher in the Decline group than in the Stable group (71.4 % vs. 13.3 %; p = 0.014). Conclusions This study provides novel insight into factors influencing post-COVID lung function, irrespective of pre-existing pulmonary conditions. Our findings underscore the significance of neutrophil counts, reduced lymphocyte counts, pulmonary reticulation on chest CT at diagnosis, and extent of GGOs on follow-up chest CT as potential indicators of decreased post-COVID lung function. This knowledge may guide prediction and further understanding of long-term sequelae of COVID-19 infection.
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Affiliation(s)
- Lin-Mei Zhao
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Andrew C. Lancaster
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ritesh Patel
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Helen Zhang
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, USA
| | - Tim Q. Duong
- Department of Radiology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA
| | - Zhicheng Jiao
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, USA
| | - Cheng Ting Lin
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Terrance Healey
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, USA
| | - Thaddeus Wright
- Department of Diagnostic Imaging, Rhode Island Hospital, Providence, RI, USA
| | - Jing Wu
- Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Harrison X. Bai
- Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Simpson S, Hershman M, Nachiappan AC, Raptis C, Hammer MM. The Short and Long of COVID-19: A Review of Acute and Chronic Radiologic Pulmonary Manifestations of SARS-2-CoV and Their Clinical Significance. Clin Chest Med 2024; 45:383-403. [PMID: 38816095 DOI: 10.1016/j.ccm.2024.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Coronavirus disease 2019 (COVID-19) pneumonia has had catastrophic effects worldwide. Radiology, in particular computed tomography (CT) imaging, has proven to be valuable in the diagnosis, prognostication, and longitudinal assessment of those diagnosed with COVID-19 pneumonia. This article will review acute and chronic pulmonary radiologic manifestations of COVID-19 pneumonia with an emphasis on CT and also highlighting histopathology, relevant clinical details, and some notable challenges when interpreting the literature.
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Affiliation(s)
- Scott Simpson
- Department of Radiology, University of Pennsylvania Hospital, 1313 East Montgomery Avenue Unit 1, Philadelphia, PA 19125, USA.
| | - Michelle Hershman
- Department of Radiology, Boise Radiology Group, 190 East Bannock St, Boise, ID 83712, USA
| | - Arun C Nachiappan
- Department of Radiology, University of Pennsylvania Hospital, 3400 Spruce Street, 1 Silverstein, Suite 130, Philadelphia, PA 19104, USA
| | - Constantine Raptis
- Department of Radiology, Mallinckrodt Institute of Radiology, Washington University, 510 South Kingshighway, St Louis 63088, USA
| | - Mark M Hammer
- Department of Radiology, Brigham and Woman's Hospital, 75 Francis Street, Boston, MA 02115, USA
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Taivans I, Grima L, Jurka N, Zvaigzne L, Gordjušina V, Strazda G. FOT Technique Applied for Monitoring of COVID-19 Pneumonia Reveals Small Airways Involvement. Diagnostics (Basel) 2024; 14:1160. [PMID: 38893686 PMCID: PMC11171776 DOI: 10.3390/diagnostics14111160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 05/24/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
The fact that some SARS-CoV-2 pneumonia patients benefit from changing body position, and some from continuous positive airways pressure (CPAP), indicates the functional character of hypoxia. We hypothesize that such effects could be explained by the closure of small airways. To prove the hypothesis, we evaluated the patency of small airways in 30 oxygen-dependent, spontaneously breathing patients with SARS-CoV-2 pneumonia during their hospital stay using the FOT method and then compared the results with data obtained three months later. During the acute period, total resistance (R5) and peripheral resistance (R5-20) rose above the upper limit of normal (ULN) in 28% and 50% of all patients, respectively. Reactance indices X5, AX and Fres exceeded ULN in 55%, 68% and 66% of cases. Significant correlations were observed between PaO2/FiO2, the time spent in the hospital and R5, X5, AX and Fres. After 3 months, 18 patients were re-examined. During the hospital stay, 11 of them had risen above the upper limit of normal (ULN), for both resistance (R5-20) and reactance (X5, AX) values. Three months later, ULN for R5-20 was exceeded in only four individuals, but ULN for X5 and AX was exceeded in five individuals. Lung function examination revealed a combined restrictive/obstructive ventilatory failure and reduced CO transfer factor. We interpret these changes as lung tissue remodeling due to the process of fibrosis. We conclude that during acute period of SARS-CoV-2 pneumonia, dilated pulmonary blood vessels and parenchymal oedema induce functional closure of small airways, which in turn induce atelectasis with pulmonary right-to-left shunting, followed by the resulting hypoxemia.
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Affiliation(s)
- Immanuels Taivans
- Medical Faculty, University of Latvia, LV1050 Riga, Latvia; (L.G.); (N.J.); (V.G.); (G.S.)
| | - Laura Grima
- Medical Faculty, University of Latvia, LV1050 Riga, Latvia; (L.G.); (N.J.); (V.G.); (G.S.)
| | - Normunds Jurka
- Medical Faculty, University of Latvia, LV1050 Riga, Latvia; (L.G.); (N.J.); (V.G.); (G.S.)
| | | | - Valentina Gordjušina
- Medical Faculty, University of Latvia, LV1050 Riga, Latvia; (L.G.); (N.J.); (V.G.); (G.S.)
| | - Gunta Strazda
- Medical Faculty, University of Latvia, LV1050 Riga, Latvia; (L.G.); (N.J.); (V.G.); (G.S.)
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Bhattacharya M, Chatterjee S, Saxena S, Nandi SS, Lee SS, Chakraborty C. Current landscape of long COVID clinical trials. Int Immunopharmacol 2024; 132:111930. [PMID: 38537538 DOI: 10.1016/j.intimp.2024.111930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 03/18/2024] [Accepted: 03/23/2024] [Indexed: 05/01/2024]
Abstract
Long COVID was reported as a multi-systemic condition after the infection of SARS-CoV-2, and more than 65 million people are suffering from this disease. It has been noted that around 10% of severe SARS-CoV-2 infected individuals are suffering from the enduring effects of long COVID. The symptoms of long COVID have also been noted in several mild or asymptomatic SARS-CoV-2 infected individuals. While limited reports on clinical trials investigating new therapeutics for long COVID exist, there is an abundance of scattered information available regarding these trials. This review explores the extensive literature search, and complete clinical trial database search to map the current status of long COVID clinical trials worldwide. The study listed about 110 long COVID clinical trials. In addition to conducting extensive long COVID clinical trials, we have comprehensively presented an overview of the condition, its symptoms, notable manifestations, associated clinical trials, the unique challenges it poses, and our recommendations for addressing long COVID.
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Affiliation(s)
- Manojit Bhattacharya
- Department of Zoology, Fakir Mohan University, Vyasa Vihar, Balasore 756020, Odisha, India
| | - Srijan Chatterjee
- Institute for Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon, Gangwon-Do 24252, Republic of Korea
| | - Sanskriti Saxena
- Division of Biology, Indian Institute of Science Education and Research-Tirupati, Panguru, Tirupati 517619, Andhra Pradesh, India
| | - Shyam Sundar Nandi
- ICMR-National Institute of Virology, (Mumbai unit), Indian Council of Medical Research, Haffkine Institute Compound, A. D. Marg, Parel, Mumbai 400012, India
| | - Sang-Soo Lee
- Institute for Skeletal Aging & Orthopedic Surgery, Hallym University-Chuncheon Sacred Heart Hospital, Chuncheon, Gangwon-Do 24252, Republic of Korea.
| | - Chiranjib Chakraborty
- Department of Biotechnology, School of Life Science and Biotechnology, Adamas University, Kolkata, West Bengal 700126, India.
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Aaløkken TM, Ashraf H, Einvik G, Lerum TV, Meltzer C, Rodriguez JR, Skjønsberg OH, Stavem K. CT abnormalities 3 and 12 months after hospitalization for COVID-19 and association with disease severity: A prospective cohort study. PLoS One 2024; 19:e0302896. [PMID: 38709747 PMCID: PMC11073708 DOI: 10.1371/journal.pone.0302896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 04/12/2024] [Indexed: 05/08/2024] Open
Abstract
OBJECTIVES To investigate changes in chest CT between 3 and 12 months and associations with disease severity in patients hospitalized for COVID-19 during the first wave in 2020. MATERIALS AND METHODS Longitudinal cohort study of patients hospitalized for COVID-19 in 2020. Chest CT was performed 3 and 12 months after admission. CT images were evaluated using a CT severity score (CSS) (0-12 scale) and recoded to an abbreviated version (0-3 scale). We analyzed determinants of the abbreviated CSS with multivariable mixed effects ordinal regression. RESULTS 242 patients completed CT at 3 months, and 124 (mean age 62.3±13.3, 78 men) also at 12 months. Between 3 and 12 months (n = 124) CSS (0-12 scale) for ground-glass opacities (GGO) decreased from median 3 (25th-75th percentile: 0-12) at 3 months to 0.5 (0-12) at 12 months (p<0.001), but increased for parenchymal bands (p<0.001). In multivariable analysis of GGO, the odds ratio for more severe abbreviated CSS (0-3 scale) at 12 months was 0.11 (95%CI 0.11 0.05 to 0.21, p<0.001) compared to 3 months, for WHO severity category 5-7 (high-flow oxygen/non-invasive ventilation/ventilator) versus 3 (non-oxygen use) 37.16 (1.18 to 43.47, p = 0.032), and for age ≥60 compared to <60 years 4.8 (1.33 to 17.6, p = 0.016). Mosaicism was reduced at 12 compared to 3 months, OR 0.33 (95%CI 0.16 to 0.66, p = 0.002). CONCLUSIONS GGO and mosaicism decreased, while parenchymal bands increased from 3 to 12 months. Persistent GGO were associated with initial COVID-19 severity and age ≥60 years.
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Affiliation(s)
- Trond Mogens Aaløkken
- Department of Radiology and Nuclear Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Haseem Ashraf
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Diagnostic Imaging, Akershus University Hospital, Lørenskog, Norway
| | - Gunnar Einvik
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Pulmonary Department, Akershus University Hospital, Lørenskog, Norway
| | - Tøri Vigeland Lerum
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Pulmonary Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Carin Meltzer
- Department of Radiology and Nuclear Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | | | - Ole Henning Skjønsberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Pulmonary Medicine, Oslo University Hospital Ullevål, Oslo, Norway
| | - Knut Stavem
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Pulmonary Department, Akershus University Hospital, Lørenskog, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
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6
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Altmayer S, Leung AN, de Oliveira GS, Prodigios J, Patel P, Mohammed TL, Verma N, Hochhegger B. Chronic Chest Computed Tomography Findings Following COVID-19 Pneumonia. Semin Ultrasound CT MR 2024:S0887-2171(24)00015-5. [PMID: 38704055 DOI: 10.1053/j.sult.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
Respiratory symptoms are a frequent manifestation of patients with post-acute sequela of SARS-CoV-2 (PASC), also known as long-COVID. Many cohorts of predominantly hospitalized patients have shown that a significant subset may have persistent chest computed tomography findings for more than 12 months after the acute infection. Proper understanding of the evolving long-term imaging findings and terminology is crucial for accurate imaging interpretation and patient care. The goal of this article is to review the chronic chest computed tomography findings of patients with PASC and common pitfalls.
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Affiliation(s)
| | - Ann N Leung
- Department of Radiology, Stanford University, Stanford, CA
| | | | - Joice Prodigios
- Department of Radiology, University of Florida Gainesville, Gainesville, FL
| | - Pratik Patel
- Department of Radiology, University of Florida Gainesville, Gainesville, FL
| | - Tan-Lucien Mohammed
- Department of Radiology, New York University - Langone Medical Center, New York, NY
| | - Nupur Verma
- Department of Radiology, Baystate Medical Center, Springfield, MA
| | - Bruno Hochhegger
- Department of Radiology, University of Florida Gainesville, Gainesville, FL
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7
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Ufuk F, Yitik AY, Sarilar B, Altinisik G. Patients With Post-COVID-19 Respiratory Condition: Chest Computed Tomography Findings and Pulmonary Function Tests and Comparison With Asymptomatic Participants. J Comput Assist Tomogr 2024; 48:415-423. [PMID: 38213073 DOI: 10.1097/rct.0000000000001577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2024]
Abstract
OBJECTIVE The aims of this study were to assess the chest computed tomography (CT) findings in post-COVID-19 respiratory condition (rPCC) patients and compare the findings with asymptomatic participants (APs). It also aimed to evaluate the relationship between CT findings and pulmonary function tests (PFTs) in rPCC patients. Finally, it aimed to compare the quantitative chest CT findings and PFT results of patients with rPCC and APs. METHODS We retrospectively enrolled consecutive patients with rPCC who underwent unenhanced chest CT and PFTs between June 2020 and September 2022. In addition, a control group (APs) was prospectively formed and underwent nonenhanced chest CT and PFTs. The presence and extent of abnormalities in unenhanced chest CT images were evaluated qualitatively and semiquantitatively in a blinded manner. We used fully automatic software for automatic lung and airway segmentation and quantitative analyses. RESULTS Sixty-three patients with rPCC and 23 APs were investigated. Reticulation/interstitial thickening and extent of parenchymal abnormalities on CT were significantly greater in the rPCC group than in the control group ( P = 0.001 and P = 0.004, respectively). Computed tomography extent score was significantly related to length of hospital stay, age, and intensive care unit stay (all P s ≤ 0.006). The rPCC group also had a lower 85th percentile attenuation lung volume ( P = 0.037). The extent of parenchymal abnormalities was significantly correlated with carbon monoxide diffusing capacity ( r = -0.406, P = 0.001), forced vital capacity (FVC) ( r = -0.342, P = 0.002), and forced expiratory volume in 1 second/FVC ( r = 0.427, P < 0.001) values. Pulmonary function tests revealed significantly lower carbon monoxide diffusing capacity ( P < 0.001), FVC ( P = 0.036), and total lung capacity ( P < 0.001) values in the rPCC group. CONCLUSIONS The rPCC is characterized by impaired PFTs, a greater extent of lung abnormalities on CT, and decreased 85th percentile attenuation lung volume. Advanced age, intensive care unit admission history, and extended hospital stay are risk factors for chest CT abnormalities.
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Affiliation(s)
- Furkan Ufuk
- From the Department of Radiology, University of Pamukkale, Denizli, Turkey
| | - Ahmet Yasin Yitik
- From the Department of Radiology, University of Pamukkale, Denizli, Turkey
| | - Burak Sarilar
- From the Department of Radiology, University of Pamukkale, Denizli, Turkey
| | - Goksel Altinisik
- Department of Pulmonology, University of Pamukkale, Denizli, Turkey
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8
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Cha MJ, Solomon JJ, Lee JE, Choi H, Chae KJ, Lee KS, Lynch DA. Chronic Lung Injury after COVID-19 Pneumonia: Clinical, Radiologic, and Histopathologic Perspectives. Radiology 2024; 310:e231643. [PMID: 38193836 PMCID: PMC10831480 DOI: 10.1148/radiol.231643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 01/10/2024]
Abstract
With the COVID-19 pandemic having lasted more than 3 years, concerns are growing about prolonged symptoms and respiratory complications in COVID-19 survivors, collectively termed post-COVID-19 condition (PCC). Up to 50% of patients have residual symptoms and physiologic impairment, particularly dyspnea and reduced diffusion capacity. Studies have also shown that 24%-54% of patients hospitalized during the 1st year of the pandemic exhibit radiologic abnormalities, such as ground-glass opacity, reticular opacity, bronchial dilatation, and air trapping, when imaged more than 1 year after infection. In patients with persistent respiratory symptoms but normal results at chest CT, dual-energy contrast-enhanced CT, xenon 129 MRI, and low-field-strength MRI were reported to show abnormal ventilation and/or perfusion, suggesting that some lung injury may not be detectable with standard CT. Histologic patterns in post-COVID-19 lung disease include fibrosis, organizing pneumonia, and vascular abnormality, indicating that different pathologic mechanisms may contribute to PCC. Therefore, a comprehensive imaging approach is necessary to evaluate and diagnose patients with persistent post-COVID-19 symptoms. This review will focus on the long-term findings of clinical and radiologic abnormalities and describe histopathologic perspectives. It also addresses advanced imaging techniques and deep learning approaches that can be applied to COVID-19 survivors. This field remains an active area of research, and further follow-up studies are warranted for a better understanding of the chronic stage of the disease and developing a multidisciplinary approach for patient management.
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Affiliation(s)
- Min Jae Cha
- From the Department of Radiology, Chung-Ang University Hospital,
Seoul, Korea (M.J.C., H.C.); Departments of Medicine (J.J.S.) and Radiology
(K.J.C., D.A.L.), National Jewish Health, 1400 Jackson St, Denver, CO 80206;
Department of Radiology, Chonnam National University Hospital, Gwangju, Republic
of Korea (J.E.L.); Department of Radiology, Research Institute of Clinical
Medicine of Jeonbuk National University, Biomedical Research Institute of
Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C); and
Department of Radiology, Sungkyunkwan University School of Medicine and Samsung
ChangWon Hospital, Gyeongsangnam, Republic of Korea (K.S.L.)
| | - Joshua J. Solomon
- From the Department of Radiology, Chung-Ang University Hospital,
Seoul, Korea (M.J.C., H.C.); Departments of Medicine (J.J.S.) and Radiology
(K.J.C., D.A.L.), National Jewish Health, 1400 Jackson St, Denver, CO 80206;
Department of Radiology, Chonnam National University Hospital, Gwangju, Republic
of Korea (J.E.L.); Department of Radiology, Research Institute of Clinical
Medicine of Jeonbuk National University, Biomedical Research Institute of
Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C); and
Department of Radiology, Sungkyunkwan University School of Medicine and Samsung
ChangWon Hospital, Gyeongsangnam, Republic of Korea (K.S.L.)
| | - Jong Eun Lee
- From the Department of Radiology, Chung-Ang University Hospital,
Seoul, Korea (M.J.C., H.C.); Departments of Medicine (J.J.S.) and Radiology
(K.J.C., D.A.L.), National Jewish Health, 1400 Jackson St, Denver, CO 80206;
Department of Radiology, Chonnam National University Hospital, Gwangju, Republic
of Korea (J.E.L.); Department of Radiology, Research Institute of Clinical
Medicine of Jeonbuk National University, Biomedical Research Institute of
Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C); and
Department of Radiology, Sungkyunkwan University School of Medicine and Samsung
ChangWon Hospital, Gyeongsangnam, Republic of Korea (K.S.L.)
| | - Hyewon Choi
- From the Department of Radiology, Chung-Ang University Hospital,
Seoul, Korea (M.J.C., H.C.); Departments of Medicine (J.J.S.) and Radiology
(K.J.C., D.A.L.), National Jewish Health, 1400 Jackson St, Denver, CO 80206;
Department of Radiology, Chonnam National University Hospital, Gwangju, Republic
of Korea (J.E.L.); Department of Radiology, Research Institute of Clinical
Medicine of Jeonbuk National University, Biomedical Research Institute of
Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C); and
Department of Radiology, Sungkyunkwan University School of Medicine and Samsung
ChangWon Hospital, Gyeongsangnam, Republic of Korea (K.S.L.)
| | - Kum Ju Chae
- From the Department of Radiology, Chung-Ang University Hospital,
Seoul, Korea (M.J.C., H.C.); Departments of Medicine (J.J.S.) and Radiology
(K.J.C., D.A.L.), National Jewish Health, 1400 Jackson St, Denver, CO 80206;
Department of Radiology, Chonnam National University Hospital, Gwangju, Republic
of Korea (J.E.L.); Department of Radiology, Research Institute of Clinical
Medicine of Jeonbuk National University, Biomedical Research Institute of
Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C); and
Department of Radiology, Sungkyunkwan University School of Medicine and Samsung
ChangWon Hospital, Gyeongsangnam, Republic of Korea (K.S.L.)
| | - Kyung Soo Lee
- From the Department of Radiology, Chung-Ang University Hospital,
Seoul, Korea (M.J.C., H.C.); Departments of Medicine (J.J.S.) and Radiology
(K.J.C., D.A.L.), National Jewish Health, 1400 Jackson St, Denver, CO 80206;
Department of Radiology, Chonnam National University Hospital, Gwangju, Republic
of Korea (J.E.L.); Department of Radiology, Research Institute of Clinical
Medicine of Jeonbuk National University, Biomedical Research Institute of
Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C); and
Department of Radiology, Sungkyunkwan University School of Medicine and Samsung
ChangWon Hospital, Gyeongsangnam, Republic of Korea (K.S.L.)
| | - David A. Lynch
- From the Department of Radiology, Chung-Ang University Hospital,
Seoul, Korea (M.J.C., H.C.); Departments of Medicine (J.J.S.) and Radiology
(K.J.C., D.A.L.), National Jewish Health, 1400 Jackson St, Denver, CO 80206;
Department of Radiology, Chonnam National University Hospital, Gwangju, Republic
of Korea (J.E.L.); Department of Radiology, Research Institute of Clinical
Medicine of Jeonbuk National University, Biomedical Research Institute of
Jeonbuk National University Hospital, Jeonju, Republic of Korea (K.J.C); and
Department of Radiology, Sungkyunkwan University School of Medicine and Samsung
ChangWon Hospital, Gyeongsangnam, Republic of Korea (K.S.L.)
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9
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Abu Hussein N, Machahua C, Ruchti SC, Horn MP, Piquilloud L, Prella M, Geiser TK, von Garnier C, Funke-Chambour M. Circulating calprotectin levels four months after severe and non-severe COVID-19. BMC Infect Dis 2023; 23:650. [PMID: 37789266 PMCID: PMC10546778 DOI: 10.1186/s12879-023-08653-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 09/27/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Calprotectin is an inflammatory marker mainly released by activated neutrophils that is increased in acute severe COVID-19. After initial recovery, some patients have persistent respiratory impairment with reduced diffusion capacity of the lungs for carbon monoxide (DLCO) months after infection. Underlying causes of this persistent impairment are unclear. We aimed to investigate the correlation between circulating calprotectin, persistent lung functional impairment and intensive care unit (ICU) stay after COVID-19 in two university hospital centres in Switzerland. METHODS Calprotectin levels were measured in serum from 124 patients (50% male) from the Bern cohort (post-ICU and non-ICU patients) and 68 (76% male) from the Lausanne cohort (only post-ICU patients) four months after COVID-19. Calprotectin was correlated with clinical parameters. Multivariate linear regression (MLR) was performed to evaluate the independent association of calprotectin in different models. RESULTS Overall, we found that post-ICU patients, compared to non-ICU, were significantly older (age 59.4 ± 13.6 (Bern), 60.5 ± 12.0 (Lausanne) vs. 48.8 ± 13.4 years) and more obese (BMI 28.6 ± 4.5 and 29.1 ± 5.3 vs. 25.2 ± 6.0 kg/m2, respectively). 48% of patients from Lausanne and 44% of the post-ICU Bern cohort had arterial hypertension as a pre-existing comorbidity vs. only 10% in non-ICU patients. Four months after COVID-19 infection, DLCO was lower in post-ICU patients (75.96 ± 19.05% predicted Bern, 71.11 ± 18.50% Lausanne) compared to non-ICU (97.79 ± 21.70% predicted, p < 0.01). The post-ICU cohort in Lausanne had similar calprotectin levels when compared to the cohort in Bern (Bern 2.74 ± 1.15 µg/ml, Lausanne 2.49 ± 1.13 µg/ml vs. non-ICU 1.86 ± 1.02 µg/ml; p-value < 0.01). Calprotectin correlated negatively with DLCO (r= -0.290, p < 0.001) and the forced vital capacity (FVC) (r= -0.311, p < 0.001). CONCLUSIONS Serum calprotectin is elevated in post-ICU patients in two independent cohorts and higher compared to non-ICU patients four months after COVID-19. In addition, there is a negative correlation between calprotectin levels and DLCO or FVC. The relationship between inflammation and lung functional impairment needs further investigations. TRIAL REGISTRATION NCT04581135.
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Affiliation(s)
- N Abu Hussein
- Department of Pulmonary Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department for BioMedical Research DBMR, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C Machahua
- Department of Pulmonary Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department for BioMedical Research DBMR, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - S C Ruchti
- Department of Pulmonary Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Faculty of Medicine, University of Bern, Bern, Switzerland
| | - M P Horn
- Department of Clinical Chemistry, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - L Piquilloud
- Division of Pulmonary Medicine, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
| | - M Prella
- Department of Diagnostic Laboratory Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - T K Geiser
- Department of Pulmonary Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- Department for BioMedical Research DBMR, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C von Garnier
- Department of Diagnostic Laboratory Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - M Funke-Chambour
- Department of Pulmonary Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
- Department for BioMedical Research DBMR, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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10
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Cherrez-Ojeda I, Osorio MF, Robles-Velasco K, Calderón JC, Cortés-Télles A, Zambrano J, Guarderas C, Intriago B, Gochicoa-Rangel L. Small airway disease in post-acute COVID-19 syndrome, a non-conventional approach in three years follow-up of a patient with long COVID: a case report. J Med Case Rep 2023; 17:386. [PMID: 37691104 PMCID: PMC10494419 DOI: 10.1186/s13256-023-04113-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 08/03/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Small airways disease (SAD), a novel finding described in post-acute COVID-19 patients, should be suspected when respiratory symptoms continue, air trapping persists on expiratory CT scans, and imaging findings fail to improve despite objectively better conventional pulmonary function test (PFT) parameters. The forced oscillation technique (FOT) and Multiple breathing washout (MBW) are both very sensitive methods for detecting anomalies in the peripheral airways. CASE PRESENTATION We discuss the case of a 60-year-old Hispanic patient who had severe COVID-19 pneumonia and developed dyspnea, fatigue, and limited daily activity a year later. The PFTs revealed restrictive lung disease, as seen by significant diffusing capacity of the lungs for carbon monoxide (DLCO) decrease, severe desaturation, and poor 6-min walk test (6MWT) performance. The patient was treated with lowering corticosteroids as well as pulmonary rehabilitation (PR). During the 24-month follow-up, the dyspnea and fatigue persisted. On PFTs, 6MWT performance and restricted pattern improved slightly, but MBW discovered significant ventilatory inhomogeneity. FOT revealed substantial peripheral airway obstructive abnormalities. On CT scans, air trapping and ground-glass opacities (GGO) improved somewhat. The patient used a bronchodilator twice a day and low-dose inhaled corticosteroids (160 µg of budesonide and 4.5 µg of formoterol fumarate dihydrate) for nine months. PR sessions were resuming. The restricting parameters were stabilized and the DLCO had normalized after 36 months, with a 6MWT performance of 87% but significant desaturation. The CT scan revealed traction bronchiectasis, low GGO, and persistent air trapping. Without normalization, FOT and MBW scores improved, indicating small airway disease. CONCLUSIONS The necessity of integrating these tests when detecting SAD is emphasized in our paper. This article lays the foundation for future research into the best ways to manage and monitor SAD in post-acute COVID-19 patients.
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Affiliation(s)
- Ivan Cherrez-Ojeda
- Universidad Espíritu Santo, Km. 2.5 Vía La Puntilla, Samborondón, 0901-952, Ecuador.
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador.
| | - Maria F Osorio
- Universidad Espíritu Santo, Km. 2.5 Vía La Puntilla, Samborondón, 0901-952, Ecuador
| | - Karla Robles-Velasco
- Universidad Espíritu Santo, Km. 2.5 Vía La Puntilla, Samborondón, 0901-952, Ecuador
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | | | - Arturo Cortés-Télles
- Departamento de Neumología y Cirugía de Tórax, Hospital Regional de Alta Especialidad de Yucatán, Mérida, Mexico
| | - Jorge Zambrano
- Centro de enfermedades respiratorias, rehabilitación y sueño (CERS), Guayaquil, Ecuador
| | - Cristian Guarderas
- Centro de enfermedades respiratorias, rehabilitación y sueño (CERS), Guayaquil, Ecuador
| | - Belen Intriago
- Universidad Espíritu Santo, Km. 2.5 Vía La Puntilla, Samborondón, 0901-952, Ecuador
- Respiralab, Respiralab Research Group, Guayaquil, Ecuador
| | - Laura Gochicoa-Rangel
- Departamento de Fisiología Respiratoria, Instituto Nacional de Enfermedades Respiratorias "Ismael Cosío Villegas", Ciudad de México, Mexico
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11
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Lassan S, Tesar T, Tisonova J, Lassanova M. Pharmacological approaches to pulmonary fibrosis following COVID-19. Front Pharmacol 2023; 14:1143158. [PMID: 37397477 PMCID: PMC10308083 DOI: 10.3389/fphar.2023.1143158] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 06/05/2023] [Indexed: 07/04/2023] Open
Abstract
Background: In the past few years, COVID-19 became the leading cause of morbidity and mortality worldwide. Although the World Health Organization has declared an end to COVID-19 as a public health emergency, it can be expected, that the emerging new cases at the top of previous ones will result in an increasing number of patients with post-COVID-19 sequelae. Despite the fact that the majority of patients recover, severe acute lung tissue injury can in susceptible individuals progress to interstitial pulmonary involvement. Our goal is to provide an overview of various aspects associated with the Post-COVID-19 pulmonary fibrosis with a focus on its potential pharmacological treatment options. Areas covered: We discuss epidemiology, underlying pathobiological mechanisms, and possible risk and predictive factors that were found to be associated with the development of fibrotic lung tissue remodelling. Several pharmacotherapeutic approaches are currently being applied and include anti-fibrotic drugs, prolonged use or pulses of systemic corticosteroids and non-steroidal anti-inflammatory and immunosuppressive drugs. In addition, several repurposed or novel compounds are being investigated. Fortunately, clinical trials focused on pharmacological treatment regimens for post-COVID-19 pulmonary fibrosis have been either designed, completed or are already in progress. However, the results are contrasting so far. High quality randomised clinical trials are urgently needed with respect to the heterogeneity of disease behaviour, patient characteristics and treatable traits. Conclusion: The Post-COVID-19 pulmonary fibrosis contributes to the burden of chronic respiratory consequences among survivors. Currently available pharmacotherapeutic approaches mostly comprise repurposed drugs with a proven efficacy and safety profile, namely, corticosteroids, immunosuppressants and antifibrotics. The role of nintedanib and pirfenidone is promising in this area. However, we still need to verify conditions under which the potential to prevent, slow or stop progression of lung damage will be fulfilled.
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Affiliation(s)
- Stefan Lassan
- Department of Pneumology, Phthisiology and Functional Diagnostics, Slovak Medical University and Bratislava University Hospital, Bratislava, Slovakia
| | - Tomas Tesar
- Department of Organisation and Management of Pharmacy, Faculty of Pharmacy, Comenius University, Bratislava, Slovakia
| | - Jana Tisonova
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
| | - Monika Lassanova
- Institute of Pharmacology and Clinical Pharmacology, Faculty of Medicine, Comenius University, Bratislava, Slovakia
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12
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Vaz N, Franquet E, Heidari P, Chow DZ, Jacene HA, Ng TSC. COVID-19: Findings in nuclear medicine from head to toe. Clin Imaging 2023; 99:10-18. [PMID: 37043868 PMCID: PMC10081937 DOI: 10.1016/j.clinimag.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 04/03/2023] [Indexed: 04/14/2023]
Abstract
COVID-19 is a multisystemic disease, and hence its potential manifestations on nuclear medicine imaging can extend beyond the lung. Therefore, it is important for the nuclear medicine physician to recognize these manifestations in the clinic. While FDG-PET/CT is not indicated routinely in COVID-19 evaluation, its unique capability to provide a functional and anatomical assessment of the entire body means that it can be a powerful tool to monitor acute, subacute, and long-term effects of COVID-19. Single-photon scintigraphy is routinely used to assess conditions such as pulmonary embolism, cardiac ischemia, and thyroiditis, and COVID-19 may present in these studies. The most common nuclear imaging finding of COVID-19 vaccination to date is hypermetabolic axillary lymphadenopathy. This may pose important diagnostic and management dilemmas in oncologic patients, particularly those with malignancies where the axilla constitutes a lymphatic drainage area. This article aims to summarize the relevant literature published since the beginning of the pandemic on the intersection between COVID-19 and nuclear medicine.
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Affiliation(s)
- Nuno Vaz
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, United States.
| | - Elisa Franquet
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, United States
| | - Pedram Heidari
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
| | - David Z Chow
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
| | - Heather A Jacene
- Department of Radiology, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, United States
| | - Thomas S C Ng
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114, United States
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13
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Yang H, Wen X, Wu F, Zheng Y, Dai C, Zhao N, Deng Z, Wang Z, Peng J, Xiao S, Lu L, Huang J, Yu S, Yang C, Chen S, Zhou Y, Ran P. Inter-relationships among neutrophilic inflammation, air trapping and future exacerbation in COPD: an analysis of ECOPD study. BMJ Open Respir Res 2023; 10:10/1/e001597. [PMID: 37028910 PMCID: PMC10083880 DOI: 10.1136/bmjresp-2022-001597] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 03/24/2023] [Indexed: 04/09/2023] Open
Abstract
BACKGROUND The inter-relationships among neutrophilic airway inflammation, air trapping and future exacerbation in chronic obstructive pulmonary disease (COPD) remain unclear. OBJECTIVE To evaluate the associations between sputum neutrophil proportions and future exacerbation in COPD and to determine whether these associations are modified by significant air trapping. METHODS Participants with completed data were included and followed up to the first year in the Early Chronic Obstructive Pulmonary Disease study (n=582). Sputum neutrophil proportions and high-resolution CT-related markers were measured at baseline. Sputum neutrophil proportions were dichotomised based on their median (86.2%) to low and high levels. In addition, subjects were divided into the air trapping or non-air trapping group. Outcomes of interest included COPD exacerbation (separately any, severe and frequent exacerbation, occurring in the first year of follow-up). Multivariable logistic regressions were performed to examine the risk of severe exacerbation and frequent exacerbation with either neutrophilic airway inflammation groups or air trapping groups. RESULTS There was no significant difference between high and low levels of sputum neutrophil proportions in the exacerbation in the preceding year. After the first year of follow-up, subjects with high sputum neutrophil proportions had increased risks of severe exacerbation (OR=1.68, 95% CI: 1.09 to 2.62, p=0.020). Subjects with high sputum neutrophil proportions and significant air trapping had increased odds of having frequent exacerbation (OR=3.29, 95% CI: 1.30 to 9.37, p=0.017) and having severe exacerbation (OR=2.72, 95% CI: 1.42 to 5.43, p=0.003) when compared with those who had low sputum neutrophil proportions and non-air trapping. CONCLUSIONS We found that subjects with high sputum neutrophil proportions and significant air trapping are prone to future exacerbation of COPD. It may be a helpful predictor of future exacerbation.
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Affiliation(s)
- Huajing Yang
- Guangzhou Institute of Respiratory Health & State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Xiang Wen
- Guangzhou Institute of Respiratory Health & State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
- Shenzhen Institute of Respiratory Disease, Shenzhen People's Hospital, Shenzhen, Guangdong, China
| | - Fan Wu
- Guangzhou Institute of Respiratory Health & State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
- Guangzhou Laboratory, Guangzhou, Guangdong, China
| | - Youlan Zheng
- Guangzhou Institute of Respiratory Health & State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Cuiqiong Dai
- Guangzhou Institute of Respiratory Health & State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Ningning Zhao
- Guangzhou Institute of Respiratory Health & State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Zhishan Deng
- Guangzhou Institute of Respiratory Health & State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Zihui Wang
- Guangzhou Institute of Respiratory Health & State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Jieqi Peng
- Guangzhou Institute of Respiratory Health & State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
- Guangzhou Laboratory, Guangzhou, Guangdong, China
| | - Shan Xiao
- Guangzhou Institute of Respiratory Health & State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
- Department of Pulmonary and Critical Care Medicine, Longgang District People's Hospital of Shenzhen, Shenzhen, Guangdong, China
| | - Lifei Lu
- Guangzhou Institute of Respiratory Health & State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
| | - Jianhui Huang
- Department of internal medicine, Lianping County People's Hospital, Heyuan, Guangdong, China
| | - Shuqing Yu
- Department of internal medicine, Lianping County People's Hospital, Heyuan, Guangdong, China
- Department of internal medicine, Lianping County Hospital of Traditional Chinese Medicine, Heyuan, Guangdong, China
| | - Changli Yang
- Department of Pulmonary and Critical Care Medicine, Wengyuan County People's Hospital, Shaoguan, Guangdong, China
| | - Shengtang Chen
- Department of Pulmonary and Critical Care Medicine, Wengyuan County People's Hospital, Shaoguan, Guangdong, China
| | - Yumin Zhou
- Guangzhou Institute of Respiratory Health & State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
- Guangzhou Laboratory, Guangzhou, Guangdong, China
| | - Pixin Ran
- Guangzhou Institute of Respiratory Health & State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China
- Guangzhou Laboratory, Guangzhou, Guangdong, China
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14
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Bonilla H, Peluso MJ, Rodgers K, Aberg JA, Patterson TF, Tamburro R, Baizer L, Goldman JD, Rouphael N, Deitchman A, Fine J, Fontelo P, Kim AY, Shaw G, Stratford J, Ceger P, Costantine MM, Fisher L, O’Brien L, Maughan C, Quigley JG, Gabbay V, Mohandas S, Williams D, McComsey GA. Therapeutic trials for long COVID-19: A call to action from the interventions taskforce of the RECOVER initiative. Front Immunol 2023; 14:1129459. [PMID: 36969241 PMCID: PMC10034329 DOI: 10.3389/fimmu.2023.1129459] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/06/2023] [Indexed: 03/11/2023] Open
Abstract
Although most individuals recover from acute SARS-CoV-2 infection, a significant number continue to suffer from Post-Acute Sequelae of SARS-CoV-2 (PASC), including the unexplained symptoms that are frequently referred to as long COVID, which could last for weeks, months, or even years after the acute phase of illness. The National Institutes of Health is currently funding large multi-center research programs as part of its Researching COVID to Enhance Recover (RECOVER) initiative to understand why some individuals do not recover fully from COVID-19. Several ongoing pathobiology studies have provided clues to potential mechanisms contributing to this condition. These include persistence of SARS-CoV-2 antigen and/or genetic material, immune dysregulation, reactivation of other latent viral infections, microvascular dysfunction, and gut dysbiosis, among others. Although our understanding of the causes of long COVID remains incomplete, these early pathophysiologic studies suggest biological pathways that could be targeted in therapeutic trials that aim to ameliorate symptoms. Repurposed medicines and novel therapeutics deserve formal testing in clinical trial settings prior to adoption. While we endorse clinical trials, especially those that prioritize inclusion of the diverse populations most affected by COVID-19 and long COVID, we discourage off-label experimentation in uncontrolled and/or unsupervised settings. Here, we review ongoing, planned, and potential future therapeutic interventions for long COVID based on the current understanding of the pathobiological processes underlying this condition. We focus on clinical, pharmacological, and feasibility data, with the goal of informing future interventional research studies.
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Affiliation(s)
- Hector Bonilla
- Department of Medicine and Infectious Diseases, Stanford University, Palo Alto, CA, United States
| | - Michael J. Peluso
- Department of Medicine and Infectious Diseases, University of California, San Francisco, San Francisco, CA, United States
| | - Kathleen Rodgers
- Center for Innovations in Brain Science, University of Arizona, Tucson, AZ, United States
| | - Judith A. Aberg
- Department of Medicine, Infectious Diseases, Icahn School of Medicine at Mount Sinai, Chief, Division of Infectious Disease, New York, NY, United States
| | - Thomas F. Patterson
- Department of Medicine, Infectious Diseases, The University of Texas Health Science Center at San Antonio, San Antonio, TX, United States
| | - Robert Tamburro
- Division of Intramural Research, National Institute of Health, Bethesda, MD, United States
| | - Lawrence Baizer
- National Heart Lung and Blood Institute, Division of Lung Diseases, National Institutes of Health, Bethesda, MD, United States
| | - Jason D. Goldman
- Department of Medicine, Organ Transplant and Liver Center, Swedish Medical Center, Seattle, WA, United States
- Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA, United States
| | - Nadine Rouphael
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, United States
| | - Amelia Deitchman
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA, United States
| | - Jeffrey Fine
- Department of Rehabilitation Medicine at New York University (NYU) Grossman School of Medicine, Physical Medicine and Rehabilitation Service, New York University (NYU), New York University Medical Center, New York, NY, United States
| | - Paul Fontelo
- Applied Clinical Informatics Branch, National Library of Medicine, National Institutes of Health, Bethesda, MD, United States
| | - Arthur Y. Kim
- Department of Medicine at Harvard Medical School, Division of Infectious Disease, Boston, MA, United States
| | - Gwendolyn Shaw
- Research Triangle Institute (RTI), International, Durham, NC, United States
| | - Jeran Stratford
- Research Triangle Institute (RTI), International, Durham, NC, United States
| | - Patricia Ceger
- Research Triangle Institute (RTI), International, Durham, NC, United States
| | - Maged M. Costantine
- Department of Obstetrics and Gynecology, The Ohio State University, Columbus, OH, United States
| | - Liza Fisher
- Long COVID Families, Houston, TX, United States
| | - Lisa O’Brien
- Utah Covid-19 Long Haulers, Salt Lake City, UT, United States
| | | | - John G. Quigley
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Vilma Gabbay
- Department of Medicine, Albert Einstein College of Medicine, New York, NY, United States
| | - Sindhu Mohandas
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | - David Williams
- Department of Medicine, University of Michigan, Ann Arbor, MI, United States
| | - Grace A. McComsey
- Department of Pediatrics and Medicine, Case Western Reserve University, Cleveland, OH, United States
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15
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Murphy MC, Little BP. Chronic Pulmonary Manifestations of COVID-19 Infection: Imaging Evaluation. Radiology 2023; 307:e222379. [PMID: 36692398 PMCID: PMC9888022 DOI: 10.1148/radiol.222379] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A patient with severe COVID-19 pneumonia requiring ICU admission and prolonged hospital stay is presented. The infection resulted in long term morbidity, functional decline and abnormal chest CT findings. Mechanisms for long term lung injury post COVID-19 infection, imaging appearances and role of imaging in follow-up are discussed.
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Affiliation(s)
- Mark C. Murphy
- Fellow in Cardiothoracic Imaging and Intervention Massachusetts
General Hospital, Boston
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16
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Kanne JP, Little BP, Schulte JJ, Haramati A, Haramati LB. Long-term Lung Abnormalities Associated with COVID-19 Pneumonia. Radiology 2022; 306:e221806. [PMID: 36040336 PMCID: PMC9462591 DOI: 10.1148/radiol.221806] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In the 3rd year of the SARS-CoV-2 pandemic, much has been learned about the long-term effects of COVID-19 pneumonia on the lungs. Approximately one-third of patients with moderate-to-severe pneumonia, especially those requiring intensive care therapy or mechanical ventilation, have residual abnormalities at chest CT 1 year after presentation. Abnormalities range from parenchymal bands to bronchial dilation to frank fibrosis. Less is known about the long-term pulmonary vascular sequelae, but there appears to be a persistent, increased risk of venothromboembolic events in a small cohort of patients. Finally, the associated histologic abnormalities resulting from SARS-CoV-2 infection are similar to those seen in patients with other causes of acute lung injury.
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17
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Cherrez-Ojeda I, Cortés-Telles A, Gochicoa-Rangel L, Camacho-Leon G, Mautong H, Robles-Velasco K, Faytong-Haro M. Challenges in the Management of Post-COVID-19 Pulmonary Fibrosis for the Latin American Population. J Pers Med 2022; 12:jpm12091393. [PMID: 36143178 PMCID: PMC9501763 DOI: 10.3390/jpm12091393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
This commentary aims to highlight some of the major issues (with possible solutions) that the Latin American region is currently dealing with in managing post-COVID-19 pulmonary fibrosis. Overall, there is little evidence for successful long-term COVID-19 follow-up treatment. The lack of knowledge regarding proper treatment is exacerbated in Latin America by a general lack of resources devoted to healthcare, and a lack of availability and access to multidisciplinary teams. The discussion suggests that better infrastructure (primarily multicenter cohorts of COVID-19 survivors) and well-designed studies are required to develop scientific knowledge to improve treatment for the increasing prevalence of pulmonary fibrosis in Latin America.
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Affiliation(s)
- Ivan Cherrez-Ojeda
- School of Health, Universidad de Especialidades Espíritu Santo, Samborondón 0901952, Guayas, Ecuador
- Respiralab Research Group, Guayaquil 090512, Guayas, Ecuador
- Correspondence: (I.C.-O.); (M.F.-H.)
| | - Arturo Cortés-Telles
- Departamento de Neumología y Cirugía de Tórax, Hospital Regional de Alta Especialidad de Yucatán, Mérida 97133, Mexico
| | - Laura Gochicoa-Rangel
- Department of Respiratory Physiology, National Institute of Respiratory Diseases “Ismael Cosío Villegas”, Mexico City 14080, Mexico
| | - Génesis Camacho-Leon
- Division of Clinical and Translational Research, Larkin Community Hospital, South Miami, FL 33143, USA
| | - Hans Mautong
- School of Health, Universidad de Especialidades Espíritu Santo, Samborondón 0901952, Guayas, Ecuador
- Respiralab Research Group, Guayaquil 090512, Guayas, Ecuador
| | - Karla Robles-Velasco
- School of Health, Universidad de Especialidades Espíritu Santo, Samborondón 0901952, Guayas, Ecuador
- Respiralab Research Group, Guayaquil 090512, Guayas, Ecuador
| | - Marco Faytong-Haro
- School of Health, Universidad de Especialidades Espíritu Santo, Samborondón 0901952, Guayas, Ecuador
- Sociology and Demography Department, The Pennsylvania State University, University Park, PA 16802, USA
- Ecuadorian Development Research Lab, Daule 090656, Guayas, Ecuador
- Correspondence: (I.C.-O.); (M.F.-H.)
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18
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Bonato M, Peditto P, Landini N, Fraccaro A, Catino C, Cuzzola M, Malacchini N, Savoia F, Roma N, Salasnich M, Turrin M, Zampieri F, Zanardi G, Zeraj F, Rattazzi M, Peta M, Baraldo S, Saetta M, Fusaro M, Morana G, Romagnoli M. Multidimensional 3-Month Follow-Up of Severe COVID-19: Airways beyond the Parenchyma in Symptomatic Patients. J Clin Med 2022; 11:jcm11144046. [PMID: 35887810 PMCID: PMC9319969 DOI: 10.3390/jcm11144046] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 07/01/2022] [Accepted: 07/07/2022] [Indexed: 12/10/2022] Open
Abstract
SARS-CoV-2 may lead to a large spectrum of respiratory manifestations, including pulmonary sequelae. We conducted a single-center longitudinal study of survivors from severe COVID-19 cases who underwent a chest CT during hospitalization (CTH). Three months after being discharged, these patients were evaluated by a clinical examination, pulmonary function tests and a chest-CT scan (CTFU). Sixty-two patients were enrolled. At follow-up, 27% complained of exertional dyspnoea and 12% of cough. Dyspnoeic patients had a lower forced expiratory flow (FEF)25–75 (p = 0.015), while a CT scan (p = 0.016 showed that patients with cough had a higher extent of bronchiectasis. Lung volumes and diffusion of carbon monoxide (DLCO) at follow-up were lower in patients who had been invasively ventilated, which correlated inversely with the length of hospitalization and ground-glass extension at CTH. At follow-up, 14.5% of patients had a complete radiological resolution, while 85.5% presented persistence of ground-glass opacities, and 46.7% showed fibrotic-like alterations. Residual ground-glass at CTFU was related to the length of hospitalization (r = 0.48; p = 0.0002) and to the need for mechanical ventilation or high flow oxygen (p = 0.01) during the acute phase. In conclusion, although patients at three months from discharge showed functional impairment and radiological abnormalities, which correlated with a prolonged hospital stay and need for mechanical ventilation, the persistence of respiratory symptoms was related not to parenchymal but rather to airway sequelae.
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Affiliation(s)
- Matteo Bonato
- Pulmonology Unit, Ca’ Foncello Hospital, Azienda Unità Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy; (P.P.); (A.F.); (C.C.); (M.C.); (N.M.); (F.S.); (M.S.); (M.T.); (F.Z.); (G.Z.); (F.Z.); (M.R.)
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy; (S.B.); (M.S.)
- Correspondence: ; Tel.: +39-0422-322729; Fax: +39-0422-322738
| | - Piera Peditto
- Pulmonology Unit, Ca’ Foncello Hospital, Azienda Unità Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy; (P.P.); (A.F.); (C.C.); (M.C.); (N.M.); (F.S.); (M.S.); (M.T.); (F.Z.); (G.Z.); (F.Z.); (M.R.)
| | - Nicholas Landini
- Department of Radiology, Ca’ Foncello Hospital, Azienda Unità Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy; (N.L.); (N.R.); (G.M.)
- Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I Hospital, “Sapienza” Rome University, 00185 Rome, Italy
| | - Alessia Fraccaro
- Pulmonology Unit, Ca’ Foncello Hospital, Azienda Unità Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy; (P.P.); (A.F.); (C.C.); (M.C.); (N.M.); (F.S.); (M.S.); (M.T.); (F.Z.); (G.Z.); (F.Z.); (M.R.)
| | - Cosimo Catino
- Pulmonology Unit, Ca’ Foncello Hospital, Azienda Unità Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy; (P.P.); (A.F.); (C.C.); (M.C.); (N.M.); (F.S.); (M.S.); (M.T.); (F.Z.); (G.Z.); (F.Z.); (M.R.)
| | - Maria Cuzzola
- Pulmonology Unit, Ca’ Foncello Hospital, Azienda Unità Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy; (P.P.); (A.F.); (C.C.); (M.C.); (N.M.); (F.S.); (M.S.); (M.T.); (F.Z.); (G.Z.); (F.Z.); (M.R.)
| | - Nicola Malacchini
- Pulmonology Unit, Ca’ Foncello Hospital, Azienda Unità Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy; (P.P.); (A.F.); (C.C.); (M.C.); (N.M.); (F.S.); (M.S.); (M.T.); (F.Z.); (G.Z.); (F.Z.); (M.R.)
| | - Francesca Savoia
- Pulmonology Unit, Ca’ Foncello Hospital, Azienda Unità Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy; (P.P.); (A.F.); (C.C.); (M.C.); (N.M.); (F.S.); (M.S.); (M.T.); (F.Z.); (G.Z.); (F.Z.); (M.R.)
| | - Nicola Roma
- Department of Radiology, Ca’ Foncello Hospital, Azienda Unità Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy; (N.L.); (N.R.); (G.M.)
| | - Mauro Salasnich
- Pulmonology Unit, Ca’ Foncello Hospital, Azienda Unità Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy; (P.P.); (A.F.); (C.C.); (M.C.); (N.M.); (F.S.); (M.S.); (M.T.); (F.Z.); (G.Z.); (F.Z.); (M.R.)
| | - Martina Turrin
- Pulmonology Unit, Ca’ Foncello Hospital, Azienda Unità Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy; (P.P.); (A.F.); (C.C.); (M.C.); (N.M.); (F.S.); (M.S.); (M.T.); (F.Z.); (G.Z.); (F.Z.); (M.R.)
| | - Francesca Zampieri
- Pulmonology Unit, Ca’ Foncello Hospital, Azienda Unità Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy; (P.P.); (A.F.); (C.C.); (M.C.); (N.M.); (F.S.); (M.S.); (M.T.); (F.Z.); (G.Z.); (F.Z.); (M.R.)
| | - Giuseppe Zanardi
- Pulmonology Unit, Ca’ Foncello Hospital, Azienda Unità Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy; (P.P.); (A.F.); (C.C.); (M.C.); (N.M.); (F.S.); (M.S.); (M.T.); (F.Z.); (G.Z.); (F.Z.); (M.R.)
| | - Fabiola Zeraj
- Pulmonology Unit, Ca’ Foncello Hospital, Azienda Unità Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy; (P.P.); (A.F.); (C.C.); (M.C.); (N.M.); (F.S.); (M.S.); (M.T.); (F.Z.); (G.Z.); (F.Z.); (M.R.)
| | - Marcello Rattazzi
- Department of Internal Medicine, Ca’ Foncello Hospital, Azienda Unità Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy;
| | - Mario Peta
- Department of Emergency, Anesthesiology, Intensive Care, Ca’ Foncello Hospital, Azienda Unità Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy;
| | - Simonetta Baraldo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy; (S.B.); (M.S.)
| | - Marina Saetta
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35122 Padova, Italy; (S.B.); (M.S.)
| | - Michele Fusaro
- Department of Radiology, Oderzo City Hospital, Azienda Unità Locale Socio-Sanitaria 2 Marca Trevigiana, 31046 Oderzo, Italy;
| | - Giovanni Morana
- Department of Radiology, Ca’ Foncello Hospital, Azienda Unità Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy; (N.L.); (N.R.); (G.M.)
| | - Micaela Romagnoli
- Pulmonology Unit, Ca’ Foncello Hospital, Azienda Unità Locale Socio-Sanitaria 2 Marca Trevigiana, 31100 Treviso, Italy; (P.P.); (A.F.); (C.C.); (M.C.); (N.M.); (F.S.); (M.S.); (M.T.); (F.Z.); (G.Z.); (F.Z.); (M.R.)
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