1
|
Casitas R, Galera R, Torres-Vargas M, Garcia-Tovar S, Alfaro E, Díaz-Garcia E, Martinez-Cerón E, Garcia-Garcia M, Torres I, Núñez-Fernández M, Fernández-Villar A, Fernández-Velilla M, Añón JM, Cubillos-Zapata C, García-Río F. Medium-Term Disability and Long-Term Functional Impairment Persistence in Survivors of Severe COVID-19 ARDS: Clinical and Physiological Insights. Arch Bronconeumol 2024; 60:619-626. [PMID: 38853119 DOI: 10.1016/j.arbres.2024.05.021] [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: 03/11/2024] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Although the medium- and long-term sequelae of survivor of acute respiratory distress syndrome (ARDS) of any cause have been documented, little is known about the way in which COVID-19-induced ARDS affects functional disability and exercise components. Our aims were to examine the medium-term disability in severe COVID-19-associated ARDS survivors, delineate pathophysiological changes contributing to their exercise intolerance, and explore its utility in predicting long-term functional impairment persistence. METHODS We studied 108 consecutive subjects with severe COVID-19 ARDS who remained alive 6 months after intensive care unit (ICU) discharge. Lung morphology was assessed with chest non-contrast CT scans and CT angiography. Functional evaluation included spirometry, plethysmography, muscle strength, and diffusion capacity, with assessment of gas exchange components through diffusing capacity of nitric oxide. Disability was assessed through an incremental exercise test, and measurements were repeated 12 and 24 months later in patients with functional impairments. RESULTS At 6 months after ICU discharge, a notable dissociation between morphological and clinical-functional sequelae was identified. Moderate-severe disability was present in 47% of patients and these subjects had greater limitation of ventilatory mechanics and gas exchange, as well as greater symptomatic perception during exercise and a probable associated cardiac limitation. Female sex, hypothyroidism, reduced membrane diffusion component, lower functional residual capacity, and high-attenuation lung volume were independently associated with the presence of moderate-severe functional disability, which in turn was related to higher frequency and greater intensity of dyspnea and worse quality of life. Out of the 71 patients with reduced lung volumes or diffusion capacity at 6 months post-ICU discharge, only 19 maintained a restrictive disorder associated with gas exchange impairment at 24 months post-discharge. In these patients, 6-month values for diffusion membrane component, maximal oxygen uptake, ventilatory equivalent for CO2, and dead space to tidal volume ratio were identified as independent risk factors for persistence of long-term functional sequelae. CONCLUSIONS Less than half of survivors of COVID-19 ARDS have moderate-severe disability in the medium term, identifying several risk factors. In turn, diffusion membrane component and exercise tolerance at 6-month ICU discharge are independently associated with the persistence of long-term functional sequelae.
Collapse
Affiliation(s)
- Raquel Casitas
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain; Departamento de Medicina, Universidad Autónoma de Madrid, Spain
| | - Raúl Galera
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain; Grupo de Enfermedades Respiratorias, IdiPAZ, Madrid, Spain
| | - María Torres-Vargas
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Sara Garcia-Tovar
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain; Grupo de Enfermedades Respiratorias, IdiPAZ, Madrid, Spain
| | - Enrique Alfaro
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain; Grupo de Enfermedades Respiratorias, IdiPAZ, Madrid, Spain
| | - Elena Díaz-Garcia
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain; Grupo de Enfermedades Respiratorias, IdiPAZ, Madrid, Spain
| | - Elisabet Martinez-Cerón
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain; Grupo de Enfermedades Respiratorias, IdiPAZ, Madrid, Spain
| | - Miguel Garcia-Garcia
- Departamento de Análisis Económico y Economía Cuantitativa, Universidad Complutense de Madrid, Spain
| | - Isabel Torres
- Servicio de Radiodiagnóstico, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Marta Núñez-Fernández
- Servicio de Neumología, Complejo Hospitalario Universitario de Vigo, Spain; NeumoVigo I+i, Galicia Sur Health Research Institute (IIGS), Vigo, Spain
| | - Alberto Fernández-Villar
- Servicio de Neumología, Complejo Hospitalario Universitario de Vigo, Spain; NeumoVigo I+i, Galicia Sur Health Research Institute (IIGS), Vigo, Spain
| | | | - José Manuel Añón
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain; Servicio de Medicina Intensiva, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
| | - Carolina Cubillos-Zapata
- Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain; Grupo de Enfermedades Respiratorias, IdiPAZ, Madrid, Spain
| | - Francisco García-Río
- Servicio de Neumología, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain; Centro de Investigación Biomédica en Red en Enfermedades Respiratorias (CIBERES), Madrid, Spain; Departamento de Medicina, Universidad Autónoma de Madrid, Spain; Grupo de Enfermedades Respiratorias, IdiPAZ, Madrid, Spain.
| |
Collapse
|
2
|
Boccatonda A, D’Ardes D, Tallarico V, Guagnano MT, Cipollone F, Schiavone C, Piscaglia F, Serra C. Role of Lung Ultrasound in the Detection of Lung Sequelae in Post-COVID-19 Patients: A Systematic Review and Meta-Analysis. J Clin Med 2024; 13:5607. [PMID: 39337096 PMCID: PMC11432428 DOI: 10.3390/jcm13185607] [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: 09/03/2024] [Revised: 09/17/2024] [Accepted: 09/19/2024] [Indexed: 09/30/2024] Open
Abstract
Background: During the COVID-19 pandemic, several studies demonstrated the effectiveness of lung ultrasound (LUS) as a frontline tool in diagnosing and managing acute SARS-CoV-2 pneumonia. However, its role in detecting post-COVID-19 lung sequelae remains to be fully determined. This study aims to evaluate the diagnostic accuracy of LUS in identifying lung parenchymal damage, particularly fibrotic-like changes, following COVID-19 pneumonia, comparing its performance to that of CT. Methods: Relevant studies published before July 2024 were identified through a comprehensive search of PubMed, Embase, and Cochrane library. The search terms were combinations of the relevant medical subject heading (MeSH) terms, key words and word variants for "lung", "post-COVID", "long-COVID", and "ultrasound". The pooled sensitivity, specificity, diagnostic odds ratio (DOR), and summary receiver-operating characteristic (SROC) curve were used to examine the accuracy of CEUS. The selected works used different thresholds for the detection and counting of B-lines by ultrasound. This led to dividing our analysis into two models, the first based on the lower thresholds for detection of B-lines found in the works, and the second on data obtained using a higher detection threshold. Results: In terms of the diagnostic accuracy of LUS in detecting residual fibrotic-like changes in patients post-COVID-19 infection, a low-threshold model displayed a pooled sensitivity of 0.98 [95% confidence interval (CI): 0.95-0.99] and a pooled specificity of 0.54 (95% CI: 0.49-0.59). The DOR was 44.9 (95% CI: 10.8-187.1). The area under the curve (AUC) of SROC was 0.90. In the second analysis, the model with the higher threshold to detect B-lines showed a pooled sensitivity of 0.90 (95% CI: 0.85-0.94) and a pooled specificity of 0.88 (95% CI: 0.84-0.91). The DOR was 50.4 (95% CI: 15.9-159.3). The AUC of SROC was 0.93. Conclusions: In both analyses (even using the high threshold for the detection of B-lines), excellent sensitivity (98% in model 1 and 90% in model 2) is maintained. The specificity has a significant variation between the two models from 54 (model 1) to 87% (model 2). The model with the highest threshold for the detection of B-lines displayed the best diagnostic accuracy, as confirmed by the AUC values of the SROC (0.93).
Collapse
Affiliation(s)
- Andrea Boccatonda
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy;
- Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| | - Damiano D’Ardes
- Department of Medicine and Aging Science, Institute of “Clinica Medica”, “G. d’Annunzio” University of Chieti, 66100 Chieti, Italy; (D.D.); (M.T.G.); (F.C.)
| | - Viola Tallarico
- Internal Medicine, Bentivoglio Hospital, Azienda Unità Sanitaria Locale (AUSL) Bologna, 40010 Bentivoglio, Italy;
| | - Maria Teresa Guagnano
- Department of Medicine and Aging Science, Institute of “Clinica Medica”, “G. d’Annunzio” University of Chieti, 66100 Chieti, Italy; (D.D.); (M.T.G.); (F.C.)
| | - Francesco Cipollone
- Department of Medicine and Aging Science, Institute of “Clinica Medica”, “G. d’Annunzio” University of Chieti, 66100 Chieti, Italy; (D.D.); (M.T.G.); (F.C.)
| | - Cosima Schiavone
- Internistic Ultrasound Unit, SS Annunziata Hospital, “G. d’Annunzio” University of Chieti, 66100 Chieti, Italy;
| | - Fabio Piscaglia
- Department of Medical and Surgical Sciences, University of Bologna, 40126 Bologna, Italy;
- Division of Internal Medicine, Hepatobiliary and Immunoallergic Diseases, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy
| | - Carla Serra
- Diagnostic and Therapeutic Interventional Ultrasound Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy;
| |
Collapse
|
3
|
Kim C, Seok H, Kim J, Park DW, van Assen M, De Cecco CN, Choi H, Kim C, Hwang SH, Yong HS, Oh YW, Choi WS. COVID-19's Radiologic, Functional, and Serologic Consequences at 6-Month and 18-Month Follow-up: A Prospective Cohort Study. J Korean Med Sci 2024; 39:e228. [PMID: 39164053 PMCID: PMC11333807 DOI: 10.3346/jkms.2024.39.e228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 06/27/2024] [Indexed: 08/22/2024] Open
Abstract
BACKGROUND We evaluated the radiologic, pulmonary functional, and antibody statuses of coronavirus disease 2019 (COVID-19) patients 6 and 18 months after discharge, comparing changes in status and focusing on risk factors for residual computed tomography (CT) abnormalities. METHODS This prospective cohort study was conducted on COVID-19 patients discharged between April 2020 and January 2021. Chest CT, pulmonary function testing (PFT), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) measurements were performed 6 and 18 months after discharge. We evaluated factors associated with residual CT abnormalities and the correlation between lesion volume in CT (lesionvolume), PFT, and IgG levels. RESULTS This study included 68 and 42 participants evaluated 6 and 18 months, respectively, after hospitalizations for COVID-19. CT abnormalities were noted in 22 participants (32.4%) at 6 months and 13 participants (31.0%) at 18 months. Lesionvolume was significantly lower at 18 months than 6 months (P < 0.001). Patients with CT abnormalities at 6 months showed lower forced expiratory volume in 1 second (FEV1) and FEV1/forced vital capacity (FVC), and patients with CT abnormalities at 18 months exhibited lower FVC. FVC significantly improved between 6 and 18 months of follow-up (all P < 0.0001). SARS-CoV-2 IgG levels were significantly higher in patients with CT abnormalities at 6 and 18 months (P < 0.001). At 18-month follow-up assessments, age was associated with CT abnormalities (odds ratio, 1.17; 95% confidence interval, 1.03-1.32; P = 0.01), and lesionvolume showed a positive correlation with IgG level (r = 0.643, P < 0.001). CONCLUSION At 18-month follow-up assessments, 31.0% of participants exhibited residual CT abnormalities. Age and higher SARS-CoV-2 IgG levels were significant predictors, and FVC was related to abnormal CT findings at 18 months. Lesionvolume and FVC improved between 6 and 18 months. TRIAL REGISTRATION Clinical Research Information Service Identifier: KCT0008573.
Collapse
Affiliation(s)
- Cherry Kim
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Hyeri Seok
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Jooyun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Dae Won Park
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Marly van Assen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Emory University School of Medicine, Atlanta, GA, USA
| | - Carlo N De Cecco
- Translational Laboratory for Cardiothoracic Imaging and Artificial Intelligence, Emory University School of Medicine, Atlanta, GA, USA
- Division of Cardiothoracic Imaging, Department of Radiology, Emory University, Atlanta, GA, USA
| | - Hangseok Choi
- Medical Science Research Center, Korea University College of Medicine, Seoul, Korea
| | - Chohee Kim
- Department of Radiology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Sung Ho Hwang
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Hwan Seok Yong
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea
| | - Yu-Whan Oh
- Department of Radiology, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Won Suk Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
| |
Collapse
|
4
|
Bradley J, Xu Q, Touloumes N, Lusciks E, Ali T, Huang EC, Chen J, Ghafghazi S, Arnold FW, Kong M, Huang J, Cavallazzi R. Association of pulmonary function test abnormalities and quality-of-life measures after COVID-19 infection. Am J Med Sci 2024; 368:112-121. [PMID: 38636655 PMCID: PMC11269026 DOI: 10.1016/j.amjms.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/29/2024] [Accepted: 04/15/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Long-COVID is a multisystem disease that can lead to significant impairments in health-related quality of life (HRQoL). Following COVID-19 infection, abnormalities on pulmonary function tests (PFT) are common. The primary aim of this study is to evaluate for any correlation between PFT abnormalities and impairment in HRQoL scores following COVID-19 infection. METHODS This is an analysis of a prospective cohort of patients in Louisville, KY who were infected with COVID-19. Data collected included demographics, past medical history, laboratory tests, PFTs, and several HRQoL questionnaires such as the EuroQol 5 Dimension HRQoL questionnaire (EQ-5D-5 L), Generalized Anxiety Disorder 7 (GAD-7), Patient Health Questionnaire (PHQ-9), and Posttraumatic stress disorder checklist for DSM-5 (PCL-5). Descriptive statistics were performed, comparing PFTs (normal vs abnormal) and time since COVID-19 infection (3- vs 6- vs ≥ 12 months). RESULTS There were no significant differences in FEV1, FVC, or the percentage of patients with abnormal PFTs over time after COVID-19 infection. Following COVID-19, patients with normal PFTs had worse impairment in mobility HRQoL scores and change in GAD-7 scores over time. There were no differences over time in any of the HRQoL scores among patients with abnormal PFTs. CONCLUSIONS Among patients with an abnormal PFT, there was no temporal association with HRQoL scores as measured by EQ-5D-5 L, GAD-7, PHQ-9, and PCL-5. Among patients with a normal PFT, mobility impairment and anxiety may be associated with COVID-19 infection. Following COVID-19 infection, impairment in HRQoL scores is not completely explained by the presence of abnormalities on spirometry.
Collapse
Affiliation(s)
- James Bradley
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, Department of Medicine, University of Louisville, Louisville, KY
| | - Qian Xu
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY
- Biometrics and Data Science, Fosun Pharma, Beijing 100026, PR China
| | - Nikolas Touloumes
- Division of General Internal Medicine, Department of Medicine, University of Louisville, Louisville, KY
| | - Eugene Lusciks
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY
| | - T’shura Ali
- Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, KY
- Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville, Louisville, KY
| | - Emma C. Huang
- Trinity College of Arts and Sciences, Duke University, Durham, NC
| | - James Chen
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY
| | - Shahab Ghafghazi
- Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, Louisville, KY
| | - Forest W Arnold
- Division of Infectious Diseases, Department of Medicine, University of Louisville, Louisville, KY
| | - Maiying Kong
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, KY
| | - Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, Louisville, KY
| | - Rodrigo Cavallazzi
- Division of Pulmonary, Critical Care Medicine, and Sleep Disorders, Department of Medicine, University of Louisville, Louisville, KY
| | | |
Collapse
|
5
|
Henríquez-Beltrán M, Vaca R, Benítez ID, González J, Santisteve S, Aguilà M, Minguez O, Moncusí-Moix A, Gort-Paniello C, Torres G, Labarca G, Caballero J, Barberà C, Torres A, de Gonzalo-Calvo D, Barbé F, Targa ADS. Sleep and Circadian Health of Critical Survivors: A 12-Month Follow-Up Study. Crit Care Med 2024; 52:1206-1217. [PMID: 38597721 PMCID: PMC11239094 DOI: 10.1097/ccm.0000000000006298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024]
Abstract
OBJECTIVES To investigate the sleep and circadian health of critical survivors 12 months after hospital discharge and to evaluate a possible effect of the severity of the disease within this context. DESIGN Observational, prospective study. SETTING Single-center study. PATIENTS Two hundred sixty patients admitted to the ICU due to severe acute respiratory syndrome coronavirus 2 infection. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS The cohort was composed of 260 patients (69.2% males), with a median (quartile 1-quartile 3) age of 61.5 years (52.0-67.0 yr). The median length of ICU stay was 11.0 days (6.00-21.8 d), where 56.2% of the patients required invasive mechanical ventilation (IMV). The Pittsburgh Sleep Quality Index (PSQI) revealed that 43.1% of the cohort presented poor sleep quality 12 months after hospital discharge. Actigraphy data indicated an influence of the disease severity on the fragmentation of the circadian rest-activity rhythm at the 3- and 6-month follow-ups, which was no longer significant in the long term. Still, the length of the ICU stay and the duration of IMV predicted a higher fragmentation of the rhythm at the 12-month follow-up with effect sizes (95% CI) of 0.248 (0.078-0.418) and 0.182 (0.005-0.359), respectively. Relevant associations between the PSQI and the Hospital Anxiety and Depression Scale (rho = 0.55, anxiety; rho = 0.5, depression) as well as between the fragmentation of the rhythm and the diffusing lung capacity for carbon monoxide (rho = -0.35) were observed at this time point. CONCLUSIONS Our findings reveal a great prevalence of critical survivors presenting poor sleep quality 12 months after hospital discharge. Actigraphy data indicated the persistence of circadian alterations and a possible impact of the disease severity on the fragmentation of the circadian rest-activity rhythm, which was attenuated at the 12-month follow-up. This altogether highlights the relevance of considering the sleep and circadian health of critical survivors in the long term.
Collapse
Affiliation(s)
- Mario Henríquez-Beltrán
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- Núcleo de Investigación en Ciencias de la Salud, Universidad Adventista de Chile, Chillán, Chile
| | - Rafaela Vaca
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- CIBER of Respiratory diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Iván D Benítez
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- CIBER of Respiratory diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Jessica González
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- CIBER of Respiratory diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Sally Santisteve
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
| | - Maria Aguilà
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
| | - Olga Minguez
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- CIBER of Respiratory diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Anna Moncusí-Moix
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- CIBER of Respiratory diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Clara Gort-Paniello
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- CIBER of Respiratory diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Gerard Torres
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- CIBER of Respiratory diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Gonzalo Labarca
- Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepcion, Concepcion, Chile
- Division of Sleep and Circadian Disorders, Brigham and Women's Hospital and Harvard Medical School, Boston, MA
| | - Jesús Caballero
- Intensive Care Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Carme Barberà
- Intensive Care Department, Hospital Universitari Santa Maria, Lleida, Spain
| | - Antoni Torres
- CIBER of Respiratory diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
- Servei de Pneumologia, Hospital Clinic, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
| | - David de Gonzalo-Calvo
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- CIBER of Respiratory diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Ferran Barbé
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- CIBER of Respiratory diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Adriano D S Targa
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), Lleida, Spain
- CIBER of Respiratory diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| |
Collapse
|
6
|
Garg M, Prabhakar N, Devkota S, Dhooria S, Debi U, Dua A, Singh T, Malarakunte M, Bhatia H, Sandhu MS. Chest CT Findings at Six Months Following COVID-19 ARDS - Correlation With the mMRC Dyspnea Scale and Pulmonary Function Tests. Br J Biomed Sci 2024; 81:12871. [PMID: 39055310 PMCID: PMC11269757 DOI: 10.3389/bjbs.2024.12871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 06/12/2024] [Indexed: 07/27/2024]
Abstract
Background: Many survivors of severe COVID-19 pneumonia experience lingering respiratory issues. There is limited research on follow-up chest imaging findings in patients with COVID-19 ARDS, particularly in relation to their mMRC dyspnea scores and pulmonary function tests (PFTs). This study addresses this gap by investigating the clinical characteristics, mMRC dyspnea scores, PFTs, and chest CT findings of COVID-19 ARDS patients at the 6 months post-recovery. By analyzing these variables together, we aim to gain a better understanding of the long-term health consequences of COVID-19 ARDS. Methods: This prospective observational study included 56 subjects with COVID-19 ARDS with dyspnea at the six-month follow-up visits. These patients were evaluated by chest CT, mMRC dyspnea scale, and PFT. The CT severity score was calculated individually for each of the four major imaging findings - ground glass opacities (GGOs), parenchymal/atelectatic bands, reticulations/septal thickening, and consolidation - using a modified CT severity scoring system. Statistics were carried out to find any association between individual CT chest findings and the mMRC dyspnea scale and forced vital capacity (FVC). p values < 0.05 were considered statistically significant. Results: Our study population had a mean age of 55.86 ± 9.60 years, with 44 (78.6%) being men. Grades 1, 2, 3, and 4 on the mMRC dyspnea scale were seen in 57.1%, 30.4%, 10.7%, and 1.8% of patients respectively. Common CT findings observed were GGOs (94.6%), reticulations/septal thickening (96.4%), parenchymal/atelectatic bands (92.8%), and consolidation (14.3%). The mean modified CT severity scores for GGOs, reticulations/septal thickening, parenchymal/atelectatic bands, and consolidation were 10.32 ± 5.51 (range: 0-21), 7.66 ± 4.33 (range: 0-19), 4.77 ± 3.03 (range: 0-14) and 0.29 ± 0.91 (range 0-5) respectively. Reticulations/septal thickening (p = 0.0129) and parenchymal/atelectatic bands (p = 0.0453) were associated with an increased mMRC dyspnea scale. Parenchymal/atelectatic bands were also associated with abnormal FVC (<80%) (p = 0.0233). Conclusion: Six-month follow-up chest CTs of COVID-19 ARDS survivors with persistent respiratory problems showed a statistically significant relationship between increased mMRC dyspnea score and imaging patterns of reticulations/septal thickening and parenchymal/atelectatic bands; while parenchymal/atelectatic bands also showed a statistically significant correlation with reduced FVC.
Collapse
Affiliation(s)
- Mandeep Garg
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Nidhi Prabhakar
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Shritik Devkota
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sahajal Dhooria
- Department of Pulmonary Medicine, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Uma Debi
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ashish Dua
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Tarvinder Singh
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Muniraju Malarakunte
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Harsimran Bhatia
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Manavjit Singh Sandhu
- Department of Radiodiagnosis and Imaging, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
7
|
Peñuelas O, Lomelí M, Del Campo-Albendea L, Toledo SI, Arellano A, Chavarría U, Marín MC, Rosas K, Galván Merlos MA, Mercado R, García-Lerma HR, Monares E, González D, Pérez J, Esteban-Fernández A, Muriel A, Frutos-Vivar F, Esteban A. Frailty in severe COVID-19 survivors after ICU admission. A prospective and multicenter study in Mexico. Med Intensiva 2024; 48:377-385. [PMID: 38582715 DOI: 10.1016/j.medine.2024.03.002] [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: 10/29/2023] [Accepted: 02/19/2024] [Indexed: 04/08/2024]
Abstract
OBJECTIVE To analyze the presence of frailty in survivors of severe COVID-19 admitted in the Intensive Care Unit (ICU) and followed six months after discharge. DESIGN An observational, prospective and multicenter, nation-wide study. SETTING Eight adult ICU across eight academic acute care hospitals in Mexico. PATIENTS All consecutive adult COVID-19 patients admitted in the ICU with acute respiratory failure between March 8, 2020 to February 28, 2021 were included. Frailty was defined according to the FRAIL scale, and was obtained at ICU admission and 6-month after hospital discharge. INTERVENTIONS None. MAIN VARIABLES OF INTEREST The primary endpoint was the frailty status 6-months after discharge. A regression model was used to evaluate the predictors during ICU stay associated with frailty. RESULTS 196 ICU survivors were evaluated for basal frailty at ICU admission and were included in this analysis. After 6-months from discharge, 164 patients were evaluated for frailty: 40 patients (20.4%) were classified as non-frail, 67 patients (34.2%) as pre-frail and 57 patients (29.1%) as frail. After adjustment, the need of invasive mechanical ventilation was the only factor independently associated with frailty at 6 month follow-up (Odds Ratio [OR] 3.70, 95% confidence interval 1.40-9.81, P = .008). CONCLUSIONS Deterioration of frailty was reported frequently among ICU survivors with severe COVID-19 at 6-months. The need of invasive mechanical ventilation in ICU survivors was the only predictor independently associated with frailty.
Collapse
Affiliation(s)
- Oscar Peñuelas
- Servicio de Medicina Intensiva. Hospital Universitario de Getafe, Madrid, Spain. CIBER de Enfermedades Respiratorias, CIBERES, Spain.
| | | | - Laura Del Campo-Albendea
- Unidad de Bioestadística, Hospital Universitario Ramón y Cajal, Madrid, Spain. CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | | | | | | | | | | | | | | | | | | | | | - Juan Pérez
- Hospital H+ Los Cabos, Baja California Sur, México
| | | | - Alfonso Muriel
- Unidad de Bioestadística, Hospital Universitario Ramón y Cajal, Madrid, Spain. CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Fernando Frutos-Vivar
- Servicio de Medicina Intensiva. Hospital Universitario de Getafe, Madrid, Spain. CIBER de Enfermedades Respiratorias, CIBERES, Spain
| | - Andrés Esteban
- Servicio de Medicina Intensiva. Hospital Universitario de Getafe, Madrid, Spain. CIBER de Enfermedades Respiratorias, CIBERES, Spain
| |
Collapse
|
8
|
Kim WY, Jung SY, Kim JY, Chae G, Kim J, Joh JS, Park TY, Baek AR, Jegal Y, Chung CR, Lee J, Cho YJ, Park JH, Hwang JH, Song JW. ECMO is associated with decreased hospital mortality in COVID-19 ARDS. Sci Rep 2024; 14:14835. [PMID: 38937516 PMCID: PMC11211457 DOI: 10.1038/s41598-024-64949-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 06/14/2024] [Indexed: 06/29/2024] Open
Abstract
This study determined whether compared to conventional mechanical ventilation (MV), extracorporeal membrane oxygenation (ECMO) is associated with decreased hospital mortality or fibrotic changes in patients with COVID-19 acute respiratory distress syndrome. A cohort of 72 patients treated with ECMO and 390 with conventional MV were analyzed (February 2020-December 2021). A target trial was emulated comparing the treatment strategies of initiating ECMO vs no ECMO within 7 days of MV in patients with a PaO2/FiO2 < 80 or a PaCO2 ≥ 60 mmHg. A total of 222 patients met the eligibility criteria for the emulated trial, among whom 42 initiated ECMO. ECMO was associated with a lower risk of hospital mortality (hazard ratio [HR], 0.56; 95% confidence interval [CI] 0.36-0.96). The risk was lower in patients who were younger (age < 70 years), had less comorbidities (Charlson comorbidity index < 2), underwent prone positioning before ECMO, and had driving pressures ≥ 15 cmH2O at inclusion. Furthermore, ECMO was associated with a lower risk of fibrotic changes (HR, 0.30; 95% CI 0.11-0.70). However, the finding was limited due to relatively small number of patients and differences in observability between the ECMO and conventional MV groups.
Collapse
Affiliation(s)
- Won-Young Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Sun-Young Jung
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Jeong-Yeon Kim
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Ganghee Chae
- Department of Pulmonary and Critical Care Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Junghyun Kim
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea
| | - Joon-Sung Joh
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, National Medical Center, Seoul, Republic of Korea
| | - Tae Yun Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul Metropolitan Government-Seoul National University Borame Medical Center, Seoul, Republic of Korea
| | - Ae-Rin Baek
- Division of Allergy and Pulmonology, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Yangjin Jegal
- Department of Pulmonary and Critical Care Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Republic of Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jinwoo Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Young-Jae Cho
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Joo Hun Park
- Department of Pulmonary and Critical Care Medicine, Ajou University Hospital, Ajou University School of Medicine, Suwon, Republic of Korea
| | - Jung Hwa Hwang
- Department of Radiology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea
| | - Jin Woo Song
- Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
9
|
Scolari FL, Rover MM, Trott G, da Silva MMD, de Souza D, de Carli Schardosim RF, da Rosa Minho dos Santos R, de Souza Roldão E, Mocellin D, de Souza JMB, Miozzo AP, Rech GS, Itaqui CR, de Mesquita J, Estivalete GPM, Freitas HJM, dos Santos CVP, da Luz LG, Kern M, Marcolino MS, Barreto BB, Schwartzman PR, Antonio ACP, Falavigna M, Robinson CC, Polanczy CA, Rosa RG. Impact on pulmonary, cardiac, and renal function and long-term quality of life after hospitalization for acute respiratory distress syndrome due to COVID-19: Protocol of the Post-COVID Brazil 3 study. CRITICAL CARE SCIENCE 2024; 36:e20240258en. [PMID: 38896723 PMCID: PMC11152444 DOI: 10.62675/2965-2774.20240258-en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 01/15/2024] [Indexed: 06/21/2024]
Abstract
RATIONALE Evidence about long-term sequelae after hospitalization for acute respiratory distress syndrome due to COVID-19 is still scarce. PURPOSE To evaluate changes in pulmonary, cardiac, and renal function and in quality of life after hospitalization for acute respiratory distress syndrome secondary to COVID-19. METHODS This will be a multicenter case-control study of 220 participants. Eligible are patients who are hospitalized for acute respiratory distress syndrome due to COVID-19. In the control group, individuals with no history of hospitalization in the last 12 months or long-term symptoms of COVID-19 will be selected. All individuals will be subjected to pulmonary spirometry with a carbon monoxide diffusion test, chest tomography, cardiac and renal magnetic resonance imaging with gadolinium, ergospirometry, serum and urinary creatinine, total protein, and urinary microalbuminuria, in addition to quality-of-life questionnaires. Patients will be evaluated 12 months after hospital discharge, and controls will be evaluated within 90 days of inclusion in the study. For all the statistical analyses, p < 0.05 is the threshold for significance. RESULTS The primary outcome of the study will be the pulmonary diffusing capacity for carbon monoxide measured after 12 months. The other parameters of pulmonary, cardiac, and renal function and quality of life are secondary outcomes. CONCLUSION This study aims to determine the long-term sequelae of pulmonary, cardiac, and renal function and the quality of life of patients hospitalized for acute respiratory distress syndrome due to COVID-19 in the Brazilian population.
Collapse
Affiliation(s)
- Fernando Luís Scolari
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Marciane Maria Rover
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Geraldine Trott
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Mariana Motta Dias da Silva
- Hospital Moinhos de VentoResearch InstitutePorto AlegreRSBrazilResearch Institute, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Denise de Souza
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | | | - Rosa da Rosa Minho dos Santos
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Emelyn de Souza Roldão
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Duane Mocellin
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | | | - Aline Paula Miozzo
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Gabriela Soares Rech
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Carolina Rothmann Itaqui
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Juliana de Mesquita
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | | | - Hellen Jordan Martins Freitas
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | | | - Lucas Gobetti da Luz
- Hospital Moinhos de VentoDepartment of NephrologyPorto AlegreRSBrazilDepartment of Nephrology, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Marcelo Kern
- Hospital Moinhos de VentoDepartment of Internal MedicinePorto AlegreRSBrazilDepartment of Internal Medicine, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Milena Soriano Marcolino
- Universidade Federal de Minas GeraisFaculdade de MedicinaDepartment of Clinical MedicineBelo HorizonteMGBrazilDepartment of Clinical Medicine, Faculdade de Medicina, Universidade Federal de Minas Gerais - Belo Horizonte (MG), Brazil.
| | - Bruna Brandão Barreto
- Universidade Federal da BahiaFaculdade de Medicina da BahiaDepartment of Internal Medicine and Diagnostic SupportSalvadorBABrazilDepartment of Internal Medicine and Diagnostic Support, Faculdade de Medicina da Bahia, Universidade Federal da Bahia - Salvador (BA), Brazil.
| | - Paulo R. Schwartzman
- Hospital Moinhos de VentoDepartamento de CardiologiaPorto AlegreRSBrazilDepartamento de Cardiologia, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Ana Carolina Peçanha Antonio
- Universidade Federal do Rio Grande do SulHospital de Clínicas de Porto AlegreIntensive Care UnitPorto AlegreRSBrazilIntensive Care Unit, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul - Porto Alegre (RS), Brazil.
| | - Maicon Falavigna
- Research Unit, Inova MedicalPorto AlegreRSBrasilResearch Unit, Inova Medical - Porto Alegre (RS), Brasil
| | - Caroline Cabral Robinson
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Carisi Anne Polanczy
- Hospital Moinhos de VentoDepartamento de CardiologiaPorto AlegreRSBrazilDepartamento de Cardiologia, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| | - Regis Goulart Rosa
- Hospital Moinhos de VentoPorto AlegreRSBrazilProject Offices, Hospital Moinhos de Vento - Porto Alegre (RS), Brazil.
| |
Collapse
|
10
|
Yang C, Tan Y, Li Z, Hu L, Chen Y, Zhu S, Hu J, Huai T, Li M, Zhang G, Rao D, Fei G, Shao M, Ding Z. Pulmonary redox imbalance drives early fibroproliferative response in moderate/severe coronavirus disease-19 acute respiratory distress syndrome and impacts long-term lung abnormalities. Ann Intensive Care 2024; 14:72. [PMID: 38735020 PMCID: PMC11089033 DOI: 10.1186/s13613-024-01293-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 04/10/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND COVID-19-associated pulmonary fibrosis remains frequent. This study aimed to investigate pulmonary redox balance in COVID-19 ARDS patients and possible relationship with pulmonary fibrosis and long-term lung abnormalities. METHODS Baseline data, chest CT fibrosis scores, N-terminal peptide of alveolar collagen III (NT-PCP-III), transforming growth factor (TGF)-β1, superoxide dismutase (SOD), reduced glutathione (GSH), oxidized glutathione (GSSG) and malondialdehyde (MDA) in bronchoalveolar lavage fluid (BALF) were first collected and compared between SARS-CoV-2 RNA positive patients with moderate to severe ARDS (n = 65, COVID-19 ARDS) and SARS-CoV-2 RNA negative non-ARDS patients requiring mechanical ventilation (n = 63, non-ARDS). Then, correlations between fibroproliferative (NT-PCP-III and TGF-β1) and redox markers were analyzed within COVID-19 ARDS group, and comparisons between survivor and non-survivor subgroups were performed. Finally, follow-up of COVID-19 ARDS survivors was performed to analyze the relationship between pulmonary abnormalities, fibroproliferative and redox markers 3 months after discharge. RESULTS Compared with non-ARDS group, COVID-19 ARDS group had significantly elevated chest CT fibrosis scores (p < 0.001) and NT-PCP-III (p < 0.001), TGF-β1 (p < 0.001), GSSG (p < 0.001), and MDA (p < 0.001) concentrations on admission, while decreased SOD (p < 0.001) and GSH (p < 0.001) levels were observed in BALF. Both NT-PCP-III and TGF-β1 in BALF from COVID-19 ARDS group were directly correlated with GSSG (p < 0.001) and MDA (p < 0.001) and were inversely correlated with SOD (p < 0.001) and GSH (p < 0.001). Within COVID-19 ARDS group, non-survivors (n = 28) showed significant pulmonary fibroproliferation (p < 0.001) with more severe redox imbalance (p < 0.001) than survivors (n = 37). Furthermore, according to data from COVID-19 ARDS survivor follow-up (n = 37), radiographic residual pulmonary fibrosis and lung function impairment improved 3 months after discharge compared with discharge (p < 0.001) and were associated with early pulmonary fibroproliferation and redox imbalance (p < 0.01). CONCLUSIONS Pulmonary redox imbalance occurring early in COVID-19 ARDS patients drives fibroproliferative response and increases the risk of death. Long-term lung abnormalities post-COVID-19 are associated with early pulmonary fibroproliferation and redox imbalance.
Collapse
Affiliation(s)
- Chun Yang
- The First Affiliated Hospital of Anhui Medical University, #218 Jixi Road, Hefei, 230022, Anhui, China
| | - Yuanyuan Tan
- The First Affiliated Hospital of Anhui Medical University, #218 Jixi Road, Hefei, 230022, Anhui, China
| | - Zihao Li
- The First Affiliated Hospital of Anhui Medical University, #218 Jixi Road, Hefei, 230022, Anhui, China
| | - Lei Hu
- The First Affiliated Hospital of Anhui Medical University, #218 Jixi Road, Hefei, 230022, Anhui, China
| | - Yuanyuan Chen
- The First Affiliated Hospital of Anhui Medical University, #218 Jixi Road, Hefei, 230022, Anhui, China
| | - Shouliang Zhu
- The First Affiliated Hospital of Anhui Medical University, #218 Jixi Road, Hefei, 230022, Anhui, China
| | - Jiawei Hu
- The First Affiliated Hospital of Anhui Medical University, #218 Jixi Road, Hefei, 230022, Anhui, China
| | - Tingting Huai
- The First Affiliated Hospital of Anhui Medical University, #218 Jixi Road, Hefei, 230022, Anhui, China
| | - Mingqing Li
- The First Affiliated Hospital of Anhui Medical University, #218 Jixi Road, Hefei, 230022, Anhui, China
| | - Guobin Zhang
- The First Affiliated Hospital of Anhui Medical University, #218 Jixi Road, Hefei, 230022, Anhui, China
| | - Dewang Rao
- Anhui Medical University, #81 Meishan Road, Hefei, 230032, Anhui, China
| | - Guanghe Fei
- The First Affiliated Hospital of Anhui Medical University, #218 Jixi Road, Hefei, 230022, Anhui, China.
| | - Min Shao
- The First Affiliated Hospital of Anhui Medical University, #218 Jixi Road, Hefei, 230022, Anhui, China.
| | - Zhenxing Ding
- The First Affiliated Hospital of Anhui Medical University, #218 Jixi Road, Hefei, 230022, Anhui, China.
| |
Collapse
|
11
|
Kłos K, Jaskóła-Polkowska D, Plewka-Barcik K, Rożyńska R, Pietruszka-Wałęka E, Żabicka M, Kania-Pudło M, Maliborski A, Plicht K, Angielski G, Wojtyszek A, Jahnz-Różyk K, Chciałowski A. Pulmonary Function, Computed Tomography Lung Abnormalities, and Small Airway Disease after COVID-19: 3-, 6-, and 9-Month Follow-Up. J Clin Med 2024; 13:2733. [PMID: 38792275 PMCID: PMC11122501 DOI: 10.3390/jcm13102733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/15/2024] [Accepted: 04/30/2024] [Indexed: 05/26/2024] Open
Abstract
Background/Objectives: Coronavirus disease 2019 (COVID-19) course may differ among individuals-in particular, those with comorbidities may have severe pneumonia, requiring oxygen supplementation or mechanical ventilation. Post-COVID-19 long-term structural changes in imaging studies can contribute to persistent respiratory disturbance. This study aimed to investigate COVID-19 sequels affecting the possibility of persistent structural lung tissue abnormalities and their influence on the respiratory function of peripheral airways and gas transfer. Methods: Patients were divided into two groups according to severity grades described by the World Health Organization. Among the 176 hospitalized patients were 154 patients with mask oxygen supplementation and 22 patients with high-flow nasal cannula (HFNC) or mechanical ventilation. All tests were performed at 3, 6, and 9 months post-hospitalization. Results: Patients in the severe/critical group had lower lung volumes in FVC, FVC%, FEV1, FEV1%, LC, TLC%, and DLCO% at three months post-hospitalization. At 6 and 9 months, neither group had significant FVC and FEV1 value improvements. The MEF 25-75 values were not significantly higher in the mild/moderate group than in the severe/critical group at three months. There were weak significant correlations between FVC and FEV1, MEF50, MEF 75, plethysmography TLC, disturbances in DLCO, and total CT abnormalities in the severe/critical group at three months. In a mild/moderate group, there was a significant negative correlation between the spirometry, plethysmography parameters, and CT lesions in all periods. Conclusions: Persistent respiratory symptoms post-COVID-19 can result from fibrotic lung parenchyma and post-infectious stenotic small airway changes not visible in CT, probably due to persistent inflammation.
Collapse
Affiliation(s)
- Krzysztof Kłos
- Department of Internal Medicine, Infectious Diseases and Allergology, Military Institute of Medicine—National Research Institute, Szaserow Str. 128, 04-141 Warsaw, Poland; (K.K.); (K.P.-B.); (A.C.)
| | - Dominika Jaskóła-Polkowska
- Department of Internal Medicine, Infectious Diseases and Allergology, Military Institute of Medicine—National Research Institute, Szaserow Str. 128, 04-141 Warsaw, Poland; (K.K.); (K.P.-B.); (A.C.)
| | - Katarzyna Plewka-Barcik
- Department of Internal Medicine, Infectious Diseases and Allergology, Military Institute of Medicine—National Research Institute, Szaserow Str. 128, 04-141 Warsaw, Poland; (K.K.); (K.P.-B.); (A.C.)
| | - Renata Rożyńska
- Department of Internal Medicine, Allergology, Pneumonology and Clinical Immunology, Military Institute of Medicine—National Research Institute, Szaserow Str. 128, 04-141 Warsaw, Poland; (R.R.); (K.J.-R.)
| | - Ewa Pietruszka-Wałęka
- Department of Internal Medicine, Allergology, Pneumonology and Clinical Immunology, Military Institute of Medicine—National Research Institute, Szaserow Str. 128, 04-141 Warsaw, Poland; (R.R.); (K.J.-R.)
| | - Magdalena Żabicka
- Department of Radiology, Military Institute of Medicine—National Research Institute, Szaserow Str. 128, 04-141 Warsaw, Poland; (M.Ż.); (M.K.-P.); (A.M.)
| | - Marta Kania-Pudło
- Department of Radiology, Military Institute of Medicine—National Research Institute, Szaserow Str. 128, 04-141 Warsaw, Poland; (M.Ż.); (M.K.-P.); (A.M.)
| | - Artur Maliborski
- Department of Radiology, Military Institute of Medicine—National Research Institute, Szaserow Str. 128, 04-141 Warsaw, Poland; (M.Ż.); (M.K.-P.); (A.M.)
| | - Katarzyna Plicht
- 7th Polish Navy Hospital, Polanki Str. 117, 80-305 Gdansk, Poland; (K.P.); (G.A.); (A.W.)
| | - Grzegorz Angielski
- 7th Polish Navy Hospital, Polanki Str. 117, 80-305 Gdansk, Poland; (K.P.); (G.A.); (A.W.)
| | - Andrzej Wojtyszek
- 7th Polish Navy Hospital, Polanki Str. 117, 80-305 Gdansk, Poland; (K.P.); (G.A.); (A.W.)
| | - Karina Jahnz-Różyk
- Department of Internal Medicine, Allergology, Pneumonology and Clinical Immunology, Military Institute of Medicine—National Research Institute, Szaserow Str. 128, 04-141 Warsaw, Poland; (R.R.); (K.J.-R.)
| | - Andrzej Chciałowski
- Department of Internal Medicine, Infectious Diseases and Allergology, Military Institute of Medicine—National Research Institute, Szaserow Str. 128, 04-141 Warsaw, Poland; (K.K.); (K.P.-B.); (A.C.)
| |
Collapse
|
12
|
Cagino L, Seagly K, Noyes E, Prescott H, Valley T, Eaton T, McSparron JI. Outcomes and Management After COVID-19 Critical Illness. Chest 2024; 165:1149-1162. [PMID: 38104961 PMCID: PMC11214908 DOI: 10.1016/j.chest.2023.11.044] [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: 10/06/2023] [Accepted: 11/01/2023] [Indexed: 12/19/2023] Open
Abstract
TOPIC IMPORTANCE COVID-19 has caused > 7 million deaths worldwide since its onset in 2019. Although the severity of illness has varied throughout the pandemic, critical illness related to COVID-19 persists. Survivors of COVID-19 critical illness can be left with sequelae of both the SARS-CoV-2 virus and long-term effects of critical illness included within post-intensive care syndrome. Given the complexity and heterogeneity of COVID-19 critical illness, the biopsychosocial-ecological model can aid in evaluation and treatment of survivors, integrating interactions among physical, cognitive, and psychological domains, as well as social systems and environments. REVIEW FINDINGS Prolonged illness after COVID-19 critical illness generally can be classified into effects on physical, cognitive, and psychosocial function, with much interaction among the various effects, and includes a wide range of symptoms such as ICU-acquired weakness, prolonged respiratory symptoms, cognitive changes, post-traumatic stress disorder post-traumatic stress disorder, anxiety, and depression. Risk factors for COVID-19 critical illness developing are complex and include preexisting factors, disease course, and specifics of hospitalization in addition to psychological comorbidities and socioenvironmental factors. Recovery trajectories are not well defined, and management requires a comprehensive, interdisciplinary, and individualized approach to care. SUMMARY The onset of vaccinations, new therapeutics, and new strains of SARS-CoV-2 virus have decreased COVID-19 mortality; however, the number of survivors of COVID-19 critical illness remains high. A biopsychosocial-ecological approach is recommended to guide care of COVID-19 critical illness survivors.
Collapse
Affiliation(s)
- Leigh Cagino
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
| | - Katharine Seagly
- Division of Rehabilitation Psychology and Neuropsychology, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Emily Noyes
- Division of Rehabilitation Psychology and Neuropsychology, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Hallie Prescott
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; VA Center for Clinical Management Research, Ann Arbor, MI
| | - Thomas Valley
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, MI; VA Center for Clinical Management Research, Ann Arbor, MI
| | - Tammy Eaton
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI; VA HSR&D Center for the Study of Healthcare Innovation, Implementation, & Policy, Ann Arbor, MI
| | - Jakob I McSparron
- Division of Pulmonary and Critical Care, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
| |
Collapse
|
13
|
Otake S, Shiraishi Y, Chubachi S, Tanabe N, Maetani T, Asakura T, Namkoong H, Shimada T, Azekawa S, Nakagawara K, Tanaka H, Fukushima T, Watase M, Terai H, Sasaki M, Ueda S, Kato Y, Harada N, Suzuki S, Yoshida S, Tateno H, Yamada Y, Jinzaki M, Hirai T, Okada Y, Koike R, Ishii M, Hasegawa N, Kimura A, Imoto S, Miyano S, Ogawa S, Kanai T, Fukunaga K. Lung volume measurement using chest CT in COVID-19 patients: a cohort study in Japan. BMJ Open Respir Res 2024; 11:e002234. [PMID: 38663888 PMCID: PMC11043761 DOI: 10.1136/bmjresp-2023-002234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/09/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVE This study aimed to investigate the utility of CT quantification of lung volume for predicting critical outcomes in COVID-19 patients. METHODS This retrospective cohort study included 1200 hospitalised patients with COVID-19 from 4 hospitals. Lung fields were extracted using artificial intelligence-based segmentation, and the percentage of the predicted (%pred) total lung volume (TLC (%pred)) was calculated. The incidence of critical outcomes and posthospitalisation complications was compared between patients with low and high CT lung volumes classified based on the median percentage of predicted TLCct (n=600 for each). Prognostic factors for residual lung volume loss were investigated in 208 patients with COVID-19 via a follow-up CT after 3 months. RESULTS The incidence of critical outcomes was higher in the low TLCct (%pred) group than in the high TLCct (%pred) group (14.2% vs 3.3%, p<0.0001). Multivariable analysis of previously reported factors (age, sex, body mass index and comorbidities) demonstrated that CT-derived lung volume was significantly associated with critical outcomes. The low TLCct (%pred) group exhibited a higher incidence of bacterial infection, heart failure, thromboembolism, liver dysfunction and renal dysfunction than the high TLCct (%pred) group. TLCct (%pred) at 3 months was similarly divided into two groups at the median (71.8%). Among patients with follow-up CT scans, lung volumes showed a recovery trend from the time of admission to 3 months but remained lower in critical cases at 3 months. CONCLUSION Lower CT lung volume was associated with critical outcomes, posthospitalisation complications and slower improvement of clinical conditions in COVID-19 patients.
Collapse
Affiliation(s)
- Shiro Otake
- ivision of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yusuke Shiraishi
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shotaro Chubachi
- ivision of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Naoya Tanabe
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomoki Maetani
- Department of Respiratory Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takanori Asakura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ho Namkoong
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Shimada
- ivision of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shuhei Azekawa
- ivision of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Kensuke Nakagawara
- ivision of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Hiromu Tanaka
- ivision of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Takahiro Fukushima
- ivision of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Mayuko Watase
- Department of Respiratory Medicine, National Hospital Organization Tokyo Medical Centre, Tokyo, Japan
| | - Hideki Terai
- ivision of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Mamoru Sasaki
- Department of Internal Medicine, Saitama Medical Center, Tokyo, Japan
| | - Soichiro Ueda
- Department of Internal Medicine, Saitama Medical Center, Tokyo, Japan
| | - Yukari Kato
- Division of Respiratory Medicine, Juntendo University School of Medicine Graduate School of Medicine, Bunkyo-ku, Japan
| | - Norihiro Harada
- Division of Respiratory Medicine, Juntendo University School of Medicine Graduate School of Medicine, Bunkyo-ku, Japan
| | - Shoji Suzuki
- Department of Pulmonary Medicine, Saitama City Hospital, Saitama, Japan
| | - Shuichi Yoshida
- Department of Pulmonary Medicine, Saitama City Hospital, Saitama, Japan
| | - Hiroki Tateno
- Department of Pulmonary Medicine, Saitama City Hospital, Saitama, Japan
| | - Yoshitake Yamada
- Keio University Department of Radiology, Shinjuku-ku, Tokyo, Japan
| | - Masahiro Jinzaki
- Keio University Department of Radiology, Shinjuku-ku, Tokyo, Japan
| | - Toyohiro Hirai
- Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yukinori Okada
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Genome Informatics, The University of Tokyo Graduate School of Medicine Faculty of Medicine, Bunkyo-ku, Japan
| | - Ryuji Koike
- Department of Pharmacovigilance, Tokyo Medical and Dental University, Tokyo, Japan
| | - Makoto Ishii
- Faculty of Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Hasegawa
- Center for Infectious Diseases and Infection Control, Keio University, School of Medicine, Tokyo, Japan
| | - Akinori Kimura
- Medical Research Institute, Tokyo Medical and Dental University, Tokyo, Japan
| | | | - Satoru Miyano
- Tokyo Medical and Dental University, Bunkyo-ku, Japan
| | - Seishi Ogawa
- Department of Pathology and Tumor Biology, Kyoto University Graduate School of Medicine Faculty of Medicine, Kyoto, Japan
- Department of Medicine, Regenerative Medicine Karolinska Institute, Stockholm, Sweden
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology Department of Internal Medicine, Keio University School of Medicine, Shinjuku-ku, Japan
| | - Koichi Fukunaga
- ivision of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
| |
Collapse
|
14
|
Patton MJ, Benson D, Robison SW, Raval D, Locy ML, Patel K, Grumley S, Levitan EB, Morris P, Might M, Gaggar A, Erdmann N. Characteristics and determinants of pulmonary long COVID. JCI Insight 2024; 9:e177518. [PMID: 38652535 PMCID: PMC11141907 DOI: 10.1172/jci.insight.177518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/12/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUNDPersistent cough and dyspnea are prominent features of postacute sequelae of SARS-CoV-2 (also termed "long COVID"); however, physiologic measures and clinical features associated with these pulmonary symptoms remain poorly defined. Using longitudinal pulmonary function testing (PFT) and CT imaging, this study aimed to identify the characteristics and determinants of pulmonary long COVID.METHODSThis single-center retrospective study included 1,097 patients with clinically defined long COVID characterized by persistent pulmonary symptoms (dyspnea, cough, and chest discomfort) lasting for 1 or more months after resolution of primary COVID infection.RESULTSAfter exclusion, a total of 929 patients with post-COVID pulmonary symptoms and PFTs were stratified as diffusion impairment and pulmonary restriction, as measured by percentage predicted diffusion capacity for carbon monoxide (DLCO) and total lung capacity (TLC). Longitudinal evaluation revealed diffusion impairment (DLCO ≤ 80%) and pulmonary restriction (TLC ≤ 80%) in 51% of the cohort overall (n = 479). In multivariable modeling regression analysis, invasive mechanical ventilation during primary infection conferred the greatest increased odds of developing pulmonary long COVID with diffusion impairment and restriction (adjusted odds ratio [aOR] = 9.89, 95% CI 3.62-26.9]). Finally, a subanalysis of CT imaging identified radiographic evidence of fibrosis in this patient population.CONCLUSIONLongitudinal PFTs revealed persistent diffusion-impaired restriction as a key feature of pulmonary long COVID. These results emphasize the importance of incorporating PFTs into routine clinical practice for evaluation of long COVID patients with prolonged pulmonary symptoms. Subsequent clinical trials should leverage combined symptomatic and quantitative PFT measurements for more targeted enrollment of pulmonary long COVID patients.FUNDINGNational Institute of Allergy and Infectious Diseases (AI156898, K08AI129705), National Heart, Lung, and Blood Institute (HL153113, OTA21-015E, HL149944), and the COVID-19 Urgent Research Response Fund at the University of Alabama at Birmingham.
Collapse
Affiliation(s)
- Michael John Patton
- Medical Scientist Training Program, Heersink School of Medicine
- Hugh Kaul Precision Medicine Institute
| | | | - Sarah W. Robison
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
| | - Dhaval Raval
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
| | - Morgan L. Locy
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
| | - Kinner Patel
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
| | | | - Emily B. Levitan
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Peter Morris
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
| | | | - Amit Gaggar
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, and
- Birmingham VA Medical Center, Pulmonary Section, Birmingham, Alabama, USA
| | - Nathaniel Erdmann
- Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
| |
Collapse
|
15
|
Liao Y, Zhang Y, Li H, Hu H, Li M, Liao C. ACE2: the node connecting the lung cancer and COVID-19. Am J Cancer Res 2024; 14:1466-1481. [PMID: 38726281 PMCID: PMC11076241 DOI: 10.62347/xjve4569] [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: 10/15/2023] [Accepted: 01/04/2024] [Indexed: 05/12/2024] Open
Abstract
Angiotensin-converting Enzyme 2 (ACE2) collaborates with Angiotensin (Ang) 1-7 and Mas receptors to establish the ACE2-Ang (1-7)-Mas receptor axis. ACE2 impacts lung function and can cause lung injury due to its inflammatory effects. Additionally, ACE2 contributes to pulmonary vasculature dysfunction, resulting in pulmonary hypertension. In addition, ACE2 is a receptor for coronavirus entry into host cells, leading to coronavirus infection. Lung cancer, one of the most common respiratory diseases worldwide, has a high rate of infection. Elevated levels of ACE2 in lung cancer patients, which increase the risk of SARS-CoV-2 infection and severe disease, have been demonstrated in clinical studies and by molecular mechanisms. The association between lung cancer and SARS-CoV-2 is closely linked to ACE2. This review examines the basic pathophysiological role of ACE2 in the lung, the long-term effects of SARS-CoV-2 infection on lung function, the development of pulmonary fibrosis, chronic inflammation in long-term COVID patients, and the clinical research and mechanisms underlying the increased susceptibility of lung cancer patients to the virus. Possible mechanisms of lung cancer in SARS-CoV-2-infected individuals and the potential role of ACE2 in this process are also explored in this review. The role of ACE2 as a therapeutic target in the novel coronavirus infection process is also summarized. This will help to inform prevention and treatment of long-term pulmonary complications in patients.
Collapse
Affiliation(s)
- Yan Liao
- School of Anesthesiology, Naval Medical UniversityShanghai 200433, China
| | - Ying Zhang
- Graduate School, Hebei North UniversityZhangjiakou 075000, Hebei, China
| | - Houfeng Li
- Graduate School, Hebei North UniversityZhangjiakou 075000, Hebei, China
| | - Huixiu Hu
- Graduate School, Hebei North UniversityZhangjiakou 075000, Hebei, China
| | - Mi Li
- School of Anesthesiology, Naval Medical UniversityShanghai 200433, China
| | - Chunhua Liao
- School of Anesthesiology, Naval Medical UniversityShanghai 200433, China
| |
Collapse
|
16
|
Björnson M, Svensson AM, He C, Sköld M, Nyrén S, Nygren-Bonnier M, Bruchfeld J, Runold M, Jalde FC, Kistner A. Residual radiological opacities correlate with disease outcomes in ICU-treated COVID-19. Front Med (Lausanne) 2024; 11:1263511. [PMID: 38633311 PMCID: PMC11021575 DOI: 10.3389/fmed.2024.1263511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 03/07/2024] [Indexed: 04/19/2024] Open
Abstract
Background Few studies consider both radiological and functional outcomes in COVID-19 survivors treated in the intensive care unit (ICU). We investigated clinical findings and pulmonary abnormalities on chest computed tomography (CT) and compared outcomes of severe versus mild-moderate acute respiratory distress syndrome (ARDS) on long-term follow-up. Methods This longitudinal cohort study included 118 COVID-19 patients (median age, 58 years; 79% men). Thoracic CT scans were performed 4, 10, and 22 months after hospital discharge. Two independent blinded radiologists analyzed the 10 months scans and scored the radiology findings semi-quantitatively, as no/minor versus widespread opacities [low-radiology opacity grade (ROG) versus high-ROG]. ARDS severity was based on the PaO2/FiO2 ratio. The 6 min walk test (6MWT) was performed after 3 and 9 months, and lung diffusion capacity for carbon monoxide (DLCO) and lung volume measurement after 9 and 15 months. Dynamic spirometry was done at all time points. Residual symptoms and health-related quality-of-life (HRQL) were evaluated using validated questionnaires. Results At 10 months, most patients (81/118; 69%) were classified as high-ROG, of which 70% had severe ARDS during hospitalisation; 69% of those with mild-moderate ARDS also had high-ROG. Patients with high-ROG had longer ICU stay and lower PaO2/FiO2 during hospitalisation (p < 0.01). At 9 months follow-up, patients with high-ROG had smaller lung volumes as % of predicted values [mean (±CI): 80 (77-84) vs. 93 (88-98) (p < 0.001)], lower DLCO as % of predicted values [74 (70-78) vs. 87 (82-92) (p < 0.001)], lower oxygen saturation during 6MWT (p = 0.02), and a tendency to more severe dyspnoea (p = 0.07), but no difference was found in HRQL compared with no/minor ROG (p = 0.92). A higher opacity score was related to lower DLCO at follow-up (r = -0.48, p < 0.001, Spearman rank test). Severe ARDS patients had slightly more severe fatigue at 9 months compared to mild-moderate, but no differences in dyspnoea or lung function at follow-up. Fibrotic-like changes were found in 93% of patients examined with CT scans at 2 years (55/118; 47%). Severe ARDS could predict widespread opacities (ROG > 25%) in most patients at follow-up at 10 months (AUC 0.74). Conclusion Residual radiological abnormalities in ICU-treated COVID-19 patients, evaluated for up to 2 years, relate to persisting symptoms and impaired lung function, demanding careful follow-up regardless of ARDS severity at hospitalisation.
Collapse
Affiliation(s)
- Mikael Björnson
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Solna, Division of Infection Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Ann Mari Svensson
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Cecilia He
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Sköld
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
- Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Sven Nyrén
- Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Malin Nygren-Bonnier
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Huddinge, Sweden
- Women’s Health and Allied Health Professionals Theme, Medical Unit Allied Health Professionals, Karolinska University Hospital, Stockholm, Sweden
| | - Judith Bruchfeld
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
- Department of Medicine Solna, Division of Infection Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Michael Runold
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Stockholm, Sweden
- Respiratory Medicine Unit, Department of Medicine Solna and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Francesca Campoccia Jalde
- Department of Cardiothoracic Surgery and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Kistner
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
17
|
Barilaite E, Watson H, Hocaoglu MB. Understanding Patient-Reported Outcome Measures Used in Adult Survivors Experiencing Long-Term Effects After COVID-19 Infection: A Rapid Review. J Patient Cent Res Rev 2024; 11:36-50. [PMID: 38596351 PMCID: PMC11000699 DOI: 10.17294/2330-0698.2041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2024] Open
Abstract
Purpose Patient-reported outcome measures (PROMs) are used in individuals experiencing long-term effects from COVID-19 infection, or Long COVID, to evaluate the quality of life and functional status of these individuals. However, little is known about which PROMs are being utilised and the psychometric properties of these PROMs. Our purpose was thus to explore which PROMs are used in Long COVID patients and to discuss the psychometric properties of the PROMs. Methods For this rapid review, a systematic literature search was performed in the PubMed, Embase, and CINAHL databases. The found studies were screened using the PRISMA flowchart. We then performed study quality appraisal and assessed the psychometric properties of the found PROMs. Results Per the systematic literature search and after removal of duplicates, 157 publications were identified for individual screening. After screening and eligibility assessment, 74 articles were selected for our review. In total, 74 PROMs were used and primarily comprised quality of life, fatigue, breathlessness, mental health, and smell/taste issues in COVID "long haulers." Five studies used newly developed, COVID-19-specific PROMs. We assessed the psychometric properties of the 10 most-used PROMs. The majority were found to be reliable and valid instruments. EQ-5D-5L was the most popular and highly rated PROM. Conclusions We assessed PROMs used in Long COVID patients and evaluated their psychometric properties. EQ-5D-5L was the most favourably rated PROM. PROMs addressing mental health issues are crucial in managing anxiety and depression in Long COVID patients. New COVID-specific PROMs assess functional status and smell/taste perception and show great utilisation potential in olfactory training at COVID smell clinics. However, many reviewed PROMs currently lack sufficient analysis of their psychometric properties. Therefore, future research needs to examine these measures.
Collapse
Affiliation(s)
- Egle Barilaite
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, United Kingdom
| | - Harry Watson
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, United Kingdom
| | - Mevhibe B Hocaoglu
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, United Kingdom
| |
Collapse
|
18
|
Juvvadi KR, Parida B, Mohapatra SSG, Behera P. High-resolution Computed Tomography Thorax Volumetric Assessment in Coronavirus Disease 2019 Patients and Correlation with Pulmonary Function Tests. Ann Afr Med 2024; 23:194-201. [PMID: 39028169 PMCID: PMC11210729 DOI: 10.4103/aam.aam_52_23] [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: 04/14/2023] [Revised: 06/11/2023] [Accepted: 06/13/2023] [Indexed: 07/20/2024] Open
Abstract
INTRODUCTION Years after SARS coronavirus disease 2019 (COVID-19) recovery, residual pulmonary abnormalities may still exist. This brings on the question of whether or not COVID-19 could have comparable late consequences. Structural changes in the lungs after recovery can be better visualized using computed tomography (CT) thorax. Computed Tomography Lung Parenchymal changes during hospitalization by COVID-19 and after 4 months of follow-up to correlate with the volumetric high-resolution computed tomography thorax indices, Pulmonary function tests (PFTs) indices, SpO2, and 6 min Walking Test (6MWT). MATERIALS AND METHODS This is a Hospital based cross-sectional study, with a follow-up among 100 Patients from 2020 to 2022. Each patient's different CT parameters and HRCT volumetric indices Normal Lung (NL), Normal Lung Percentage (NL%), Whole Lung (WL) were correlated with the PFT indices (Forced expiratory volume in 1s [FEV1], forced vital capacity [FVC], FEV1/FVC), Oxygen Saturation (SpO2) and 6-Minute Walking Test (6MWT). RESULTS The mean NL (L) and NL% during COVID were significantly lower than the mean values 4 months post-COVID. Architectural distortion, bronchiolar dilatation, interstitial thickening, and parenchymal bands were reduced considerably after 4 months post-COVID, compared to during COVID. PFTs results, such as PFT indices, were not significantly different after 4 months post-COVID, compared to during COVID. SpO2 (%) and 6 MWT (m) were significantly increased. During COVID and post-COVID, the values of NL (L) and NL (%) had a significant positive correlation with PFT indices, SpO2, and 6MWT (m). CONCLUSION Hence, the different CT indices (NL and NL%) can be used as a surrogate for functional recovery of COVID patients since it correlates with the PFT indices (FEV1 and FEV1/FVC), SpO2, and 6MWT post-COVID.
Collapse
Affiliation(s)
- Kaushik Rao Juvvadi
- Department of Radiology, Institute of Medical Sciences and Sum Hospital, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| | - Bikash Parida
- Department of Radiology, Institute of Medical Sciences and Sum Hospital, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| | - Satya Sundar Gajendra Mohapatra
- Department of Radiology, Institute of Medical Sciences and Sum Hospital, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| | - Priyadarshini Behera
- Department of Pulmonary Medicine, Institute of Medical Sciences and Sum Hospital, Siksha ‘O’ Anusandhan Deemed to be University, Bhubaneswar, Odisha, India
| |
Collapse
|
19
|
Tang X, Xu XL, Wan N, Zhao Y, Wang R, Li XY, Li Y, Wang L, Li HC, Gu Y, Zhang CY, Yang Q, Tong ZH, Sun B. Long-term outcomes of survivors with influenza A H1N1 virus-induced severe pneumonia and ARDS: a single-center prospective cohort study. Front Cell Infect Microbiol 2024; 14:1378379. [PMID: 38606295 PMCID: PMC11007161 DOI: 10.3389/fcimb.2024.1378379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 03/21/2024] [Indexed: 04/13/2024] Open
Abstract
Introduction Systematic evaluation of long-term outcomes in survivors of H1N1 is still lacking. This study aimed to characterize long-term outcomes of severe H1N1-induced pneumonia and acute respiratory distress syndrome (ARDS). Method This was a single-center, prospective, cohort study. Survivors were followed up for four times after discharge from intensive care unit (ICU) by lung high-resolution computed tomography (HRCT), pulmonary function assessment, 6-minute walk test (6MWT), and SF-36 instrument. Result A total of 60 survivors of H1N1-induced pneumonia and ARDS were followed up for four times. The carbon monoxide at single breath (DLCO) of predicted values and the 6MWT results didn't continue improving after 3 months. Health-related quality of life didn't change during the 12 months after ICU discharge. Reticulation or interlobular septal thickening on HRCT did not begin to improve significantly until the 12-month follow-up. The DLCO of predicted values showed negative correlation with the severity degree of primary disease and reticulation or interlobular septal thickening, and a positive correlation with physical functioning. The DLCO of predicted values and reticulation or interlobular septal thickening both correlated with the highest tidal volume during mechanical ventilation. Levels of fibrogenic cytokines had a positive correlation with reticulation or interlobular septal thickening. Conclusion The improvements in pulmonary function and exercise capacity, imaging, and health-related quality of life had different time phase and impact on each other during 12 months of follow-up. Long-term outcomes of pulmonary fibrosis might be related to the lung injury and excessive lung fibroproliferation at the early stage during ICU admission.
Collapse
Affiliation(s)
- Xiao Tang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xiao-Li Xu
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Na Wan
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yu Zhao
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Rui Wang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xu-Yan Li
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ying Li
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Li Wang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hai-Chao Li
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yue Gu
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Chun-Yan Zhang
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Qi Yang
- Department of Radiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhao-Hui Tong
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Bing Sun
- Department of Respiratory and Critical Care Medicine, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
20
|
Kavalcı Kol B, Boşnak Güçlü M, Baytok E, Yılmaz Demirci N. Comparison of the muscle oxygenation during submaximal and maximal exercise tests in patients post-coronavirus disease 2019 syndrome with pulmonary involvement. Physiother Theory Pract 2024:1-14. [PMID: 38469863 DOI: 10.1080/09593985.2024.2327534] [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: 09/22/2023] [Accepted: 03/03/2024] [Indexed: 03/13/2024]
Abstract
INTRODUCTION Pulmonary involvement is prevalent in patients with coronavirus disease 2019 (COVID-19). Arterial hypoxemia may reduce oxygen transferred to the skeletal muscles, possibly leading to impaired exercise capacity. Oxygen uptake may vary depending on the increased oxygen demand of the muscles during submaximal and maximal exercise. OBJECTIVE This study aimed to compare muscle oxygenation during submaximal and maximal exercise tests in patients with post-COVID-19 syndrome with pulmonary involvement. METHODS Thirty-nine patients were included. Pulmonary function (spirometry), peripheral muscle strength (dynamometer), quadriceps femoris (QF) muscle oxygenation (Moxy® device), and submaximal exercise capacity (six-minute walk test (6-MWT)) were tested on the first day, maximal exercise capacity (cardiopulmonary exercise test (CPET)) was tested on the second day. Physical activity level was evaluated using an activity monitor worn for five consecutive days. Cardiopulmonary responses and muscle oxygenation were compared during 6-MWT and CPET. RESULTS Patients' minimum and recovery muscle oxygen saturation were significantly decreased; maximum total hemoglobin increased, heart rate, blood pressure, breathing frequency, dyspnea, fatigue, and leg fatigue at the end-of-test and recovery increased in CPET compared to 6-MWT (p < .050). Peak oxygen consumption (VO2peak) was 18.15 ± 4.75 ml/min/kg, VO2peak; percent predicted < 80% was measured in 51.28% patients. Six-MWT distance and QF muscle strength were less than 80% predicted in 58.9% and 76.9% patients, respectively. CONCLUSIONS In patients with post-COVID-19 syndrome with pulmonary involvement, muscle deoxygenation of QF is greater during maximal exercise than during submaximal exercise. Specifically, patients with lung impairment should be evaluated for deoxygenation and should be taken into consideration during pulmonary rehabilitation.
Collapse
Affiliation(s)
- Başak Kavalcı Kol
- Pilot Health Coordinatorship, Kırşehir Ahi Evran University, Kırşehir, Türkiye
| | - Meral Boşnak Güçlü
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Gazi University, Çankaya, Ankara, Türkiye
| | - Ece Baytok
- Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Gazi University, Çankaya, Ankara, Türkiye
| | - Nilgün Yılmaz Demirci
- Faculty of Medicine, Department of Pulmonology, Gazi University, Yenimahalle, Ankara, Türkiye
| |
Collapse
|
21
|
García-Hidalgo MC, Benítez ID, Perez-Pons M, Molinero M, Belmonte T, Rodríguez-Muñoz C, Aguilà M, Santisteve S, Torres G, Moncusí-Moix A, Gort-Paniello C, Peláez R, Larráyoz IM, Caballero J, Barberà C, Nova-Lamperti E, Torres A, González J, Barbé F, de Gonzalo-Calvo D. MicroRNA-guided drug discovery for mitigating persistent pulmonary complications in critical COVID-19 survivors: A longitudinal pilot study. Br J Pharmacol 2024. [PMID: 38359818 DOI: 10.1111/bph.16330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 12/21/2023] [Accepted: 01/02/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND AND PURPOSE The post-acute sequelae of SARS-CoV-2 infection pose a significant global challenge, with nearly 50% of critical COVID-19 survivors manifesting persistent lung abnormalities. The lack of understanding about the molecular mechanisms and effective treatments hampers their management. Here, we employed microRNA (miRNA) profiling to decipher the systemic molecular underpinnings of the persistent pulmonary complications. EXPERIMENTAL APPROACH We conducted a longitudinal investigation including 119 critical COVID-19 survivors. A comprehensive pulmonary evaluation was performed in the short-term (median = 94.0 days after hospital discharge) and long-term (median = 358 days after hospital discharge). Plasma miRNAs were quantified at the short-term evaluation using the gold-standard technique, RT-qPCR. The analyses combined machine learning feature selection techniques with bioinformatic investigations. Two additional datasets were incorporated for validation. KEY RESULTS In the short-term, 84% of the survivors exhibited impaired lung diffusion (DLCO < 80% of predicted). One year post-discharge, 54.4% of this patient subgroup still presented abnormal DLCO . Four feature selection methods identified two specific miRNAs, miR-9-5p and miR-486-5p, linked to persistent lung dysfunction. The downstream experimentally validated targetome included 1473 genes, with heterogeneous enriched pathways associated with inflammation, angiogenesis and cell senescence. Validation studies using RNA-sequencing and proteomic datasets emphasized the pivotal roles of cell migration and tissue repair in persistent lung dysfunction. The repositioning potential of the miRNA targets was limited. CONCLUSION AND IMPLICATIONS Our study reveals early mechanistic pathways contributing to persistent lung dysfunction in critical COVID-19 survivors, offering a promising approach for the development of targeted disease-modifying agents.
Collapse
Affiliation(s)
- María C García-Hidalgo
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Iván D Benítez
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Manel Perez-Pons
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Marta Molinero
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Thalía Belmonte
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Carlos Rodríguez-Muñoz
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - María Aguilà
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Sally Santisteve
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Gerard Torres
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
- Group of Precision Medicine in Chronic Diseases, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Anna Moncusí-Moix
- Group of Precision Medicine in Chronic Diseases, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
| | - Clara Gort-Paniello
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Rafael Peláez
- Biomarkers and Molecular Signaling Group, Neurodegenerative Diseases Area Center for Biomedical Research of La Rioja, CIBIR, Logroño, Spain
| | - Ignacio M Larráyoz
- Biomarkers and Molecular Signaling Group, Neurodegenerative Diseases Area Center for Biomedical Research of La Rioja, CIBIR, Logroño, Spain
- BIAS, Department of Nursing, University of La Rioja, Logroño, Spain
| | - Jesús Caballero
- Grup de Recerca Medicina Intensiva, Intensive Care Department Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Carme Barberà
- Intensive Care Department, University Hospital Santa María, IRBLleida, Lleida, Spain
| | - Estefania Nova-Lamperti
- Molecular and Translational Immunology Laboratory, Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, Universidad de Concepcion, Concepcion, Chile
| | - Antoni Torres
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
- Pneumology Department, Clinic Institute of Thorax (ICT), Hospital Clinic of Barcelona, Insitut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), ICREA, University of Barcelona (UB), Barcelona, Spain
| | - Jessica González
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Ferran Barbé
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - David de Gonzalo-Calvo
- Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| |
Collapse
|
22
|
Patton MJ, Benson D, Robison SW, Dhaval R, Locy ML, Patel K, Grumley S, Levitan EB, Morris P, Might M, Gaggar A, Erdmann N. Characteristics and Determinants of Pulmonary Long COVID. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.02.13.24302781. [PMID: 38405753 PMCID: PMC10888999 DOI: 10.1101/2024.02.13.24302781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
RATIONALE Persistent cough and dyspnea are prominent features of post-acute sequelae of SARS-CoV-2 (termed 'Long COVID'); however, physiologic measures and clinical features associated with these pulmonary symptoms remain poorly defined. OBJECTIVES Using longitudinal pulmonary function testing (PFTs) and CT imaging, this study aimed to identify the characteristics and determinants of pulmonary Long COVID. METHODS The University of Alabama at Birmingham Pulmonary Long COVID cohort was utilized to characterize lung defects in patients with persistent pulmonary symptoms after resolution primary COVID infection. Longitudinal PFTs including total lung capacity (TLC) and diffusion limitation of carbon monoxide (DLCO) were used to evaluate restriction and diffusion impairment over time in this cohort. Analysis of chest CT imaging was used to phenotype the pulmonary Long COVID pathology. Risk factors linked to development of pulmonary Long COVID were estimated using univariate and multivariate logistic regression models. MEASUREMENTS AND MAIN RESULTS Longitudinal evaluation 929 patients with post-COVID pulmonary symptoms revealed diffusion impairment (DLCO ≤80%) and restriction (TLC ≤80%) in 51% of the cohort (n=479). In multivariable logistic regression analysis (adjusted odds ratio; aOR, 95% confidence interval [CI]), invasive mechanical ventilation during primary infection conferred the greatest increased odds of developing pulmonary Long COVID with diffusion impaired restriction (aOR=10.9 [4.09-28.6]). Finally, a sub-analysis of CT imaging identified evidence of fibrosis in this population. CONCLUSIONS Persistent diffusion impaired restriction was identified as a key feature of pulmonary Long COVID. Subsequent clinical trials should leverage combined symptomatic and quantitative PFT measurements for more targeted enrollment of pulmonary Long COVID patients.
Collapse
|
23
|
Aljuhani O, Korayem GB, Altebainawi AF, AlMohammady D, Alfahed A, Altebainawi EF, Aldhaeefi M, Badreldin HA, Vishwakarma R, Almutairi FE, Alenazi AA, Alsulaiman T, Alqahtani RA, Al Dhahri F, Aldardeer N, Alenazi AO, Al Harbi S, Kensara R, Alalawi M, Al Sulaiman K. Dexamethasone versus methylprednisolone for multiple organ dysfunction in COVID-19 critically ill patients: a multicenter propensity score matching study. BMC Infect Dis 2024; 24:189. [PMID: 38350878 PMCID: PMC10863167 DOI: 10.1186/s12879-024-09056-y] [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: 04/22/2023] [Accepted: 01/24/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Dexamethasone usually recommended for patients with severe coronavirus disease 2019 (COVID-19) to reduce short-term mortality. However, it is uncertain if another corticosteroid, such as methylprednisolone, may be utilized to obtain better clinical outcome. This study assessed dexamethasone's clinical and safety outcomes compared to methylprednisolone. METHODS A multicenter, retrospective cohort study was conducted between March 01, 2020, and July 31, 2021. It included adult COVID-19 patients who were initiated on either dexamethasone or methylprednisolone therapy within 24 h of intensive care unit (ICU) admission. The primary outcome was the progression of multiple organ dysfunction score (MODS) on day three of ICU admission. Propensity score (PS) matching was used (1:3 ratio) based on the patient's age and MODS within 24 h of ICU admission. RESULTS After Propensity Score (PS) matching, 264 patients were included; 198 received dexamethasone, while 66 patients received methylprednisolone within 24 h of ICU admission. In regression analysis, patients who received methylprednisolone had a higher MODS on day three of ICU admission than those who received dexamethasone (beta coefficient: 0.17 (95% CI 0.02, 0.32), P = 0.03). Moreover, hospital-acquired infection was higher in the methylprednisolone group (OR 2.17, 95% CI 1.01, 4.66; p = 0.04). On the other hand, the 30-day and the in-hospital mortality were not statistically significant different between the two groups. CONCLUSION Dexamethasone showed a lower MODS on day three of ICU admission compared to methylprednisolone, with no statistically significant difference in mortality.
Collapse
Affiliation(s)
- Ohoud Aljuhani
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ghazwa B Korayem
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Ali F Altebainawi
- Pharmaceutical Care Services, King Salman Specialist Hospital, Hail Health Cluster, Ministry of Health, Hail, Saudi Arabia
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail, Saudi Arabia
| | - Daniah AlMohammady
- Department of Pharmacy Practice, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amjaad Alfahed
- Department of Pharmacy Practice, College of Pharmacy, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Elaf F Altebainawi
- Department of Medicine, King Khalid Hospital, Hail Health Cluster, Hail, Saudi Arabia
| | - Mohammed Aldhaeefi
- Clinical and Administrative Pharmacy Sciences, College of Pharmacy, Howard University, Washington, DC, 20059, USA
| | - Hisham A Badreldin
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center-King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Ramesh Vishwakarma
- Norwich clinical trial unit, Norwich medical school, University of east Anglia, Norwich, UK
| | - Faisal E Almutairi
- Clinical Pharmacy Department, Pharmacy Services Administration, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abeer A Alenazi
- Pharmaceutical Care Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Thamer Alsulaiman
- Family Medicine Department, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia
| | - Rahaf Ali Alqahtani
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Fahad Al Dhahri
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center-King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Namareq Aldardeer
- Pharmaceutical Care Services, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed O Alenazi
- Pharmaceutical Care Department, King Abdulaziz Medical City, Dammam, Saudi Arabia
| | - Shmeylan Al Harbi
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center-King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Raed Kensara
- King Abdullah International Medical Research Center-King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
- Pharmaceutical Care Department, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Mai Alalawi
- Pharmaceutical Care Services, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Khalid Al Sulaiman
- Pharmaceutical Care Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia.
- College of Pharmacy, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
- King Abdullah International Medical Research Center-King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.
- King Abdulaziz Medical City (KAMC) - Ministry of National Guard Health Affairs (MNGHA), King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, PO Box 22490, Riyadh, 11426, Saudi Arabia.
| |
Collapse
|
24
|
Lord JM, Veenith T, Sullivan J, Sharma-Oates A, Richter AG, Greening NJ, McAuley HJC, Evans RA, Moss P, Moore SC, Turtle L, Gautam N, Gilani A, Bajaj M, Wain LV, Brightling C, Raman B, Marks M, Singapuri A, Elneima O, Openshaw PJM, Duggal NA. Accelarated immune ageing is associated with COVID-19 disease severity. Immun Ageing 2024; 21:6. [PMID: 38212801 PMCID: PMC10782727 DOI: 10.1186/s12979-023-00406-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 12/18/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND The striking increase in COVID-19 severity in older adults provides a clear example of immunesenescence, the age-related remodelling of the immune system. To better characterise the association between convalescent immunesenescence and acute disease severity, we determined the immune phenotype of COVID-19 survivors and non-infected controls. RESULTS We performed detailed immune phenotyping of peripheral blood mononuclear cells isolated from 103 COVID-19 survivors 3-5 months post recovery who were classified as having had severe (n = 56; age 53.12 ± 11.30 years), moderate (n = 32; age 52.28 ± 11.43 years) or mild (n = 15; age 49.67 ± 7.30 years) disease and compared with age and sex-matched healthy adults (n = 59; age 50.49 ± 10.68 years). We assessed a broad range of immune cell phenotypes to generate a composite score, IMM-AGE, to determine the degree of immune senescence. We found increased immunesenescence features in severe COVID-19 survivors compared to controls including: a reduced frequency and number of naïve CD4 and CD8 T cells (p < 0.0001); increased frequency of EMRA CD4 (p < 0.003) and CD8 T cells (p < 0.001); a higher frequency (p < 0.0001) and absolute numbers (p < 0.001) of CD28-ve CD57+ve senescent CD4 and CD8 T cells; higher frequency (p < 0.003) and absolute numbers (p < 0.02) of PD-1 expressing exhausted CD8 T cells; a two-fold increase in Th17 polarisation (p < 0.0001); higher frequency of memory B cells (p < 0.001) and increased frequency (p < 0.0001) and numbers (p < 0.001) of CD57+ve senescent NK cells. As a result, the IMM-AGE score was significantly higher in severe COVID-19 survivors than in controls (p < 0.001). Few differences were seen for those with moderate disease and none for mild disease. Regression analysis revealed the only pre-existing variable influencing the IMM-AGE score was South Asian ethnicity ([Formula: see text] = 0.174, p = 0.043), with a major influence being disease severity ([Formula: see text] = 0.188, p = 0.01). CONCLUSIONS Our analyses reveal a state of enhanced immune ageing in survivors of severe COVID-19 and suggest this could be related to SARS-Cov-2 infection. Our data support the rationale for trials of anti-immune ageing interventions for improving clinical outcomes in these patients with severe disease.
Collapse
Affiliation(s)
- Janet M Lord
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Office 6, University of Birmingham Research Labs, Institute of Inflammation and Ageing, Queen Elizabeth Hospital, Birmingham, UK
- NIHR Birmingham Biomedical Research Centre, University Hospital Birmingham and University of Birmingham, Birmingham, UK
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospital Birmingham, Birmingham, UK
| | - Tonny Veenith
- NIHR Surgical Reconstruction and Microbiology Research Centre, University Hospital Birmingham, Birmingham, UK
| | - Jack Sullivan
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Office 6, University of Birmingham Research Labs, Institute of Inflammation and Ageing, Queen Elizabeth Hospital, Birmingham, UK
| | | | - Alex G Richter
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Neil J Greening
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, Leicester, UK
| | - Hamish J C McAuley
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, Leicester, UK
| | - Rachael A Evans
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, Leicester, UK
| | - Paul Moss
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
| | - Shona C Moore
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Lance Turtle
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Nandan Gautam
- Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Ahmed Gilani
- Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Manan Bajaj
- Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
| | - Louise V Wain
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, Leicester, UK
- Department of Population Health Sciences, University of Leicester, Leicester, UK
| | - Christopher Brightling
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, Leicester, UK
| | - Betty Raman
- Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Michael Marks
- London School of Hygiene and Tropical Medicine, University of London, London, UK
| | - Amisha Singapuri
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, Leicester, UK
| | - Omer Elneima
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, University of Leicester, Leicester, UK
| | | | - Niharika A Duggal
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, Office 6, University of Birmingham Research Labs, Institute of Inflammation and Ageing, Queen Elizabeth Hospital, Birmingham, UK.
| |
Collapse
|
25
|
Pappas AG, Eleftheriou K, Vlahakos V, Magkouta SF, Riba T, Dede K, Siampani R, Kompogiorgas S, Polydora E, Papalampidou A, Loutsidi NE, Mantas N, Tavernaraki E, Exarchos D, Kalomenidis I. High Plasma Osteopontin Levels Are Associated with Serious Post-Acute-COVID-19-Related Dyspnea. J Clin Med 2024; 13:392. [PMID: 38256526 PMCID: PMC10816040 DOI: 10.3390/jcm13020392] [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: 12/11/2023] [Revised: 12/30/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
COVID-19 survivors commonly report persistent symptoms. In this observational study, we investigated the link between osteopontin (OPN) and post-acute COVID-19 symptoms and lung functional/imaging abnormalities. We recorded symptoms and lung imaging/functional data from previously hospitalized COVID-19 patients, who were followed for 4-84 weeks (122 patients/181 visits) post-symptom onset at our outpatient clinic. Circulating OPN was determined using ELISA. Plasma OPN levels were higher in symptomatic patients (compared with the asymptomatic ones); those with dyspnea (compared with those without dyspnea);those with a combination of serious symptoms, i.e., the presence of at least one of the following: dyspnea, fatigue and muscular weakness (compared with those with none of these symptoms); and those with dyspnea and m-MRC > 1 (compared with those with m-MRC = 0-1). Plasma OPN levels were inversely correlated with EQ-VAS (visual analog scale of the EQ-5D-5L health-related quality-of-life questionnaire) values. High-resolution CT or diffusion lung capacity (DLCO) findings were not related to circulating OPN. In the multiple logistic regression, the presence of symptoms, dyspnea, or the combination of serious symptoms were linked to female gender, increased BMI and pre-existing dyspnea (before the acute disease), while increased plasma OPN levels, female gender and pre-existing dyspnea with m-MRC > 1 were independently associated with severe post-COVID-19 dyspnea (m-MRC > 1). Using a correlation matrix to investigate multiple correlations between EQ-VAS, OPN and epidemiological data, we observed an inverse correlation between the OPN and EQ-VAS values. Increased circulating OPN was linked to the persistence of severe exertional dyspnea and impaired quality of life in previously hospitalized COVID-19 patients.
Collapse
Affiliation(s)
- Apostolos G. Pappas
- First Department of Critical Care and Pulmonary Medicine, “Evangelismos” General Hospital, School of Medicine, National and Kapodistrian University of Athens, 10676 Athens, Greece (T.R.); (K.D.); (A.P.); (I.K.)
| | - Konstantinos Eleftheriou
- First Department of Critical Care and Pulmonary Medicine, “Evangelismos” General Hospital, School of Medicine, National and Kapodistrian University of Athens, 10676 Athens, Greece (T.R.); (K.D.); (A.P.); (I.K.)
| | - Vassilios Vlahakos
- First Department of Critical Care and Pulmonary Medicine, “Evangelismos” General Hospital, School of Medicine, National and Kapodistrian University of Athens, 10676 Athens, Greece (T.R.); (K.D.); (A.P.); (I.K.)
| | - Sophia F. Magkouta
- “Marianthi Simou Laboratory”, First Department of Critical Care and Pulmonary Medicine, “Evangelismos” General Hospital, School of Medicine, National and Kapodistrian University of Athens, 10676 Athens, Greece
| | - Theofani Riba
- First Department of Critical Care and Pulmonary Medicine, “Evangelismos” General Hospital, School of Medicine, National and Kapodistrian University of Athens, 10676 Athens, Greece (T.R.); (K.D.); (A.P.); (I.K.)
| | - Konstantina Dede
- First Department of Critical Care and Pulmonary Medicine, “Evangelismos” General Hospital, School of Medicine, National and Kapodistrian University of Athens, 10676 Athens, Greece (T.R.); (K.D.); (A.P.); (I.K.)
| | - Rafaela Siampani
- First Department of Critical Care and Pulmonary Medicine, “Evangelismos” General Hospital, School of Medicine, National and Kapodistrian University of Athens, 10676 Athens, Greece (T.R.); (K.D.); (A.P.); (I.K.)
| | - Steven Kompogiorgas
- Department of Pulmonary Medicine, “Evangelismos” General Hospital, 10676 Athens, Greece
| | - Eftychia Polydora
- First Department of Critical Care and Pulmonary Medicine, “Evangelismos” General Hospital, School of Medicine, National and Kapodistrian University of Athens, 10676 Athens, Greece (T.R.); (K.D.); (A.P.); (I.K.)
| | - Athanasia Papalampidou
- First Department of Critical Care and Pulmonary Medicine, “Evangelismos” General Hospital, School of Medicine, National and Kapodistrian University of Athens, 10676 Athens, Greece (T.R.); (K.D.); (A.P.); (I.K.)
| | - Natasa-Eleni Loutsidi
- Hematology—Lymphomas Department and Bone Marrow Transplant Unit, “Evangelismos” General Hospital, 10676 Athens, Greece;
| | - Nikolaos Mantas
- Department of CT-MRI, “Evangelismos” General Hospital, 10676 Athens, Greece (D.E.)
| | | | - Demetrios Exarchos
- Department of CT-MRI, “Evangelismos” General Hospital, 10676 Athens, Greece (D.E.)
| | - Ioannis Kalomenidis
- First Department of Critical Care and Pulmonary Medicine, “Evangelismos” General Hospital, School of Medicine, National and Kapodistrian University of Athens, 10676 Athens, Greece (T.R.); (K.D.); (A.P.); (I.K.)
| |
Collapse
|
26
|
Caamano E, Velasco L, Garcia MV, Asencio JM, Piñeiro P, Hortal J, Garutti I. Prognostic factors for deterioration of quality of life one year after admission to ICU for severe SARS-COV2 infection. Qual Life Res 2024; 33:123-132. [PMID: 37615735 DOI: 10.1007/s11136-023-03503-0] [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] [Accepted: 08/01/2023] [Indexed: 08/25/2023]
Abstract
PURPOSE Patients with COVID-19 present long-term symptoms collectively known as "post-COVID syndrome". Long-term manifestations are more frequent in patients requiring admission to Intensive Care Units (ICU), but the risk factors for their development are still unknown. This study explores the quality of life of patients with severe COVID-19 one year after their discharge from ICU. METHODS Prospective observational study including 106 patients admitted to the ICU of a tertiary care hospital between March and August 2020. We analysed quality of life using the EuroQol-5D index (EQ-5D). We evaluated as possible risk factors associated with a worse value of the EQ-5D index the medical record, the clinical situation at hospital admission, the clinical situation at ICU admission and evolution in the ICU. As a secondary objective, we explored the presence of other frequent symptoms. RESULTS Most patients (55.4%) reported that their quality of life worsened one year after admission. The mean perceived health status, on the EQ-VAS scale (0-100), was 70.4, with a median of 70 (RI 60-90). The median EQ-5D index was 0.91 (RI 0.76-1). The factors independently related to lower quality of life were female sex and duration of mechanical ventilation. Almost all (91%) of the patients had sequelae one year after discharge from the ICU. The most frequent manifestations were neuropsychiatric (71%). CONCLUSIONS Critically ill COVID-19 patients worsen their quality of life more than one year after discharge. Female sex and duration of mechanical ventilation predict a lower quality of life assessed by the EQ-5D index.
Collapse
Affiliation(s)
- E Caamano
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain.
| | - L Velasco
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain
| | - M V Garcia
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain
| | - J M Asencio
- Department of General Surgery, Gregorio Maranon National Hospital, Madrid, Spain
| | - P Piñeiro
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain
| | - J Hortal
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain
| | - I Garutti
- Department of Anaesthesiology and Critical Care Medicine, Gregorio Maranon National Hospital, Madrid, Spain
| |
Collapse
|
27
|
Kjellberg S, Holm A, Berguerand N, Sandén H, Schiöler L, Olsén MF, Olin A. Impaired function in the lung periphery following COVID-19 is associated with lingering breathing difficulties. Physiol Rep 2024; 12:e15918. [PMID: 38253977 PMCID: PMC10803222 DOI: 10.14814/phy2.15918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 11/15/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Lingering breathing difficulties are common after COVID-19. However, the underlying causes remains unclear, with spirometry often being normal. We hypothesized that small airway dysfunction (SAD) can partly explain these symptoms. We examined 48 individuals (32 women, 4 hospitalized in the acute phase) who experienced dyspnea and/or cough in the acute phase and/or aftermath of COVID-19, and 22 non-COVID-19 controls. Time since acute infection was, median (range), 65 (10-131) weeks. We assessed SAD using multiple breath washout (MBW) and impulse oscillometry (IOS) and included spirometry and diffusing-capacity test (DLCO). One-minute-sit-to-stand test estimated physical function, and breathing difficulties were defined as answering "yes" to the question "do you experience lingering breathing difficulties?" Spirometry, DLCO, and IOS were normal in almost all cases (spirometry: 90%, DLCO: 98%, IOS: 88%), while MBW identified ventilation inhomogeneity in 50%. Breathing difficulties (n = 21) was associated with increased MBW-derived Sacin . However, physical function did not correlate with SAD. Among individuals with breathing difficulties, 25% had reduced physical function, 25% had SAD, 35% had both, and 15% had normal lung function and physical function. Despite spirometry and DLCO being normal in almost all post-COVID-19 individuals, SAD was present in a high proportion and was associated with lingering breathing difficulties.
Collapse
Affiliation(s)
- Sanna Kjellberg
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Alexander Holm
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of Respiratory Medicine and AllergologySahlgrenska University HospitalGothenburgSweden
| | - Nicolas Berguerand
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Helena Sandén
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Linus Schiöler
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Monika Fagevik Olsén
- Department of Health and Rehabilitation/PhysiotherapyInstitute of Neuroscience and Physiology, Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Anna‐Carin Olin
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| |
Collapse
|
28
|
del Corral T, Menor‐Rodríguez N, Fernández‐Vega S, Díaz‐Ramos C, Aguilar‐Zafra S, López‐de‐Uralde‐Villanueva I. Longitudinal study of changes observed in quality of life, psychological state cognition and pulmonary and functional capacity after COVID-19 infection: A six- to seven-month prospective cohort. J Clin Nurs 2024; 33:89-102. [PMID: 35534994 PMCID: PMC9348063 DOI: 10.1111/jocn.16352] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 01/06/2022] [Accepted: 04/22/2022] [Indexed: 12/24/2022]
Abstract
AIMS To investigate the health-related quality of life (HRQoL), symptoms, psychological and cognitive state and pulmonary and physical function of nonhospitalised COVID-19 patients at long-term, and to identify factors to predict a poor HRQoL in this follow-up. BACKGROUND Studies have focused on persistent symptoms of hospitalised COVID-19 patients in the medium term. Thus, long-term studies of nonhospitalised patients are urgently required. DESIGN A longitudinal cohort study. METHODS In 102 nonhospitalised COVID-19 patients, we collected symptoms at 3 months (baseline) and at 6-7 months (follow-up) from diagnosis (dyspnoea, fatigue/muscle weakness and chest/joint pain), HRQoL, psychological state, cognitive function, pulmonary and physical function. This study adhered to the STROBE statement. RESULTS HRQoL was impaired in almost 60% of the sample and remained impaired 6-7 months. At 3 months, more than 60% had impaired physical function (fatigue/muscle weakness and reduced leg and inspiratory muscle strength). About 40%-56% of the sample showed an altered psychological state (post-traumatic stress disorder (PTSD), anxiety/depression), cognitive function impairment and dyspnoea. At 6-7-months, only a slight improvement in dyspnoea and physical and cognitive function was observed, with a very high proportion of the sample (29%-55%) remained impaired. Impaired HRQoL at 6-7 months was predicted with 82.4% accuracy (86.7% sensitivity and 83.3% specificity) by the presence at 3 months of muscle fatigue/muscle weakness (OR = 5.7 (1.8-18.1)), PTSD (OR = 6.0 (1.7-20.7)) and impaired HRQoL (OR = 11.7 (3.7-36.8)). CONCLUSION A high proportion of nonhospitalised patients with COVID-19 experience an impaired HRQoL, cognitive and psychological function at long-term. HRQoL, PTSD and dyspnoea at 3 months can identify the majority of patients with COVID-19 who will have impaired quality of life at long-term. RELEVANCE TO CLINICAL PRACTICE Treatments aimed at improving psychological state and reducing the fatigue/muscle weakness of post-COVID-19 patients could be necessary to prevent the patients' HRQoL from being impaired at 6-7 months after their reported recovery.
Collapse
Affiliation(s)
- Tamara del Corral
- Department of Radiology, Rehabilitation and PhysiotherapyFaculty of Nursing, Physiotherapy and PodiatryUniversidad Complutense de Madrid (UCM)IdISSCMadridSpain
| | - Noemí Menor‐Rodríguez
- Departamento de FisioterapiaFacultad de Ciencias de la SaludCentro Superior de Estudios Universitarios La SalleUniversidad Autónoma de MadridMadridSpain
| | - Sara Fernández‐Vega
- Departamento de FisioterapiaFacultad de Ciencias de la SaludCentro Superior de Estudios Universitarios La SalleUniversidad Autónoma de MadridMadridSpain
| | - Celia Díaz‐Ramos
- Departamento de FisioterapiaFacultad de Ciencias de la SaludCentro Superior de Estudios Universitarios La SalleUniversidad Autónoma de MadridMadridSpain
| | - Sandra Aguilar‐Zafra
- Departamento de FisioterapiaFacultad de Ciencias de la SaludMotion in Brains Research GroupCentro Superior de Estudios Universitarios La SalleUniversidad Autónoma de MadridMadridSpain
- Téxum S.L Physiotherapy CenterCoslada, MadridSpain
| | - Ibai López‐de‐Uralde‐Villanueva
- Department of Radiology, Rehabilitation and PhysiotherapyFaculty of Nursing, Physiotherapy and PodiatryUniversidad Complutense de Madrid (UCM)IdISSCMadridSpain
| |
Collapse
|
29
|
Ando T, Shimada S, Sugihara J, Takayama K, Kobayashi M, Miyashita Y, Ito T, Okayasu K, Tsuyuki S, Ohba T, Doi M, Saito H, Fujie T, Chiaki T, Nakagawa A, Anzai T, Takahashi K, Shibata S, Tateishi T, Miyazaki Y. Impairment of Social-Related Quality of Life in COVID-19 Pneumonia Survivors: A Prospective Longitudinal Study. J Clin Med 2023; 12:7640. [PMID: 38137709 PMCID: PMC10743725 DOI: 10.3390/jcm12247640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/22/2023] [Accepted: 12/08/2023] [Indexed: 12/24/2023] Open
Abstract
The post-acute sequelae of SARS-CoV-2 (PASC) pose a threat to patients' health-related quality of life (HRQOL). Here, the impact of COVID-19 on HRQOL and the clinical factors associated with impaired HRQOL were examined. Discharged COVID-19 patients were assessed at 3 and 6 months after disease onset. The patients completed a medical examination and the SF-36 questionnaire at these two time points and underwent pulmonary function testing at 6 months after disease onset. All had undergone computed tomography (CT) imaging upon hospital admission. Of the 74 included patients, 38% reported respiratory symptoms at 3 months, and 26% reported respiratory symptoms at 6 months after disease onset. The aggregated SF-36 scores declined in the role/social component summary (RCS), a category related to social activity. Patients with lower RCS tended to have respiratory sequelae or a relatively lower forced vital capacity. The CT score that reflected the extent of COVID-19 pneumonia was inversely correlated with the RCS score (3 months, p = 0.0024; 6 months, p = 0.0464). A high CT score (≥10 points) predicted a low RCS score at 6 months (p = 0.013). This study highlights the impairment of RCS and its associations with respiratory sequelae. The study also emphasizes the importance of radiological findings in predicting long-term HRQOL outcomes after COVID-19.
Collapse
Affiliation(s)
- Takahiro Ando
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (T.A.); (S.S.); (J.S.); (S.S.); (Y.M.)
| | - Sho Shimada
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (T.A.); (S.S.); (J.S.); (S.S.); (Y.M.)
| | - Jun Sugihara
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (T.A.); (S.S.); (J.S.); (S.S.); (Y.M.)
| | - Koji Takayama
- Department of Respiratory Medicine, Musashino Red Cross Hospital, 1-26-1 Kyonancho, Musashino-shi, Tokyo 180-8610, Japan;
| | - Masayoshi Kobayashi
- Department of Respiratory Medicine, Tokyo Metropolitan Bokutoh Hospital, 4-23-15 Koutoubashi, Sumida-ku, Tokyo 130-8575, Japan;
| | - Yoshihiro Miyashita
- Department of Respiratory Medicine, Yamanashi Prefectural Central Hospital, 1-1-1 Fujimi, Kofu-shi, Yamanashi 400-8506, Japan;
| | - Tatsuya Ito
- Department of Respiratory Medicine, Yokosuka Kyosai Hospital, 1-16 Yonegahama-dori, Yokosuka-shi, Kanagawa 238-8558, Japan;
| | - Kaori Okayasu
- Department of Respiratory Medicine, Yokohama Municipal Minato Red Cross Hospital, 3-12-1 Shinyamashita, Naka-ku, Yokohama-shi, Kanagawa 231-8682, Japan;
| | - Shun Tsuyuki
- Department of Respiratory Medicine, Kudanzaka Hospital, 1-6-12 Kudanminami, Chiyoda-ku, Tokyo 102-0074, Japan;
| | - Takehiko Ohba
- Department of Respiratory Medicine, Ome Municipal General Hospital, 4-16-5 Higashi-ome, Ome-shi, Tokyo 198-0042, Japan;
| | - Masafumi Doi
- Department of Respiratory Medicine, Kashiwa Municipal Hospital, 1-3 Fuse, Kashiwa-shi, Chiba 277-0825, Japan;
| | - Hiroaki Saito
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, 4-1-1 Otsuno, Tsuchiura-shi, Ibaraki 300-0028, Japan;
| | - Toshihide Fujie
- Department of Respiratory Medicine, Tokyo Metropolitan Ohtsuka Hospital, 2-8-1 Minami-ohtsuka, Toshima-ku, Tokyo 170-8476, Japan;
| | - Tomoshige Chiaki
- Department of Respiratory Medicine, Hokushin General Hospital, 1-5-63 Nishi, Nakano-shi, Nagano 383-8505, Japan;
| | - Atsushi Nakagawa
- Department of Respiratory Medicine, Tokyo Kyosai Hospital, 2-3-8 Nakameguro, Meguro-ku, Tokyo 153-8934, Japan;
| | - Tatsuhiko Anzai
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (T.A.); (K.T.)
| | - Kunihiko Takahashi
- Department of Biostatistics, M&D Data Science Center, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (T.A.); (K.T.)
| | - Sho Shibata
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (T.A.); (S.S.); (J.S.); (S.S.); (Y.M.)
| | - Tomoya Tateishi
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (T.A.); (S.S.); (J.S.); (S.S.); (Y.M.)
| | - Yasunari Miyazaki
- Department of Respiratory Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo 113-8519, Japan; (T.A.); (S.S.); (J.S.); (S.S.); (Y.M.)
| |
Collapse
|
30
|
Öz M, Erol S, Gürün Kaya A, Işık Ö, Çiftci F, Çınar G, Uzun Ç, Azap A, Çiledağ A, Kaya A, Özdemir Kumbasar Ö. Recovery from Respiratory Failure in Patients with Coronavirus Disease 2019. THORACIC RESEARCH AND PRACTICE 2023; 25. [PMID: 38015163 PMCID: PMC11160421 DOI: 10.5152/thoracrespract.2023.23001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 09/25/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Coronavirus disease 2019 (COVID-19) can cause hypoxic respiratory failure; long-term oxygen therapy (LTOT) duration is unknown. MATERIAL AND METHODS The aim was to investigate which patients would need LTOT after COVID-19 pneumonia. This single-center, prospective study was conducted at the Ankara University Faculty of Medicine, Department of Chest Diseases, between May 2021 and December 2021. The 70 patients hospitalized for COVID-19 pneumonia and discharged with LTOT due to hypoxemic respiratory failure were included. Patients were divided into 2 groups as group I (LTOT requirement <3 months) and group II (LTOT requirement continued ≥3 months). RESULTS The mean age was 64.4 ± 13.5 years, and 44 (62.9%) of them were male. The most frequently encountered comorbidities were cardiovascular disease (57.1%) and lung disease (22.9%). While PaO2 levels increased in both groups during the follow-up period, this increment was significantly higher in group I (PaO2: 66.6 ± 9.9 mm Hg, P < .001). The factors affecting the LTOT requirement were evaluated using binary logistic regression. On multivariate analyses of lymphocytes, ferritin, C-reactive protein, PaO2, SaO2, subpleural reticulation, and number of lobes affected (≥3 lobes), the SaO2 level and presence of subpleural reticulation were significantly different between the 2 groups [odds ratio (OR) (95% CI): 0.853 (0.749-0.971), P = .016] and [OR (95% CI): 0.171 (0.042-0.733), P = .017], respectively. CONCLUSION A significant proportion of patients who develop respiratory failure due to COVID-19 recover within the first 3 months. Factors determining the LTOT requirement for more than 3 months were SaO2 and the presence of subpleural reticulation.
Collapse
Affiliation(s)
- Miraç Öz
- Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Serhat Erol
- Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Aslıhan Gürün Kaya
- Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Özlem Işık
- Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Fatma Çiftci
- Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Güle Çınar
- Department of Infectious Diseases and Clinical Microbiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Çağlar Uzun
- Department of Radiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Alpay Azap
- Department of Infectious Diseases and Clinical Microbiology, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Aydın Çiledağ
- Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Akın Kaya
- Department of Chest Diseases, Ankara University Faculty of Medicine, Ankara, Turkey
| | | |
Collapse
|
31
|
Chan KKP, Ng SSS, Lui GCY, Leung HS, Wong KT, Chu WCW, Chan TO, Yiu KYS, Tso EYK, To KW, Ngai JCL, Yip TWH, Lo RLP, Ng JKC, Ko FWS, Hui DSC. Comparison of the 12-month impact of COVID-19 and SARS on physiological capacity and health-related quality of life. BMC Pulm Med 2023; 23:441. [PMID: 37964259 PMCID: PMC10644631 DOI: 10.1186/s12890-023-02750-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 11/06/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Little is known about the differences in medium to long-term recovery on spirometry, 6-minute walking distance (6MWD) and health-related quality of life (HRQoL) between COVID-19 and SARS. METHODS We performed a 12-month prospective study on COVID-19 survivors. The changes in dynamic lung volumes at spirometry (%predicted FEV1, %predicted FVC), 6MWD and HRQoL at 1-3, 6 to 12 months were compared against a historical cohort of SARS survivors using the same study protocol. The residual radiological changes in HRCT in COVID-19 survivors were correlated with their functional capacity. RESULTS 108 COVID-19 survivors of various disease severity (asymptomatic 2.9%, mild 33.3%, moderate 47.2%, severe 8.3%, critical 8.3%) were recruited. When compared with 97 SARS survivors, 108 COVID-19 survivors were older (48.1 ± 16.4 vs. 36.1 ± 9.5 years, p < 0.001) and required less additional support during hospitalization; with lower dynamic lung volumes, shorter 6MWD and better physical component score. Both groups of survivors had comparable changes in these parameters at subsequent follow-ups. Both COVID-19 and SARS survivors had similar mental component score (MCS) at 6 and 12 months. COVID-19 survivors initially experienced less (between-group difference, -3.1, 95% confidence interval [CI] -5.5 to -0.7, p = 0.012) and then more improvement (between-group difference 2.9, 95%, CI 0.8 to 5.1, p = 0.007) than SARS survivors in the MCS at 1-3 to 6 months and 6 to 12 months respectively. Forty (44.0%) out of 91 COVID-19 survivors had residual abnormalities on HRCT at 12 months, with a negative correlation between the severity scores of parenchymal changes and 6MWD (r=-0.239, p < 0.05). CONCLUSIONS COVID-19 survivors demonstrated a similar recovery speed in dynamic lung volumes and exercise capacity, but different paces of psychological recovery as SARS survivors in the convalescent phase. The severity of parenchymal changes in HRCT is negatively correlated with the 6MWD of COVID-19 survivors. TRIAL REGISTRATION This prospective study was registered at ClinicalTrials.gov on 2 November 2020 (Identifier: NCT04611243).
Collapse
Affiliation(s)
- Ken Ka Pang Chan
- Division of Respiratory Medicine, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Susanna So Shan Ng
- Division of Respiratory Medicine, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Grace Chung Yan Lui
- Division of Infectious Diseases, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Ho Sang Leung
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Tak Wong
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Winnie Chiu Wing Chu
- Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Tat On Chan
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, China
| | - Karen Yee Shan Yiu
- Division of Respiratory Medicine, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Kin Wang To
- Division of Respiratory Medicine, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Jenny Chun Li Ngai
- Division of Respiratory Medicine, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Tommy Wing Ho Yip
- Division of Respiratory Medicine, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Rachel Lai Ping Lo
- Division of Respiratory Medicine, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Joyce Ka Ching Ng
- Division of Respiratory Medicine, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - Fanny Wai San Ko
- Division of Respiratory Medicine, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China
| | - David Shu Cheong Hui
- Division of Respiratory Medicine, Department of Medicine & Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
| |
Collapse
|
32
|
Slotegraaf AI, Gerards MHG, Verburg AC, de van der Schueren MAE, Kruizenga HM, Graff MJL, Cup EHC, Kalf JG, Lenssen AF, Meijer WM, Kool RA, de Bie RA, van der Wees PJ, Hoogeboom TJ. Evaluation of Primary Allied Health Care in Patients Recovering From COVID-19 at 6-Month Follow-up: Dutch Nationwide Prospective Cohort Study. JMIR Public Health Surveill 2023; 9:e44155. [PMID: 37862083 PMCID: PMC10592721 DOI: 10.2196/44155] [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: 11/08/2022] [Revised: 07/10/2023] [Accepted: 07/31/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Patients recovering from COVID-19 often experience persistent problems in their daily activities related to limitations in physical, nutritional, cognitive, and mental functioning. To date, it is unknown what treatment is needed to support patients in their recovery from COVID-19. OBJECTIVE This study aimed to evaluate the primary allied health care of patients recovering from COVID-19 at 6-month follow-up and to explore which baseline characteristics are associated with changes in the scores of outcomes between baseline and 6-month follow-up. METHODS This Dutch nationwide prospective cohort study evaluated the recovery of patients receiving primary allied health care (ie, dietitians, exercise therapists, occupational therapists, physical therapists, and speech and language therapists) after COVID-19. All treatments offered by primary allied health professionals in daily practice were part of usual care. Patient-reported outcome measures on participation, health-related quality of life, fatigue, physical functioning, and psychological well-being were assessed at baseline and at 3- and 6-month follow-up. Linear mixed model analyses were used to evaluate recovery over time, and uni- and multivariable linear regression analyses were used to examine the association between baseline characteristics and recovery. RESULTS A total of 1451 adult patients recovering from COVID-19 and receiving treatment from 1 or more primary allied health professionals were included. For participation (Utrecht Scale for Evaluation of Rehabilitation-Participation range 0-100), estimated mean differences of at least 2.3 points were observed at all time points. For the health-related quality of life (EuroQol Visual Analog Scale, range 0-100), the mean increase was 12.3 (95% CI 11.1-13.6) points at 6 months. Significant improvements were found for fatigue (Fatigue Severity Scale, range 1-7): the mean decrease was -0.7 (95% CI -0.8 to -0.6) points at 6 months. However, severe fatigue was reported by 742/929 (79.9%) patients after 6 months. For physical functioning (Patient-Reported Outcomes Measurement Information System-Physical Function Short Form 10b, range 13.8-61.3), the mean increase was 5.9 (95% CI 5.9-6.4) points at 6 months. Mean differences of -0.8 (95% CI -1.0 to -0.5) points for anxiety (Hospital Anxiety and Depression Scale range 0-21) and -1.6 (95% CI -1.8 to -1.3) points for depression were found after 6 months. A worse baseline score, hospital admission, and male sex were associated with greater improvement between baseline and 6-month follow-up, whereas age, the BMI, comorbidities, and smoking status were not associated with mean changes in any outcome measures. CONCLUSIONS Patients recovering from COVID-19 who receive primary allied health care make progress in recovery but still experience many limitations in their daily activities after 6 months. Our findings provide reference values to health care providers and health care policy makers regarding what to expect from the recovery of patients who receive health care from 1 or more primary allied health professionals. TRIAL REGISTRATION ClinicalTrials.gov NCT04735744; https://tinyurl.com/3vf337pn. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2340/jrm.v54.2506.
Collapse
Affiliation(s)
- Anne I Slotegraaf
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
| | - Marissa H G Gerards
- Department of Epidemiology, Care and Public Health Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
- Department of Physical Therapy, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Arie C Verburg
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Marian A E de van der Schueren
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, Netherlands
- Department of Nutrition, Dietetics and Lifestyle, HAN University of Applied Sciences, Nijmegen, Netherlands
| | - Hinke M Kruizenga
- Department of Nutrition and Dietetics, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Maud J L Graff
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Edith H C Cup
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Johanna G Kalf
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Antoine F Lenssen
- Department of Physical Therapy, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Willemijn M Meijer
- Netherlands Institute for Health Services Research, Nivel, Utrecht, Netherlands
| | - Renée A Kool
- Lung Foundation Netherlands, Amersfoort, Netherlands
| | - Rob A de Bie
- Department of Epidemiology, Care and Public Health Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, Netherlands
| | - Philip J van der Wees
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
- Department of Rehabilitation, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Thomas J Hoogeboom
- IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| |
Collapse
|
33
|
Henríquez-Beltrán M, Benítez I, Belmonte T, Jorquera J, Jorquera-Diaz J, Cigarroa I, Burgos M, Sanhueza R, Jeria C, Fernandez-Bussy I, Nova-Lamperti E, Barbé F, Targa A, Labarca G. Association between Acute Respiratory Distress Syndrome Due to COVID-19 and Long-Term Sleep and Circadian Sleep-Wake Disorders. J Clin Med 2023; 12:6639. [PMID: 37892777 PMCID: PMC10607050 DOI: 10.3390/jcm12206639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 10/12/2023] [Accepted: 10/14/2023] [Indexed: 10/29/2023] Open
Abstract
Current studies agree on the impact of sleep and circadian rest-activity rhythm alterations in acute respiratory distress syndrome (ARDS) survivors. However, research on the duration of this impact is scarce. In this study, we evaluate the impact of ARDS on the sleep and circadian rest-activity rhythm of COVID-19 survivors twelve months after hospital discharge. This is a prospective study including COVID-19 survivors with and without ARDS during hospitalization. Data was collected four and twelve months after hospital discharge. The interventions included one-week wrist actigraphy and a home sleep apnea test (HSAT), and evaluations were conducted according to the Pittsburgh sleep quality index (PSQI), Epworth sleepiness scale (ESS), and insomnia severity index (ISI). Fifty-two patients were evaluated (ARDS = 31 and non-ARDS = 21); they had a median age of 49.0 [39.0;57.2] years and 53.8% were male. After twelve months, 91.3% presented poor sleep quality, 58.7% presented insomnia, 50% presented daytime somnolence, and 37% presented comorbid insomnia and obstructive sleep apnea (COMISA). No significant improvement was observed in relation to sleep or the circadian rest-activity rhythm between four and twelve months. A tendency of poor sleep quality, insomnia, daytime somnolence, and COMISA was observed. Finally, there was no significant impact on the circadian rest-activity rhythm between four and twelve months or between the groups.
Collapse
Affiliation(s)
- Mario Henríquez-Beltrán
- Núcleo de Investigación en Ciencias de la Salud, Universidad Adventista de Chile, Chillán 3780000, Chile;
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), 25198 Lleida, Spain; (I.B.); (T.B.); (F.B.); (A.T.)
| | - Iván Benítez
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), 25198 Lleida, Spain; (I.B.); (T.B.); (F.B.); (A.T.)
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Thalía Belmonte
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), 25198 Lleida, Spain; (I.B.); (T.B.); (F.B.); (A.T.)
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Jorge Jorquera
- Centro de Enfermedades Respiratorias, Clínica Las Condes, Facultad de Medicina, Universidad Finis Terrae, Santiago 7591047, Chile;
| | - Jorge Jorquera-Diaz
- Facultad de Ciencias Medicas, Universidad Favarolo, Buenos Aires C1079ABE, Argentina;
| | - Igor Cigarroa
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Santiago 8370003, Chile; (I.C.); (M.B.); (R.S.)
| | - Matías Burgos
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Santiago 8370003, Chile; (I.C.); (M.B.); (R.S.)
| | - Rocio Sanhueza
- Escuela de Kinesiología, Facultad de Salud, Universidad Santo Tomás, Santiago 8370003, Chile; (I.C.); (M.B.); (R.S.)
| | - Claudia Jeria
- Área Transversal de Formación General, Unidad de Idiomas, Universidad Santo Tomás, Santiago 8370003, Chile;
| | - Isabel Fernandez-Bussy
- Departamento de Medicina, Facultad de Ciencias Medicas, Universidad Católica Argentina, Buenos Aires C1107AFB, Argentina;
| | - Estefania Nova-Lamperti
- Laboratorio de Inmunología Molecular y Traslacional, Departamento de Bioquímica Clínica e Inmunología, Facultad de Farmacia, Universidad de Concepción, Concepción 4070112, Chile;
| | - Ferrán Barbé
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), 25198 Lleida, Spain; (I.B.); (T.B.); (F.B.); (A.T.)
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Adriano Targa
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, Biomedical Research Institute of Lleida (IRBLleida), 25198 Lleida, Spain; (I.B.); (T.B.); (F.B.); (A.T.)
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Gonzalo Labarca
- Department of Clinical Biochemistry and Immunology, Faculty of Pharmacy, University of Concepción, Concepción 4070112, Chile
- Division of Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, USA
| |
Collapse
|
34
|
Toh MR, Teo YR, Poh LCR, Tang Y, Soh RY, Sharma K, Kalyanasundaram G, Poh KC. Impact of COVID infection on lung function test and quality of life. Sci Rep 2023; 13:17275. [PMID: 37828107 PMCID: PMC10570308 DOI: 10.1038/s41598-023-43710-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/27/2023] [Indexed: 10/14/2023] Open
Abstract
Post-COVID-19 pulmonary sequalae are well-recognized early in the pandemic. Survivorship clinics are crucial for managing at-risk patients. However, it is unclear who requires pulmonary function test (PFT) and when PFTs should be performed. We aim to investigate for whom and how these interval PFTs should be performed. We performed a single-centre, prospective cohort study on COVID-19 survivors between 1st May 2020 and 31st April 2022. These patients were followed up at 6, 9 and 12 months with interval PFT and Short Form-36 (SF-36) Health Survey. Those with PFT defects were offered a computed tomography scan of the thorax. Of the 46 patients recruited, 17 (37%) had severe/critical illness. Compared to those with mild/moderate disease, these patients were more likely to experience DLCO defects (59% versus 17%, p = 0.005) and had lower SF-36 scores (mean physical component summary score of 45 ± 12 versus 52 ± 8, p = 0.046). These differences were most notable at 6 months, compared to the 9- and 12-months intervals. DLCO defects were also associated with older age, raised inflammatory markers and extensive CXR infiltrates. Besides interstitial-like abnormalities, obesity and undiagnosed lung conditions accounted for 39% of the PFT abnormalities. Interval PFTs can be performed earliest 6 months post-COVID-19. Patients with normal tests were unlikely to develop new abnormalities and would not require repeat PFTs. Abnormal PFTs can be followed-up with repeat PFTs 6 monthly until resolution. Non-COVID-19 differentials should be considered for persistent PFT abnormalities.
Collapse
Affiliation(s)
- Ming Ren Toh
- Department of Internal Medicine, Sengkang General Hospital, Singapore, Singapore.
- Department of Respiratory Medicine, Sengkang General Hospital, Singapore, Singapore.
| | - Ying Rachel Teo
- Department of Clinical Measurement Centre, Sengkang General Hospital, Singapore, Singapore
| | - Li Choo Ruby Poh
- Department of Clinical Measurement Centre, Sengkang General Hospital, Singapore, Singapore
| | - Yiting Tang
- Department of Internal Medicine, Sengkang General Hospital, Singapore, Singapore
| | - Rui Ya Soh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | - Kiran Sharma
- Department of Internal Medicine, Sengkang General Hospital, Singapore, Singapore
| | | | - Kai Chin Poh
- Department of Internal Medicine, Sengkang General Hospital, Singapore, Singapore
| |
Collapse
|
35
|
Tanaka H, Maetani T, Chubachi S, Tanabe N, Shiraishi Y, Asakura T, Namkoong H, Shimada T, Azekawa S, Otake S, Nakagawara K, Fukushima T, Watase M, Terai H, Sasaki M, Ueda S, Kato Y, Harada N, Suzuki S, Yoshida S, Tateno H, Yamada Y, Jinzaki M, Hirai T, Okada Y, Koike R, Ishii M, Hasegawa N, Kimura A, Imoto S, Miyano S, Ogawa S, Kanai T, Fukunaga K. Clinical utilization of artificial intelligence-based COVID-19 pneumonia quantification using chest computed tomography - a multicenter retrospective cohort study in Japan. Respir Res 2023; 24:241. [PMID: 37798709 PMCID: PMC10552312 DOI: 10.1186/s12931-023-02530-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/04/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Computed tomography (CT) imaging and artificial intelligence (AI)-based analyses have aided in the diagnosis and prediction of the severity of COVID-19. However, the potential of AI-based CT quantification of pneumonia in assessing patients with COVID-19 has not yet been fully explored. This study aimed to investigate the potential of AI-based CT quantification of COVID-19 pneumonia to predict the critical outcomes and clinical characteristics of patients with residual lung lesions. METHODS This retrospective cohort study included 1,200 hospitalized patients with COVID-19 from four hospitals. The incidence of critical outcomes (requiring the support of high-flow oxygen or invasive mechanical ventilation or death) and complications during hospitalization (bacterial infection, renal failure, heart failure, thromboembolism, and liver dysfunction) was compared between the groups of pneumonia with high/low-percentage lung lesions, based on AI-based CT quantification. Additionally, 198 patients underwent CT scans 3 months after admission to analyze prognostic factors for residual lung lesions. RESULTS The pneumonia group with a high percentage of lung lesions (N = 400) had a higher incidence of critical outcomes and complications during hospitalization than the low percentage group (N = 800). Multivariable analysis demonstrated that AI-based CT quantification of pneumonia was independently associated with critical outcomes (adjusted odds ratio [aOR] 10.5, 95% confidence interval [CI] 5.59-19.7), as well as with oxygen requirement (aOR 6.35, 95% CI 4.60-8.76), IMV requirement (aOR 7.73, 95% CI 2.52-23.7), and mortality rate (aOR 6.46, 95% CI 1.87-22.3). Among patients with follow-up CT scans (N = 198), the multivariable analysis revealed that the pneumonia group with a high percentage of lung lesions on admission (aOR 4.74, 95% CI 2.36-9.52), older age (aOR 2.53, 95% CI 1.16-5.51), female sex (aOR 2.41, 95% CI 1.13-5.11), and medical history of hypertension (aOR 2.22, 95% CI 1.09-4.50) independently predicted persistent residual lung lesions. CONCLUSIONS AI-based CT quantification of pneumonia provides valuable information beyond qualitative evaluation by physicians, enabling the prediction of critical outcomes and residual lung lesions in patients with COVID-19.
Collapse
Affiliation(s)
- Hiromu Tanaka
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Tomoki Maetani
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Shotaro Chubachi
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Naoya Tanabe
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Yusuke Shiraishi
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Takanori Asakura
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Department of Clinical Medicine (Laboratory of Bioregulatory Medicine), Kitasato University School of Pharmacy, Tokyo, Japan
- Department of Respiratory Medicine, Kitasato University, Kitasato Institute Hospital, Tokyo, Japan
| | - Ho Namkoong
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Shimada
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shuhei Azekawa
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Shiro Otake
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kensuke Nakagawara
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takahiro Fukushima
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Mayuko Watase
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hideki Terai
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Mamoru Sasaki
- Department of Respiratory Medicine, JCHO (Japan Community Health care Organization), Saitama Medical Center, Saitama, Japan
| | - Soichiro Ueda
- Department of Respiratory Medicine, JCHO (Japan Community Health care Organization), Saitama Medical Center, Saitama, Japan
| | - Yukari Kato
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Norihiro Harada
- Department of Respiratory Medicine, Juntendo University Faculty of Medicine and Graduate School of Medicine, Tokyo, Japan
| | - Shoji Suzuki
- Department of Pulmonary Medicine, Saitama City Hospital, Saitama, Japan
| | - Shuichi Yoshida
- Department of Pulmonary Medicine, Saitama City Hospital, Saitama, Japan
| | - Hiroki Tateno
- Department of Pulmonary Medicine, Saitama City Hospital, Saitama, Japan
| | - Yoshitake Yamada
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Jinzaki
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Toyohiro Hirai
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yukinori Okada
- Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
- Department of Genome Informatics, Graduate School of Medicine, the University of Tokyo, Tokyo, Japan
- Laboratory for Systems Genetics, RIKEN Center for Integrative Medical Sciences, Kanagawa, Japan
| | - Ryuji Koike
- Health Science Research and Development Center (HeRD), Tokyo Medical and Dental University, Tokyo, Japan
| | - Makoto Ishii
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
- Department of Respiratory Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Hasegawa
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Akinori Kimura
- Institute of Research, Tokyo Medical and Dental University, Tokyo, Japan
| | - Seiya Imoto
- Division of Health Medical Intelligence, Human Genome Center, the Institute of Medical Science, the University of Tokyo, Tokyo, Japan
| | - Satoru Miyano
- M&D Data Science Center, Tokyo Medical and Dental University, Tokyo, Japan
| | - Seishi Ogawa
- Department of Pathology and Tumor Biology, Kyoto University, Kyoto, Japan
| | - Takanori Kanai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Koichi Fukunaga
- Division of Pulmonary Medicine, Department of Internal Medicine, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| |
Collapse
|
36
|
Declercq PL, Fournel I, Demeyere M, Berraies A, Ksiazek E, Nyunga M, Daubin C, Ampere A, Sauneuf B, Badie J, Delbove A, Nseir S, Artaud-Macari E, Bironneau V, Ramakers M, Maizel J, Miailhe AF, Lacombe B, Delberghe N, Oulehri W, Georges H, Tchenio X, Clarot C, Redureau E, Bourdin G, Federici L, Adda M, Schnell D, Bousta M, Salmon-Gandonnière C, Vanderlinden T, Plantefeve G, Delacour D, Delpierre C, Le Bouar G, Sedillot N, Beduneau G, Rivière A, Meunier-Beillard N, Gélinotte S, Rigaud JP, Labruyère M, Georges M, Binquet C, Quenot JP. Influence of socio-economic status on functional recovery after ARDS caused by SARS-CoV-2: the multicentre, observational RECOVIDS study. Intensive Care Med 2023; 49:1168-1180. [PMID: 37620561 PMCID: PMC10556111 DOI: 10.1007/s00134-023-07180-y] [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: 03/05/2023] [Accepted: 07/28/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE Survivors after acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19) are at high risk of developing respiratory sequelae and functional impairment. The healthcare crisis caused by the pandemic hit socially disadvantaged populations. We aimed to evaluate the influence of socio-economic status on respiratory sequelae after COVID-19 ARDS. METHODS We carried out a prospective multicenter study in 30 French intensive care units (ICUs), where ARDS survivors were pre-enrolled if they fulfilled the Berlin ARDS criteria. For patients receiving high flow oxygen therapy, a flow ≥ 50 l/min and an FiO2 ≥ 50% were required for enrollment. Socio-economic deprivation was defined by an EPICES (Evaluation de la Précarité et des Inégalités de santé dans les Centres d'Examens de Santé - Evaluation of Deprivation and Inequalities in Health Examination Centres) score ≥ 30.17 and patients were included if they performed the 6-month evaluation. The primary outcome was respiratory sequelae 6 months after ICU discharge, defined by at least one of the following criteria: forced vital capacity < 80% of theoretical value, diffusing capacity of the lung for carbon monoxide < 80% of theoretical value, oxygen desaturation during a 6-min walk test and fibrotic-like findings on chest computed tomography. RESULTS Among 401 analyzable patients, 160 (40%) were socio-economically deprived and 241 (60%) non-deprived; 319 (80%) patients had respiratory sequelae 6 months after ICU discharge (81% vs 78%, deprived vs non-deprived, respectively). No significant effect of socio-economic status was identified on lung sequelae (odds ratio (OR), 1.19 [95% confidence interval (CI), 0.72-1.97]), even after adjustment for age, sex, most invasive respiratory support, obesity, most severe P/F ratio (adjusted OR, 1.02 [95% CI 0.57-1.83]). CONCLUSIONS In COVID-19 ARDS survivors, socio-economic status had no significant influence on respiratory sequelae 6 months after ICU discharge.
Collapse
Affiliation(s)
| | - Isabelle Fournel
- Centre d’Investigation Clinique, CHU Dijon, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | | | | | - Eléa Ksiazek
- Centre d’Investigation Clinique, CHU Dijon, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | - Martine Nyunga
- Service de Médecine Intensive Réanimation, CH de Roubaix, Roubaix, France
| | - Cédric Daubin
- Department of Medical Intensive Care, CHU de Caen Normandie, Caen, France
| | | | - Bertrand Sauneuf
- Service de Médecine Intensive Réanimation, CH Public du Cotentin, Cherbourg-en-Cotentin, France
| | - Julio Badie
- Service de Médecine Intensive Réanimation, Hopital Nord Franche-Comte, Trevenans, France
| | - Agathe Delbove
- Service de Réanimation Polyvalente, CHBA Vannes, Vannes, France
| | - Saad Nseir
- Service de Médecine Intensive Réanimation, CHRU Roger Salengro, Lille, France
- Inserm U1285, Univ. Lille, CNRS, UMR 8576-UGSF-Unité de Glycobiologie Structurale et Fonctionnelle, Lille, France
| | - Elise Artaud-Macari
- University of Normandie, UNIROUEN, EA3830, CHU Rouen, Department of Pneumology, Thoracic Oncology and Respiratory Intensive Care Unit, Rouen, France
| | - Vanessa Bironneau
- Service de Pneumologie, CHU Poitiers, Poitiers, France
- INSERM CIC 1402, ALIVES Research Group, Université de Poitiers, Poitiers, France
| | - Michel Ramakers
- Service de Médecine Intensive Réanimation, Centre Hospitalier Mémorial de Saint-Lô, Saint-Lô, France
| | - Julien Maizel
- Service de Médecine Intensive Réanimation, CHU d’Amiens, Amiens, France
| | | | - Béatrice Lacombe
- Service de Réanimation Polyvalente, Groupe Hospitalier Bretagne Sud, Lorient, France
| | | | - Walid Oulehri
- Service de Réanimation Chirurgicale, CHRU Strasbourg, Strasbourg, France
| | - Hugues Georges
- Service de Médecine Intensive Réanimation, CH de Tourcoing, Tourcoing, France
| | - Xavier Tchenio
- Service de Réanimation Polyvalente, Centre Hospitalier Fleyriat, Bourg en Bresse, France
| | | | - Elise Redureau
- Service de Pneumologie, CHD Vendée, La Roche-sur-Yon, France
| | - Gaël Bourdin
- Service de Réanimation Polyvalente, CH Saint Joseph Saint Luc, Lyon, France
| | - Laura Federici
- Service de Médecine Intensive Réanimation, AP-HP, Hôpital Louis Mourier, Colombes, France
| | - Mélanie Adda
- Service de Médecine Intensive Réanimation, Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | - David Schnell
- Service de Réanimation Polyvalente et USC, CH d’Angoulême, Angoulême, France
| | - Mehdi Bousta
- Service de Réanimation Médico-Chirugicale, Groupe Hospitalier du Havre, Le Havre, France
| | | | - Thierry Vanderlinden
- Intensive Care Unit, St Philibert hospital, ETHICS EA 7446, Lille Catholic University, Lille, France
| | - Gaëtan Plantefeve
- Service de Médecine Intensive Réanimation, CH d’Argenteuil, Argenteuil, France
| | - David Delacour
- Service de radiologie, Clinique du Cèdre, Bois-Guillaume, France
| | | | - Gurvan Le Bouar
- Service de Médecine Intensive Réanimation, CHES Evreux, Evreux, France
| | - Nicholas Sedillot
- Service de Réanimation Polyvalente, Centre Hospitalier Fleyriat, Bourg en Bresse, France
| | - Gaëtan Beduneau
- Normandie Univ, UNIROUEN, UR3830, CHU Rouen, Department of Medical Intensive Care, 76000 Rouen, France
| | - Antoine Rivière
- Service de Réanimation Polyvalente, CH d’Abbeville, Abbeville, France
| | - Nicolas Meunier-Beillard
- Centre d’Investigation Clinique, CHU Dijon, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | | | - Jean-Philippe Rigaud
- Service de Médecine Intensive Réanimation, CH de Dieppe, Dieppe, France
- Espace de Réflexion Ethique de Normandie, CHU Caen, Caen, France
| | - Marie Labruyère
- Department of Intensive Care, Burgundy University Hospital, 14 rue Paul Gaffarel, B.P 77908, 21079 Dijon Cedex, France
- Lipness Team, INSERM Research Center LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| | - Marjolaine Georges
- Department of Pulmonary Medicine and Intensive Care Unit, University Hospital, Dijon, France
| | - Christine Binquet
- Centre d’Investigation Clinique, CHU Dijon, Dijon, France
- INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France
| | - Jean-Pierre Quenot
- Department of Intensive Care, Burgundy University Hospital, 14 rue Paul Gaffarel, B.P 77908, 21079 Dijon Cedex, France
- Lipness Team, INSERM Research Center LNC-UMR1231 and LabEx LipSTIC, University of Burgundy, Dijon, France
- INSERM CIC 1432, Clinical Epidemiology, University of Burgundy, Dijon, France
| |
Collapse
|
37
|
González J, Zuil M, Benítez ID, de Batlle J, Aguilà M, Santisteve S, Varvará N, Monge A, Forns N, Vaca R, Minguez O, Seck F, Gort-Paniello C, Moncusí-Moix A, Caballero J, Barberà C, de Gonzalo-Calvo D, Torres A, Barbé F. Long-term Outcomes in Critical COVID-19 Survivors: A 2-Year Longitudinal Cohort. Arch Bronconeumol 2023; 59:691-697. [PMID: 37640655 DOI: 10.1016/j.arbres.2023.08.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 08/31/2023]
Affiliation(s)
- Jessica González
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain; Pulmonary Department, Hospital Universitari Arnau de Vilanova-Santa Maria, Lleida, Spain
| | - María Zuil
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain; Pulmonary Department, Hospital Universitari Arnau de Vilanova-Santa Maria, Lleida, Spain
| | - Iván D Benítez
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Jordi de Batlle
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Maria Aguilà
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain; Pulmonary Department, Hospital Universitari Arnau de Vilanova-Santa Maria, Lleida, Spain
| | - Sally Santisteve
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain; Pulmonary Department, Hospital Universitari Arnau de Vilanova-Santa Maria, Lleida, Spain
| | - Natalia Varvará
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain; Pulmonary Department, Hospital Universitari Arnau de Vilanova-Santa Maria, Lleida, Spain
| | - Aida Monge
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain; Pulmonary Department, Hospital Universitari Arnau de Vilanova-Santa Maria, Lleida, Spain
| | - Nuria Forns
- Pulmonary Department, Hospital Universitari Arnau de Vilanova-Santa Maria, Lleida, Spain
| | - Rafaela Vaca
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain; Pulmonary Department, Hospital Universitari Arnau de Vilanova-Santa Maria, Lleida, Spain
| | - Olga Minguez
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain; Pulmonary Department, Hospital Universitari Arnau de Vilanova-Santa Maria, Lleida, Spain
| | - Faty Seck
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain; Pulmonary Department, Hospital Universitari Arnau de Vilanova-Santa Maria, Lleida, Spain
| | - Clara Gort-Paniello
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Anna Moncusí-Moix
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Jesús Caballero
- Intensive Care Department, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Carme Barberà
- Intensive Care Department, Hospital Universitari Santa Maria, Lleida, Spain
| | - David de Gonzalo-Calvo
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
| | - Antonio Torres
- CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain; Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain
| | - Ferran Barbé
- Translational Research in Respiratory Medicine, Hospital Universitari Arnau de Vilanova-Santa Maria, IRBLleida, Lleida, Spain; CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain; Pulmonary Department, Hospital Universitari Arnau de Vilanova-Santa Maria, Lleida, Spain.
| |
Collapse
|
38
|
Guinto E, Gerayeli FV, Eddy RL, Lee H, Milne S, Sin DD. Post-COVID-19 dyspnoea and pulmonary imaging: a systematic review and meta-analysis. Eur Respir Rev 2023; 32:220253. [PMID: 37558261 PMCID: PMC10410398 DOI: 10.1183/16000617.0253-2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 05/31/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND A proportion of coronavirus disease 2019 (COVID-19) survivors experience persistent dyspnoea without measurable impairments in lung function. We performed a systematic review and meta-analysis to determine relationships between dyspnoea and imaging abnormalities over time in post-COVID-19 patients. METHODS Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we analysed studies published prior to 15 September 2022 and indexed by Google Scholar, PubMed and LitCOVID which assessed chest imaging in adults ≥3 months after COVID-19. Demographic, chest imaging, spirometric and post-COVID-19 symptom data were extracted. The relationships between imaging abnormalities and dyspnoea, sex and age were determined using a random effects model and meta-regression. RESULTS 47 studies were included in the meta-analysis (n=3557). The most prevalent computed tomography (CT) imaging abnormality was ground-glass opacities (GGOs) (44.9% (95% CI 37.0-52.9%) at any follow-up time-point). Occurrence of reticulations significantly decreased between early and late follow-up (p=0.01). The prevalence of imaging abnormalities was related to the proportion of patients with dyspnoea (p=0.012). The proportion of females was negatively correlated with the presence of reticulations (p=0.001), bronchiectasis (p=0.001) and consolidations (p=0.025). Age was positively correlated with imaging abnormalities across all modalities (p=0.002) and imaging abnormalities present only on CT (p=0.001) (GGOs (p=0.004) and reticulations (p=0.001)). Spirometric values improved during follow-up but remained within the normal range at all time-points. CONCLUSIONS Imaging abnormalities were common 3 months after COVID-19 and their occurrence was significantly related to the presence of dyspnoea. This suggests that CT imaging is a sensitive tool for detecting pulmonary abnormalities in patients with dyspnoea, even in the presence of normal spirometric measurements.
Collapse
Affiliation(s)
- Elizabeth Guinto
- Centre for Heart Lung Innovation, St Paul's Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Firoozeh V Gerayeli
- Centre for Heart Lung Innovation, St Paul's Hospital, The University of British Columbia, Vancouver, BC, Canada
| | - Rachel L Eddy
- Centre for Heart Lung Innovation, St Paul's Hospital, The University of British Columbia, Vancouver, BC, Canada
- Division of Respiratory Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - Hyun Lee
- Centre for Heart Lung Innovation, St Paul's Hospital, The University of British Columbia, Vancouver, BC, Canada
- Division of Pulmonary Medicine and Allergy, Hanyang University College of Medicine, Seoul, South Korea
| | - Stephen Milne
- Centre for Heart Lung Innovation, St Paul's Hospital, The University of British Columbia, Vancouver, BC, Canada
- Division of Respiratory Medicine, The University of British Columbia, Vancouver, BC, Canada
- Sydney Medical School, The University of Sydney, Camperdown, Australia
| | - Don D Sin
- Centre for Heart Lung Innovation, St Paul's Hospital, The University of British Columbia, Vancouver, BC, Canada
- Division of Respiratory Medicine, The University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
39
|
Konsberg Y, Szaro P, Aneman A, Kjellberg S, Solidakis N, Svedlund S, Nellgård B, Dalla K. Radiological appearance and lung function six months after invasive ventilation in ICU for COVID-19 pneumonia: An observational follow-up study. PLoS One 2023; 18:e0289603. [PMID: 37656699 PMCID: PMC10473523 DOI: 10.1371/journal.pone.0289603] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 07/22/2023] [Indexed: 09/03/2023] Open
Abstract
BACKGROUND Respiratory functional sequelae in COVID-19 patients admitted to the intensive care unit for invasive ventilation are sparsely reported. The aim of this study was to investigate the radiological lung appearance, lung function and their association at 6 months after hospital discharge. It was hypothesized that the degree of pathological morphology on CT scans would correlate with lung function at the time of follow-up. METHODS AND FINDINGS In this single-centre prospective observational study, 86 from 154 patients admitted to ICU due to COVID-19 between March 2020 and May 2021 were followed up at 6 months post discharge with computed tomography (CT) of the chest and pulmonary function tests (PFTs). The PFT results were expressed as z-scores calculated as the difference between the measured and predicted values divided by the standard deviation obtained from a reference population. Correlations were evaluated by Spearman's rho including the 95% confidence interval. Pathological changes on CT were found in 78/85 participants with fibrous parenchymal bands being the most prevalent finding (91%) followed by traction bronchiectasis (64%) and ground glass opacities (41%). Sixty-five participants performed PFTs, and a restrictive pattern was the most prevalent abnormality (34%). Diffusing capacity of the lung for carbon monoxide (DLCO) was reduced in 66% of participants. The CT severity score weakly correlated with forced vital capacity (FVC) z-score (0.295, p = 0.006), DLCO z-score (-0.231, p = 0.032) and alveolar volume (VA) z-score (0.253, p = 0.019). CONCLUSIONS Most patients showed persistent radiological abnormalities on CT and reduced lung volumes, impaired diffusion capacity and patterns of restrictive lung function at 6 months post discharge from the ICU. The correlations between abnormalities on CT and lung function tests were weak. Further, studies with a long-term follow-up of lung function in this group of patients are needed.
Collapse
Affiliation(s)
- Ylva Konsberg
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Pawel Szaro
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anders Aneman
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, Australia
- South Western Clinical School, University of New South Wales, Sydney, Australia
- Ingham Institute for Applied Medical Science, Sydney, Australia
| | - Sanna Kjellberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy University of Gothenburg, Göteborg, Sweden
| | - Nektarios Solidakis
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sara Svedlund
- Department of Clinical Physiology, Sahlgrenska Univsersity Hospital, Gothenburg, Sweden
| | - Bengt Nellgård
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| | - Keti Dalla
- Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
| |
Collapse
|
40
|
Sperling S, Leth S, Fløe A, Hyldgaard C, Gissel T, Topcu A, Kristensen L, Sønderskov Dahl L, Martin Schmid J, Jensen-Fangel S, Bendstrup E. Twelve-month follow-up after hospitalization for SARS-COV-2: Physiology improves, symptoms remain. Infect Dis Now 2023; 53:104686. [PMID: 36842501 PMCID: PMC9957660 DOI: 10.1016/j.idnow.2023.104686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/15/2022] [Accepted: 02/17/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVES Persistent symptoms on short-term follow-up after infection with COVID-19 are common, but long-term consequences have been insufficiently studied. The aim of this study was to characterize pulmonary function and ongoing symptoms 12 months after hospitalization with COVID-19. METHODS This prospective multicenter study included 222 patients hospitalized with PCR-confirmed COVID-19 in the Central Denmark Region. Disease severity was stratified using WHO Clinical Progression Scale. Clinical characteristics, pulmonary function test (PFT), 6-minute walk test (6MWT), and patient-reported outcome measures were collected at follow-up 3 and 12 months after discharge. Outcome measures from follow-up 3 months after discharge have previously been published. RESULTS A total of 179 (81%) patients completed the 12-month follow-up. Median age was 60 years (IQR 51, 69) and 58% were male patients. At 12-month follow-up 49.7% had a normal diffusion capacity for carbon monoxide (DLCO), while 39.4% had DLCO < 80%. The 6MWT distance increased significantly (29 m 95% CI 19, 40; p < 0.01). An mMRC score of 0 was reported by 51% and an mMRC ≥ 2 by 20%. The frequency and severity of fatigue, depression, and anxiety did not improve over time. CONCLUSIONS The study found that impaired DLCO percentage is common 12 months after hospitalization with SARS-CoV-2 and reduction in DLCO percentage is associated to dyspnea.
Collapse
Affiliation(s)
- Søren Sperling
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | - Steffen Leth
- Department of Clinical Medicine, Aarhus University, Denmark; Department of Internal Medicine, Gødstrup Hospital, Denmark; Department of Infectious Diseases, Aarhus University Hospital, Denmark
| | - Andreas Fløe
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Denmark
| | | | - Tina Gissel
- Department of Internal Medicine, Viborg Regional Hospital, Denmark
| | - Ayfer Topcu
- Department of Internal Medicine, Regional Hospital Horsens, Denmark
| | | | | | - Johannes Martin Schmid
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| | - Søren Jensen-Fangel
- Department of Clinical Medicine, Aarhus University, Denmark; Department of Infectious Diseases, Aarhus University Hospital, Denmark
| | - Elisabeth Bendstrup
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark
| |
Collapse
|
41
|
Monteiro IP, Appelt PA, Sisconetto AT, Minaré Baldo Sucupira KS, Bazan R, Luvizutto GJ, Pascucci Sande de Souza LA. Post-coronavirus disease 2019 functional impairments, limitations, and restrictions: A prospective cohort study based on the international classification of functioning, disability, and health. J Cent Nerv Syst Dis 2023; 15:11795735231195759. [PMID: 38025402 PMCID: PMC10655659 DOI: 10.1177/11795735231195759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Background Current knowledge regarding coronavirus disease 2019 (COVID-19) is constantly evolving, and the long-term functional impairments, limitations, and restrictions have not yet been well established. Objective to evaluate the impact of post-COVID condition on the human functioning through the International Classification of Functioning, Disability and Health (ICF) classification. Methods This is a prospective cohort study with 53 individuals with post-COVID condition at 3 time points: 0 to 3 (baseline), 3 to 6, and 6-12 months (follow-up). Outcomes were organized in dichotomous variable: No impairment (0); presence of impairment (≥1) in body function, structure, activities, and participation domains according to the ICF checklist. Chi-square test was used to determine the differences of 3 time points, and association with persistent symptoms. Results A statistically significant difference was observed between the periods, with greater disabilities at 6-12 than at 0-3 months in mental, sensory, pain, and movement-related functions; cardiovascular, immunological, and respiratory systems. In terms of activity and participation, a greater limitation at 6-12 months was observed than at 0-3 months in learning and applying knowledge, general tasks, and mobility. In the domain of interpersonal interactions and relationships, there was a statistically significant difference between the 6-12 and 3-6 months groups. Associations between COVID-19 symptoms and ICF components at the first follow-up were: anosmia and dysgeusia with weight maintenance, fatigue and irritability with pain, brain fog with watching and listening, walking difficulty with pain, and headache with pain, watching, and listening. At the second follow-up were: anosmia and dysgeusia with energy and drive functions, attention, memory, and emotional functions; dizziness with watching and listening; fatigue with emotional function, pain, undertaking multiple tasks, lifting and carrying objects, and driving; irritability with energy and drive, emotional function, undertaking multiple tasks, lifting and carrying objects, and walking; walking difficulty with energy and driving, emotional function, respiration, muscle power, cardiovascular system, undertaking multiple tasks, lifting and carrying objects, and walking; and headache with emotional function, watching, and listening. Conclusions Individuals with COVID-19 persistent symptoms showed impairments in structure and function, activity limitations, and participation restrictions during the 1-year follow-up period.
Collapse
Affiliation(s)
- Isabella Polo Monteiro
- Departamento de Fisioterapia Aplicada, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Brasil
| | - Pablo Andrei Appelt
- Departamento de Fisioterapia Aplicada, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Brasil
| | | | | | - Rodrigo Bazan
- Departamento de Neurologia, Psicologia e Psiquiatria, Universidade Estadual Paulista (UNESP), Botucatu, Brasil
| | - Gustavo José Luvizutto
- Departamento de Fisioterapia Aplicada, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Brasil
| | | |
Collapse
|
42
|
Singh SJ, Baldwin MM, Daynes E, Evans RA, Greening NJ, Jenkins RG, Lone NI, McAuley H, Mehta P, Newman J, Novotny P, Smith DJF, Stanel S, Toshner M, Brightling CE. Respiratory sequelae of COVID-19: pulmonary and extrapulmonary origins, and approaches to clinical care and rehabilitation. THE LANCET. RESPIRATORY MEDICINE 2023; 11:709-725. [PMID: 37216955 PMCID: PMC10198676 DOI: 10.1016/s2213-2600(23)00159-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 05/24/2023]
Abstract
Although the exact prevalence of post-COVID-19 condition (also known as long COVID) is unknown, more than a third of patients with COVID-19 develop symptoms that persist for more than 3 months after SARS-CoV-2 infection. These sequelae are highly heterogeneous in nature and adversely affect multiple biological systems, although breathlessness is a frequently cited symptom. Specific pulmonary sequelae, including pulmonary fibrosis and thromboembolic disease, need careful assessment and might require particular investigations and treatments. COVID-19 outcomes in people with pre-existing respiratory conditions vary according to the nature and severity of the respiratory disease and how well it is controlled. Extrapulmonary complications such as reduced exercise tolerance and frailty might contribute to breathlessness in post-COVID-19 condition. Non-pharmacological therapeutic options, including adapted pulmonary rehabilitation programmes and physiotherapy techniques for breathing management, might help to attenuate breathlessness in people with post-COVID-19 condition. Further research is needed to understand the origins and course of respiratory symptoms and to develop effective therapeutic and rehabilitative strategies.
Collapse
Affiliation(s)
- Sally J Singh
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK.
| | - Molly M Baldwin
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
| | - Enya Daynes
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
| | - Rachael A Evans
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
| | - Neil J Greening
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
| | - R Gisli Jenkins
- Imperial College London National Heart and Lung Institute, London, UK
| | - Nazir I Lone
- Department of Anaesthesia, Critical Care and Pain Medicine, Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Hamish McAuley
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
| | - Puja Mehta
- Centre for Inflammation and Tissue Repair, Division of Medicine, University College London, London, UK
| | - Joseph Newman
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, UK
| | - Petr Novotny
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
| | | | - Stefan Stanel
- Manchester University NHS Foundation Trust, Manchester, UK
| | - Mark Toshner
- NIHR Cambridge Biomedical Research Centre, Cambridge, UK
| | - Christopher E Brightling
- Institute for Lung Health, NIHR Leicester Biomedical Research Centre-Respiratory and Infectious Diseases, Leicester, UK
| |
Collapse
|
43
|
Polese J, Ramos AD, Moulaz IR, Sant'Ana L, Lacerda BSDP, Soares CES, Lança KEM, Thompson BP, Júnior GPB, Polese Pinto II, Mill JG. Pulmonary function and exercise capacity six months after hospital discharge of patients with severe COVID-19. Braz J Infect Dis 2023; 27:102789. [PMID: 37442195 PMCID: PMC10403708 DOI: 10.1016/j.bjid.2023.102789] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 05/30/2023] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
INTRODUCTION The long-term consequences of COVID-19, especially pulmonary impairment, are frequent but not well understood. The knowledge about sequels or long COVID-19 are necessary, considering the high prevalence and need for specific public strategies. METHOD The study was conducted to evaluate symptoms (standardized questionnaire), pulmonary function (spirometry), and exercise capacity (6-minute-walk-test) at 30 (D30), 90 (D90), and 180 (D180) days after hospital discharge of patients surviving to severe COVID-19. We excluded in this follow up patients with comorbidities before COVID infection. RESULTS 44 patients were included and 31 (26 men) completed the 6-month follow-up (age mean 53.6 ± 9.6 years). At D180, 28% presented still at least one symptom. The most common was dyspnea (17.2%), followed by cough (13.8%), and myalgia (10.3%). All spirometric parameters showed progressive improvement from D30 to D180. However, 16% maintained a restrictive pattern on spirometry test, 44% presented desaturation on the 6-minute walk-test, and 25% walked < 75% of the predicted value. CONCLUSION 6-months after hospital discharge, reduced pulmonary function and reduced exercise capacity was founded frequently and more than a quarter remained symptomatic. The persistent symptoms and functional impairment suggest that sequels and development of Long COVID-19 are very common. The identification of these patients to provide the necessary health care is a challenging task, considering the large number of patients infected and surviving to COVID-19 disease.
Collapse
Affiliation(s)
- Jessica Polese
- Universidade Federal do Espírito Santo, Departamento de Pneumologia, Vitória, ES, Brazil.
| | | | | | | | | | | | | | | | | | | | - José Geraldo Mill
- Universidade Federal do Espírito Santo, Departamento de Ciências Fisiológicas, Vitória, ES, Brazil
| |
Collapse
|
44
|
Kızılırmak D, Sarı S, Can F, Havlucu Y. Radiological findings based comparison of functional status in patients who have post-covid lung injury or idiopathic pulmonary fibrosis. BMC Pulm Med 2023; 23:234. [PMID: 37391786 DOI: 10.1186/s12890-023-02527-z] [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: 04/15/2023] [Accepted: 06/21/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Following COVID-19 infection, some patients acquired lung injury and fibrosis. Idiopathic pulmonary fibrosis is characterized by lung fibrosis. Both post-COVID lung injury and idiopathic pulmonary fibrosis cause loss of respiratory function and involvement of the lung parenchyma. We aimed to compare respiratory related functional characteristics and radiological involvement between post-COVID lung injury and idiopathic pulmonary fibrosis. METHODS A single center, cross-sectional study was applied. Patients with post-COVID lung injury and idiopathic pulmonary fibrosis included in the study. All patients underwent the 6-minute walk test, as well as the Borg and MRC scales. Radiological images were evaluated and scored for lung parenchymal involvement. The impact of post-COVID lung injury and idiopathic pulmonary fibrosis on respiratory functions of were compared. The relationship of functional status and radiological involvement, as well as the effect of potential confounding factors were investigated. RESULTS A total of 71 patients were included in the study. Forty-eight (67.6%) of the patients were male and the mean age was 65.4 ± 10.3 years. Patients with post-COVID lung injury had greater 6-minute walk test distance and duration, as well as higher oxygen saturations. The MRC and Borg dyspnea scores were comparable. At radiologic evaluation, ground glass opacity scores were higher in patients with post-COVID lung injury, whereas pulmonary fibrosis scores were higher in patients with idiopathic pulmonary fibrosis. However, the total severity scores were similar. While pulmonary fibrosis score was found to have a negative correlation with 6-minute walk test distance, test duration, and pre- and post-test oxygen saturation levels, there was a positive correlation with oxygen saturation recovery time and MRC score. There was no relationship between ground glass opacity and the functional parameters. CONCLUSIONS Despite having equal degrees of radiological involvement and dyspnea symptom severity, PCLI patients exhibited higher levels of functional status. This might be due to different pathophysiological mechanisms and radiological involvement patterns of both diseases.
Collapse
Affiliation(s)
- Deniz Kızılırmak
- Faculty of Medicine, Chest Diseases Department, Manisa Celal Bayar University, Manisa, Turkey.
| | - Seçil Sarı
- Hafsa Sultan Hospital, Respiratory Therapist, Manisa Celal Bayar University, Manisa, Turkey
| | - Fatma Can
- Faculty of Medicine, Department of Radiodiagnostics, Manisa Celal Bayar University, Manisa, Turkey
| | - Yavuz Havlucu
- Faculty of Medicine, Chest Diseases Department, Manisa Celal Bayar University, Manisa, Turkey
| |
Collapse
|
45
|
De Juana C, Herrera S, Ponce S, Calvache S, Dahmazi L, Vitale R, Ferrer AJ, Valentín V, Acosta M, López I, Martínez-Moragón E. Health-related quality of life and radiological and functional lung changes of patients with COVID-19 Pneumonia 3 and 10 months after discharge. BMC Pulm Med 2023; 23:231. [PMID: 37370050 PMCID: PMC10303856 DOI: 10.1186/s12890-023-02520-6] [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: 04/28/2023] [Accepted: 06/15/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Few studies have evaluated the long-term impact on health-related quality of life (HRQoL) in patients who have been hospitalized for COVID-19 pneumonia. Specific follow-up should be carried out to detect and treat possible pulmonary abnormalities, and the worsening of HRQoL should be estimated to target necessary resources for care of these patients after acute phase. The objective was to know the impact on HRQoL of patients who have been admitted for COVID-19 pneumonia, and to evaluate the clinical-radiological and functional changes of patients who have overcome COVID-19 pneumonia at 3 and 10 months of follow-up. METHODS Prospective observational study of patients who required hospitalization for COVID-19 pneumonia between April and December 2020. All patients filled out the EuroQol five-dimension (EQ-5D) questionnaire with the EuroQol Visual Analogue Scale (E-VAS) for self-assessment of health status. Respiratory function tests and chest X-ray were carried out at 3 and 10 months of follow-up. RESULTS 61 patients were included in the study. The need for ventilatory support was associated with anxiety/depression on the EQ-5D scale, as well as patients admitted to the intensive care unit (ICU). The mean EQ-5D and E-VAS index scores decreased with hospitalization time, the number of days spent in intermediate respiratory care unit (IRCU) and the level of dyspnoea at the beginning of the hospitalization period. Pulmonary sequelae were observed in 25 patients (41%) at 3 months and 17 (27.9%) at 10 months. Patients improve their forced vital capacity (FVC) by 196 ml (p = 0.001) at 10 months as well as 9% in diffusing capacity of lung for carbon monoxide (DLCO) (p = 0.001) at 10 months. DLCO was found to be correlated to lymphopenia and time spent in IRCU. Low FVC values were detected 10 months after discharge for subjects exhibiting high levels of dyspnoea at 3 months after discharge. CONCLUSIONS Hospitalization for COVID-19 pneumonia affects the HRQoL of patients, with greater anxiety/depression in those who were more serious affected and are younger. A significant percentage of patients present fibrotic abnormalities and lung function impairment at the first and second follow-up after discharge.
Collapse
Affiliation(s)
- Cristina De Juana
- Department of Respiratory Medicine, Universitary Hospital Doctor Peset of Valencia, Valencia, Spain.
| | - Susana Herrera
- Department of Respiratory Medicine, Universitary Hospital Doctor Peset of Valencia, Valencia, Spain
| | - Silvia Ponce
- Department of Respiratory Medicine, Universitary Hospital Doctor Peset of Valencia, Valencia, Spain
| | - Sergio Calvache
- Department of Respiratory Medicine, Universitary Hospital Doctor Peset of Valencia, Valencia, Spain
| | - Loubna Dahmazi
- Department of Respiratory Medicine, Universitary Hospital Doctor Peset of Valencia, Valencia, Spain
| | | | | | - Verónica Valentín
- Department of Respiratory Medicine, Universitary Hospital Doctor Peset of Valencia, Valencia, Spain
| | - Marta Acosta
- Department of Respiratory Medicine, Universitary Hospital Doctor Peset of Valencia, Valencia, Spain
| | - Irene López
- Department of Respiratory Medicine, Universitary Hospital Doctor Peset of Valencia, Valencia, Spain
| | - Eva Martínez-Moragón
- Department of Respiratory Medicine, Universitary Hospital Doctor Peset of Valencia, Valencia, Spain
| |
Collapse
|
46
|
Thomas M, Raza T, Hameed M, Sharma R, Rajagopal RM, Hussain O Al Adab A, Ahmad M, George S, Hussein M, Akram J, Mohamed Ibrahim MI, Ait Hssain A, Yousaf M, Yahya Khatib M. A Prospective Cohort Study (OUTSTRIP-COVID) on Functional and Spirometry Outcomes in COVID-19 ICU Survivors at 3 Months. Int J Gen Med 2023; 16:2633-2642. [PMID: 37377780 PMCID: PMC10292620 DOI: 10.2147/ijgm.s404834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023] Open
Abstract
Purpose COVID-19 pandemic resulted in a significant number of critical care admissions secondary to severe pneumonia and acute respiratory distress syndrome. We evaluated the short-, medium- and long-term outcomes of lung function and quality of life in this prospective cohort study and reported the outcomes at 7 weeks and 3 months from discharge from intensive care unit. Methods A prospective cohort study of ICU survivors with COVID-19 was conducted from August 2020 to May 2021 to evaluate baseline demographic and clinical variables as well as determine lung function, exercise capacity, and health-related quality of life (HRQOL) using spirometry and 6-minute walk test (6MWT) conducted in accordance with American Thoracic Society standards, and SF-36 (Rand), respectively. SF-36 is a generic 36 question standardized health survey. Descriptive and inferential statistics (alpha = 0.05) were used to analyse the data. Results At baseline, 100 participants were enrolled in the study of whom 76 followed up at 3 months. Majority of the patients were male (83%), Asians (84%) and less than 60 years of age (91%). HRQOL showed significant improvement in all domains of SF-36, except in emotional wellbeing. Spirometry variables also showed significant improvement in all variables over time with greatest improvement in percentage predicted Forced expiratory volume 1 (79% vs 88% p < 0.001). 6MWT showed significant improvement in variables of walk distance, dyspnea, and fatigue with greatest improvement in change in oxygen saturation (3% vs 1.44% p < 0.001). Intubation status did not impact the changes in SF-36, spirometry or 6MWT variables. Conclusion Our findings suggest that ICU survivors of COVID-19 have significant improvement in their lung function, exercise capacity and HRQOL within 3 months of ICU discharge regardless of intubation status.
Collapse
Affiliation(s)
- Merlin Thomas
- Department of Chest, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Tasleem Raza
- Department of Chest, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
- Department of Medical Intensive Care, Hamad General Hospital, Doha, Qatar
| | - Mansoor Hameed
- Department of Chest, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Rohit Sharma
- Department of Internal Medicine, Geisinger Health System, Danville, PA, USA
| | | | - Aisha Hussain O Al Adab
- Department of Chest, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Mushtaq Ahmad
- Department of Chest, Hamad General Hospital, Doha, Qatar
- Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Saibu George
- Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
- Department of Medical Intensive Care, Hamad General Hospital, Doha, Qatar
| | - Mousa Hussein
- Department of Chest, Hamad General Hospital, Doha, Qatar
| | - Jaweria Akram
- Department of Medical Intensive Care, Hamad General Hospital, Doha, Qatar
| | | | - Ali Ait Hssain
- Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
- Department of Medical Intensive Care, Hamad General Hospital, Doha, Qatar
| | - Muhammad Yousaf
- Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
- Department of Chest, Hazm Mebaireekh General Hospital, Doha, Qatar
| | - Mohamad Yahya Khatib
- Department of Clinical Medicine, Weill Cornell Medicine, Doha, Qatar
- Department of Chest, Hazm Mebaireekh General Hospital, Doha, Qatar
| |
Collapse
|
47
|
Steinmetz A, Gross S, Lehnert K, Lücker P, Friedrich N, Nauck M, Bahlmann S, Fielitz J, Dörr M. Longitudinal Clinical Features of Post-COVID-19 Patients-Symptoms, Fatigue and Physical Function at 3- and 6-Month Follow-Up. J Clin Med 2023; 12:3966. [PMID: 37373660 DOI: 10.3390/jcm12123966] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/06/2023] [Accepted: 06/07/2023] [Indexed: 06/29/2023] Open
Abstract
Post-COVID-19 syndrome (PCS) has been described as 'the pandemic after the pandemic' with more than 65 million people worldwide being affected. The enormous range of symptoms makes both diagnosis complex and treatment difficult. In a post-COVID rehabilitation outpatient clinic, 184 patients, mostly non-hospitalized, received a comprehensive, interdisciplinary diagnostic assessment with fixed follow-up appointments. At baseline, three in four patients reported more than 10 symptoms, the most frequent symptoms were fatigue (84.9%), decreased physical capacity (83.0%), tiredness (81.1%), poor concentration (73.6%), sleeping problems (66.7%) and shortness of breath (67.3%). Abnormalities were found in the mean values of scores for fatigue (FAS = 34.3), cognition (MoCA = 25.5), psychological alterations (anxiety, depression, post-traumatic stress disorder), limitation of lung function (CAT) and severity scores for PCS (PCFS, MCRS). Clinical abnormalities were found in elevated values of heart rate, breathing rate at rest, blood pressure and NT-proBNP levels. As the frequency of the described symptoms decreases only slowly but most often significantly over the course, it is important to monitor the patients over a longer period of time. Many of them suffer from an immense symptom burden, often without pre-existing clinical correlates. Our results show a clear association with objectifiable assessments and tests as well as pronounced symptoms.
Collapse
Affiliation(s)
- Anke Steinmetz
- Physical and Rehabilitation Medicine, Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
- DZHK (German Center for Cardiovascular Research), University Medicine Greifswald, 17475 Greifswald, Germany
| | - Stefan Gross
- DZHK (German Center for Cardiovascular Research), University Medicine Greifswald, 17475 Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Kristin Lehnert
- DZHK (German Center for Cardiovascular Research), University Medicine Greifswald, 17475 Greifswald, Germany
- Department of Internal Medicine B, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Petra Lücker
- Physical and Rehabilitation Medicine, Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Nele Friedrich
- DZHK (German Center for Cardiovascular Research), University Medicine Greifswald, 17475 Greifswald, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Matthias Nauck
- DZHK (German Center for Cardiovascular Research), University Medicine Greifswald, 17475 Greifswald, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Susanne Bahlmann
- Physical and Rehabilitation Medicine, Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Jens Fielitz
- Department of Internal Medicine B, University Medicine Greifswald, 17475 Greifswald, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Marcus Dörr
- Department of Internal Medicine B, University Medicine Greifswald, 17475 Greifswald, Germany
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, 17475 Greifswald, Germany
| |
Collapse
|
48
|
Cerier EJ, Bharat A. Lung transplantation for coronavirus disease 2019 acute respiratory distress syndrome/fibrosis: silver lining of a global pandemic. Curr Opin Organ Transplant 2023; 28:157-162. [PMID: 37040626 PMCID: PMC10155614 DOI: 10.1097/mot.0000000000001068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2023]
Abstract
PURPOSE OF REVIEW The COVID-19 pandemic revolutionized the field of lung transplantation, as lung transplant is now an acceptable life-saving therapy for select patients with COVID-19-associated acute respiratory distress syndrome (ARDS), while prior to the pandemic, few transplants were performed for ARDS. This review article details the establishment of lung transplantation as a viable therapy for COVID-19-related respiratory failure, how to evaluate COVID-19 patients for lung transplant, and specific technical considerations for the operation. RECENT FINDINGS Lung transplantation is a life-altering treatment for two distinct cohorts of COVID-19 patients: those with irrecoverable COVID-19-associated ARDS and those who recover from the initial COVID-19 insult but are left with chronic, debilitating post-COVID fibrosis. Both cohorts require stringent selection criteria and extensive evaluation to be listed for lung transplantation. As the first COVID-19 lung transplantation was recently performed, long-term outcomes are lacking; however, short-term outcome data of COVID-19-related lung transplants are promising. SUMMARY Given the challenges and complexities associated with COVID-19-related lung transplantation, strict patient selection and evaluation are required with an experienced multidisciplinary team at a high-volume/resource center. With promising short-term outcome data, ongoing studies are needed to assess long-term outcomes of COVID-19-related lung transplants.
Collapse
Affiliation(s)
- Emily J Cerier
- Department of Thoracic Surgery, Northwestern University Feinberg School of Medicine Chicago, Illinois, USA
| | | |
Collapse
|
49
|
Romanet C, Wormser J, Fels A, Lucas P, Prudat C, Sacco E, Bruel C, Plantefève G, Pene F, Chatellier G, Philippart F. Effectiveness of exercise training on the dyspnoea of individuals with long COVID: A randomised controlled multicentre trial. Ann Phys Rehabil Med 2023; 66:101765. [PMID: 37271020 PMCID: PMC10237688 DOI: 10.1016/j.rehab.2023.101765] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 03/07/2023] [Accepted: 03/18/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND COVID-19-related acute respiratory distress syndrome (CARDS) is a severe evolution of the Sars-Cov-2 infection and necessitates intensive care. COVID-19 may subsequently be associated with long COVID, whose symptoms can include persistent respiratory symptoms up to 1 year later. Rehabilitation is currently recommended by most guidelines for people with this condition. OBJECTIVES To evaluate the effects of exercise training rehabilitation (ETR) on dyspnoea and health-related quality of life measures in people with continuing respiratory discomfort following CARDS. METHODS In this multicentre, two-arm, parallel, open, assessor-blinded, randomised controlled trial, we enroled adults previously admitted with CARDS to 3 French intensive care units who had been discharged at least 3 months earlier and who presented with an mMRC dyspnoea scale score > 1. Participants received either ETR or standard physiotherapy (SP) for 90 days. The primary outcome was dyspnoea, as measured by the Multidimensional Dyspnoea Profile (MDP), at day 0 (inclusion) and after 90 days of physiotherapy. Secondary outcomes were the mMRC and 12-item Short-Form Survey scores. RESULTS Between August 7, 2020, and January 26, 2022, 487 participants with CARDS were screened for inclusion, of whom 60 were randomly assigned to receive either ETR (n = 27) or SP (n = 33). Mean MDP following ETR was 42% lower than after SP (26.15 vs. 44.76); a difference of -18.61 (95% CI -27.78 to -9.44; p<10-4). CONCLUSION People who were still suffering from breathlessness three months after being discharged from hospital with CARDS had significantly improved dyspnoea scores when treated with ETR therapy for 90 days unlike those who only received SP. Study registered 29/09/2020 on Clinicaltrials.gov (NCT04569266).
Collapse
Affiliation(s)
- Christophe Romanet
- Department of Intensive Care, Groupe Hospitalier Paris Saint Joseph, Paris, France.
| | - Johan Wormser
- Department of Intensive Care, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Audrey Fels
- Department of Clinical Research, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Pauline Lucas
- Department of Intensive Care, Hopital Cochin - Port Royal, Paris, France
| | - Camille Prudat
- Department of Clinical Research, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Emmanuelle Sacco
- Department of Clinical Research, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Cédric Bruel
- Department of Intensive Care, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Gaëtan Plantefève
- Department of Intensive Care, Centre Hospitalier Victor Dupouy, Argenteuil, France
| | - Frédéric Pene
- Department of Intensive Care, Hopital Cochin - Port Royal, Paris, France
| | - Gilles Chatellier
- Department of Clinical Research, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - François Philippart
- Department of Intensive Care, Groupe Hospitalier Paris Saint Joseph, Paris, France
| |
Collapse
|
50
|
Dusart C, Smet J, Chirumberro A, André S, Roman A, Claus M, Bruyneel AV, Menez O, Alard S, De Vos N, Bruyneel M. Pulmonary Functional Outcomes at 3 Months in Critical COVID-19 Survivors Hospitalized during the First, Second, and Third Pandemic Waves. J Clin Med 2023; 12:jcm12113712. [PMID: 37297906 DOI: 10.3390/jcm12113712] [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: 05/05/2023] [Revised: 05/23/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
INTRODUCTION Despite improved management of patients with COVID-19, we still ignore whether pharmacologic treatments and improved respiratory support have modified outcomes for intensive care unit (ICU) surviving patients of the three first consecutive waves (w) of the pandemic. The aim of this study was to evaluate whether developments in the management of ICU COVID-19 patients have positively impacted respiratory functional outcomes, quality of life (QoL), and chest CT scan patterns in ICU COVID-19 surviving patients at 3 months, according to pandemic waves. METHODS We prospectively included all patients admitted to the ICU of two university hospitals with acute respiratory distress syndrome (ARDS) related to COVID-19. Data related to hospitalization (disease severity, complications), demographics, and medical history were collected. Patients were assessed 3 months post-ICU discharge using a 6 min walking distance test (6MWT), a pulmonary function test (PFT), a respiratory muscle strength (RMS) test, a chest CT scan, and a Short Form 36 (SF-36) questionnaire. RESULTS We included 84 ARDS COVID-19 surviving patients. Disease severity, complications, demographics, and comorbidities were similar between groups, but there were more women in wave 3 (w3). Length of stay at the hospital was shorter during w3 vs. during wave 1 (w1) (23.4 ± 14.2 days vs. 34.7 ± 20.8 days, p = 0.0304). Fewer patients required mechanical ventilation (MV) during the second wave (w2) vs. during w1 (33.3% vs. 63.9%, p = 0.0038). Assessment at 3 months after ICU discharge revealed that PFTs and 6MWTs scores were worse for w3 > w2 > w1. QoL (SF-36) deteriorated (vitality and mental health) more for patients in w1 vs. in w3 (64.7 ± 16.3 vs. 49.2 ± 23.2, p = 0.0169). Mechanical ventilation was associated with reduced forced expiratory volume (FEV1), total lung capacity (TLC), diffusing capacity for carbon monoxide (DLCO), and respiratory muscle strength (RMS) (w1,2,3, p < 0.0500) on linear/logistic regression analysis. The use of glucocorticoids, as well as tocilizumab, was associated with improvements in the number of affected segments in chest CT, FEV1, TLC, and DLCO (p < 0.01). CONCLUSIONS With better understanding and management of COVID-19, there was an improvement in PFT, 6MWT, and RMS in ICU survivors 3 months after ICU discharge, regardless of the pandemic wave during which they were hospitalized. However, immunomodulation and improved best practices for the management of COVID-19 do not appear to be sufficient to prevent significant morbidity in critically ill patients.
Collapse
Affiliation(s)
- Cecile Dusart
- Department of Pneumology, CHU Saint-Pierre, 1000 Brussels, Belgium
- Department of Pneumology, Université Libre de Bruxelles, CHU Saint-Pierre, 1000 Brussels, Belgium
| | - Jelle Smet
- Department of Pneumology, CHU Saint-Pierre, 1000 Brussels, Belgium
- Department of Pneumology, Université Libre de Bruxelles, CHU Saint-Pierre, 1000 Brussels, Belgium
| | - Audrey Chirumberro
- Department of Pneumology, CHU Saint-Pierre, 1000 Brussels, Belgium
- Department of Pneumology, Université Libre de Bruxelles, CHU Saint-Pierre, 1000 Brussels, Belgium
| | - Stephanie André
- Department of Pneumology, Université Libre de Bruxelles, CHU Saint-Pierre, 1000 Brussels, Belgium
- Department of Pneumology, CHU Brugmann, 1020 Brussels, Belgium
| | - Alain Roman
- Department of Pneumology, Université Libre de Bruxelles, CHU Saint-Pierre, 1000 Brussels, Belgium
- GDepartment of Intensive Care Medicine, CHU Saint-Pierre, 1000 Brussels, Belgium
| | - Marc Claus
- Department of Pneumology, Université Libre de Bruxelles, CHU Saint-Pierre, 1000 Brussels, Belgium
- GDepartment of Intensive Care Medicine, CHU Saint-Pierre, 1000 Brussels, Belgium
| | - Anne-Violette Bruyneel
- Geneva School of Health Sciences, HES-SO University of Applied Sciences and Arts Western Switzerland, 1206 Geneva, Switzerland
| | - Ophelie Menez
- Department of Pneumology, Université Libre de Bruxelles, CHU Saint-Pierre, 1000 Brussels, Belgium
- Department of Radiology, CHU Saint-Pierre, 1000 Brussels, Belgium
| | - Stephane Alard
- Department of Pneumology, Université Libre de Bruxelles, CHU Saint-Pierre, 1000 Brussels, Belgium
- Department of Radiology, CHU Saint-Pierre, 1000 Brussels, Belgium
| | - Nathalie De Vos
- Department of Pneumology, Université Libre de Bruxelles, CHU Saint-Pierre, 1000 Brussels, Belgium
- Department of Clinical Chemistry, LHUB-ULB, CHU Saint-Pierre, 1000 Brussels, Belgium
| | - Marie Bruyneel
- Department of Pneumology, CHU Saint-Pierre, 1000 Brussels, Belgium
- Department of Pneumology, Université Libre de Bruxelles, CHU Saint-Pierre, 1000 Brussels, Belgium
| |
Collapse
|