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Dietz TK, Brondstater KN. Long COVID management: a mini review of current recommendations and underutilized modalities. Front Med (Lausanne) 2024; 11:1430444. [PMID: 38947233 PMCID: PMC11211541 DOI: 10.3389/fmed.2024.1430444] [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: 05/09/2024] [Accepted: 06/04/2024] [Indexed: 07/02/2024] Open
Abstract
Long COVID is a condition that develops in a subset of patients after COVID-19 infection comprising of symptoms of varying severity encompassing multiple organ systems. Currently, long COVID is without consensus on a formal definition, identifiable biomarkers, and validated treatment. Long COVID is expected to be a long-term chronic condition for a subset of patients and is associated with suffering and incapacity. There is an urgent need for clear management guidelines for the primary care provider, who is essential in bridging the gap with more specialized care to improve quality of life and functionality in their patients living with long COVID. The purpose of this mini review is to provide primary care providers with the latest highlights from existing literature regarding the most common long COVID symptoms and current management recommendations. This review also highlights the underutilized interventions of stellate ganglion blocks and low-dose naltrexone, both with well-established safety profiles demonstrated to improve quality of life and functionality for patients suffering with some symptoms of long COVID, and encourages prompt referral to interventional pain management.
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Affiliation(s)
- Tiffany K. Dietz
- School of Health Professions, Shenandoah University, Winchester, VA, United States
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2
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Smith MP, Sharpe H, Damant RW, Ferrara G, Lim RK, Stickland MK, Lam GY. Factors associated with phenotypes of dyspnea in post-COVID-19 condition: a cross-sectional study. Sci Rep 2024; 14:13387. [PMID: 38862585 PMCID: PMC11167032 DOI: 10.1038/s41598-024-64370-4] [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: 01/03/2024] [Accepted: 06/06/2024] [Indexed: 06/13/2024] Open
Abstract
Post-COVID-19 condition (PCC) is defined as the persistence of symptoms, like fatigue and dyspnea, at least 3 months post-COVID infection. As dyspnea is a common symptom, we attempted to further clinically phenotype those with PCC-associated dyspnea. 1642 adults (average age of 49.6y with 63% female-predominance and BMI of 31.2 kg/m2) with physician confirmed diagnosis of PCC from June 2020-April 2023 in Alberta, Canada were included. Those with dyspnea were more likely to be female (56.5%, p = 0.005) and have higher BMI (31.3 kg/m2 vs. 29.5 kg/m2; p = 0.0008), history of asthma (21.1% vs. 12.3%; p < 0.001), more persistent PCC symptoms (p = 0.0001), more functional limitations, as well as lower quality of life (p < 0.0001). Multivariable-adjusted logistic regression analysis demonstrated dyspnea was independently associated with fatigue (OR = 4.20; CI = 2.71,6.59) and inversely associated with hospitalization for COVID-19 (OR = 0.53; CI = 0.32,0.91), age (OR = 0.98 per one year of age; CI = 0.96,0.99) and 6-min-walk-distance per 10 m difference (OR = 0.98, CI = 0.96,1.0). Fatigue was a predictor of dyspnea, and was associated with milder infection, higher BMI, and reduced 6-min-walk-distance despite normal pulmonary function. Reduced TLC or DLCO was associated with more severe infection and reduced 6-min-walk-distance. Thus, we speculate there are at least two dyspnea-associated phenotypes: phenotype with pronounced fatigue (normal PFT) and phenotype with pronounced pulmonary abnormalities (abnormal PFT). Improved understanding of the dyspnea-associated phenotypes may allow for better targeted rehabilitation.
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Affiliation(s)
- Maeve P Smith
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta and Alberta Health Services, 3-111C Clinical Sciences Building, 11302 83 Ave NW, Edmonton, T6G 2G3, AB, Canada
- Alberta Respiratory Centre, University of Alberta, Edmonton, AB, Canada
| | - Heather Sharpe
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta and Alberta Health Services, 3-111C Clinical Sciences Building, 11302 83 Ave NW, Edmonton, T6G 2G3, AB, Canada
| | - Ronald W Damant
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta and Alberta Health Services, 3-111C Clinical Sciences Building, 11302 83 Ave NW, Edmonton, T6G 2G3, AB, Canada
- Alberta Respiratory Centre, University of Alberta, Edmonton, AB, Canada
| | - Giovanni Ferrara
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta and Alberta Health Services, 3-111C Clinical Sciences Building, 11302 83 Ave NW, Edmonton, T6G 2G3, AB, Canada
- Alberta Respiratory Centre, University of Alberta, Edmonton, AB, Canada
| | - Rachel K Lim
- Division of Respiratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michael K Stickland
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta and Alberta Health Services, 3-111C Clinical Sciences Building, 11302 83 Ave NW, Edmonton, T6G 2G3, AB, Canada
- Alberta Respiratory Centre, University of Alberta, Edmonton, AB, Canada
| | - Grace Y Lam
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta and Alberta Health Services, 3-111C Clinical Sciences Building, 11302 83 Ave NW, Edmonton, T6G 2G3, AB, Canada.
- Alberta Respiratory Centre, University of Alberta, Edmonton, AB, Canada.
- Women and Children's Health Research Institute, University of Alberta, Edmonton, AB, Canada.
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3
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Nasrullah A, Virk S, Javed A, Shah A, Ramanujam D, Sharma A, Gutierrez L, Nauer K, Maggio M, Yin Y, Bajwa Y, Cheema T, Disilvio B. Effects of pulmonary rehabilitation on functional and psychological parameters in post-acute sequelae of SARS-CoV-2 infection (PASC) patients. BMC Pulm Med 2024; 24:231. [PMID: 38745298 PMCID: PMC11092229 DOI: 10.1186/s12890-024-03047-0] [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] [Received: 12/08/2023] [Accepted: 05/06/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND COVID-19 survivors may develop long-term symptoms of fatigue, dyspnea, mental health issues, and functional limitations: a condition termed post-acute sequelae of COVID-19 (PASC). Pulmonary rehabilitation (PR) is a recommended treatment for PASC; however, there is a lack of data regarding PR's effect on multiple health indices and the factors that influence patient outcomes. The aim of our study is to evaluate the impact of pulmonary rehabilitation on functional and psychological parameters in patients diagnosed with Post-Acute Sequelae of SARS-CoV-2 Infection (PASC), thereby offering insights into the efficacy of such interventions in improving the quality of life and clinical outcomes for these individuals. METHODS We extracted patient demographic, comorbidity, and outcome data from Allegheny Health Network's electronic medical records. Functionality test results were compared before and after PR, including 6-minute walk test (6MWT), chair rise repetitions (CR reps), timed up and go test (TUG), gait speed (Rehab gait), modified medical research council scale (MMRC), shortness of breath questionnaire (SOBQ), hospital anxiety and depression scale (HADS) and chronic obstructive pulmonary disease assessment test (CAT) scores. Multiple regression analysis was done to evaluate the effect of comorbidities and patient factors on patient responses to PR. RESULTS The 55 patients included in this study had a mean time of 4 months between the initial COVID-19 diagnosis and the subsequent PASC diagnosis. Following pulmonary rehabilitation (PR), significant improvements were observed across various metrics. The distance covered in the 6-minute walk test (6MWT) increased markedly from a pre-rehabilitation average of 895 feet (SD 290) to 1,300 feet (SD 335) post-rehabilitation, with a mean change of 405 feet (95% CI [333, 477]). Chair rise repetitions (CR reps) saw an increase from 9 (SD 3) reps to 13 (SD 3) reps, with a change of 4 reps (95% CI [3.7, 4.9]). The timed up and go test (TUG) time decreased significantly from 13 s (SD 5) to 10 s (SD 2), reflecting a mean reduction of 3 s (95% CI [-4.5, -2.5]). Rehabilitation gait speed improved from 1.0 m/s to 1.3 m/s, changing by 0.3 m/s (95% CI [0.2, 0.3]). The Modified Medical Research Council (MMRC) dyspnea scale showed a notable decrease from a mean of 2 (SD 1) to 1 (SD 1), a change of -1 (95% CI [-1.5, -1]). The Shortness of Breath Questionnaire (SOBQ) scores reduced significantly from 51 (SD 21) to 22 (SD 18), with a change of -29 (95% CI [-34, -23]). The Hospital Anxiety and Depression Scale (HADS) scores decreased from 11 (SD 7) to 8 (SD 7), a reduction of -4 (95% CI [-5, -2]). Lastly, the Chronic Obstructive Pulmonary Disease (COPD) Assessment Test (CAT) scores significantly dropped from 18 (SD 7) to 9 (SD 7), changing by -10 (95% CI [-11, -8]). However, the presence of hypertension, diabetes, chronic lung diseases, outpatient status, and receipt of specific pharmacologic treatments (decadron, decadron + remdesivir, and decadron + remdesivir + tocilizumab) were identified as factors associated with a poor response to PR. CONCLUSION Our study supports PR as an integrated model of care for PASC patients to improve several physical and mental health indices. The long-term effects of PR on patients' functional status should be investigated in the future.
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Affiliation(s)
- Adeel Nasrullah
- Division of Pulmonary and Critical Care, Allegheny Health Network, Pittsburgh, PA, USA.
| | - Shiza Virk
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Anam Javed
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Aaisha Shah
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Deeksha Ramanujam
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Alisha Sharma
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Laura Gutierrez
- Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA
| | - Kevin Nauer
- Division of Pulmonary and Critical Care, Allegheny Health Network, Pittsburgh, PA, USA
| | | | - Yue Yin
- Allegheny-Singer Research Institute, Allegheny Health Network, Pittsburgh, PA, USA
| | | | - Tariq Cheema
- Division of Pulmonary and Critical Care, Allegheny Health Network, Pittsburgh, PA, USA
| | - Briana Disilvio
- Division of Pulmonary and Critical Care, Allegheny Health Network, Pittsburgh, PA, USA
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Socolovsky M, Lu JCY, Zarra F, Wei CK, Chang TNJ, Chuang DCC. Effects of COVID-19 Pandemic in Patients with a Previous Phrenic Nerve Transfer for a Traumatic Brachial Plexus Palsy. J Brachial Plex Peripher Nerve Inj 2024; 19:e20-e26. [PMID: 38868462 PMCID: PMC11168810 DOI: 10.1055/s-0044-1787296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/03/2024] [Indexed: 06/14/2024] Open
Abstract
Background With the advent of the coronavirus disease 2019 (COVID-19) pandemic, some doubts have been raised regarding the potential respiratory problems that patients who previously underwent a phrenic nerve transfer could have. Objectives To analyze the effects of the coronavirus infection on two populations, one from Argentina and another from Taiwan. Specific objectives were: (1) to identify the rate of COVID in patients with a history of phrenic nerve transfer for treatment of palsy; (2) to identify the overall symptom profile; (3) to compare Argentinian versus Taiwanese populations; and (4) to determine if any phrenic nerve transfer patients are at particular risk of more severe COVID. Methods A telephonic survey that included data regarding the number of episodes of acute COVID-19 infection, the symptoms it caused, the presence or absence of potential or life-threatening complications, and the status of COVID-19 vaccination were studied. Intergroup comparisons were conducted using the nonparametric Mann-Whitney U test, with categorical variables conducted using either the Pearson χ2 analysis or the Fisher's exact test, as appropriate. Results A total of 77 patients completed the survey, 40 from Taiwan and 37 from Argentina. Fifty-five (71.4%) developed a diagnosis of COVID. However, among these, only four had any level of dyspnea reported (4/55 = 7.3%), all mild. There were also no admissions to hospital or an intensive care unit, no intubations, and no deaths. All 55 patients isolated themselves at home. Conclusions It can be concluded that an acute COVID-19 infection was very well tolerated in our patients. (Level of evidence 3b, case reports).
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Affiliation(s)
- Mariano Socolovsky
- Division of Neurosurgery, Hospital de Clínicas, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
| | - Johnny Chuieng-Yi Lu
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Francisco Zarra
- Department of Neurosurgery, Sanatorio Guemes, University of Buenos Aires School of Medicine, Buenos Aires, Argentina
| | - Chen Kuan Wei
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Tommy Nai-Jen Chang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - David Chwei-Chin Chuang
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Resta E, Cuscianna E, Pierucci P, Custodero C, Solfrizzi V, Sabbà C, Palmisano CM, Barratta F, De Candia ML, Tummolo MG, Capozza E, Lomuscio S, De Michele L, Tafuri S, Resta O, Lenato GM. Significant burden of post-COVID exertional dyspnoea in a South-Italy region: knowledge of risk factors might prevent further critical overload on the healthcare system. Front Public Health 2023; 11:1273853. [PMID: 38179561 PMCID: PMC10764627 DOI: 10.3389/fpubh.2023.1273853] [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: 08/07/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
Background Exertional dyspnoea in post-COVID syndrome is a debilitating manifestation, requiring appropriate comprehensive management. However, limited-resources healthcare systems might be unable to expand their healthcare-providing capacity and are expected to be overwhelmed by increasing healthcare demand. Furthermore, since post-COVID exertional dyspnoea is regarded to represent an umbrella term, encompassing several clinical conditions, stratification of patients with post-COVID exertional dyspnoea, depending on risk factors and underlying aetiologies might provide useful for healthcare optimization and potentially help relieve healthcare service from overload. Hence, we aimed to investigate the frequency, functional characterization, and predictors of post-COVID exertional dyspnoea in a large cohort of post-COVID patients in Apulia, Italy, at 3-month post-acute SARS-CoV-2 infection. Methods A cohort of laboratory-confirmed 318 patients, both domiciliary or hospitalized, was evaluated in a post-COVID Unit outpatient setting. Post-COVID exertional dyspnoea and other post-COVID syndrome manifestations were collected by medical history. Functional characterization of post-COVID exertional dyspnoea was performed through a 6-min walking test (6-mwt). The association of post-COVID exertional dyspnoea with possible risk factors was investigated through univariate and multivariate logistic regression analysis. Results At medical evaluation, post-COVID exertional dyspnoea was reported by as many as 190/318 patients (59.7%), showing relatively high prevalence also in domiciliary-course patients. However, functional characterization disclosed a 6-mwt-based desaturation walking drop in only 24.1% of instrumental post-COVID exertional dyspnoea patients. Multivariate analysis identified five independent predictors significantly contributing to PCED, namely post-COVID-fatigue, pre-existing respiratory co-morbidities, non-asthmatic allergy history, age, and acute-phase-dyspnoea. Sex-restricted multivariate analysis identified a differential risk pattern for males (pre-existing respiratory co-morbidities, age, acute-phase-dyspnoea) and females (post-COVID-fatigue and acute-phase-dyspnoea). Conclusion Our findings revealed that post-COVID exertional dyspnoea is characterized by relevant clinical burden, with potential further strain on healthcare systems, already weakened by pandemic waves. Sex-based subgroup analysis reveals sex-specific dyspnoea-underlying risk profiles and pathogenic mechanisms. Knowledge of sex-specific risk-determining factors might help optimize personalized care management and healthcare resources.
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Affiliation(s)
- Emanuela Resta
- University of Foggia – Doctorate School of Translational Medicine and Management of Health Systems, Foggia, Italy
| | - Eustachio Cuscianna
- Dipartimento Interdisciplinare di Medicina, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Paola Pierucci
- Policlinico Hospital, University of Bari Aldo Moro – Respiratory Medicine Unit, Bari, Italy
| | - Carlo Custodero
- Policlinico Hospital – University of Bari Aldo Moro – “Frugoni” Internal Medicine and Geriatric Unit, Bari, Italy
| | - Vincenzo Solfrizzi
- Policlinico Hospital – University of Bari Aldo Moro – “Frugoni” Internal Medicine and Geriatric Unit, Bari, Italy
| | - Carlo Sabbà
- Policlinico Hospital – University of Bari Aldo Moro – “Frugoni” Internal Medicine and Geriatric Unit, Bari, Italy
| | - Chiara Maria Palmisano
- Policlinico Hospital – University of Bari Aldo Moro – “Frugoni” Internal Medicine and Geriatric Unit, Bari, Italy
| | - Federica Barratta
- “POC Central-SS. Annunziata-Moscati” Taranto Hospital – Pulmonology Unit, Taranto, Italy
| | | | | | - Elena Capozza
- Terlizzi “Sarcone” Hospital – Pulmonology and Respiratory Rehabilitation Unit, Terlizzi, Italy
| | - Sonia Lomuscio
- Department of Biomedicine and Prevention, Tor Vergata University of Rome, Rome, Italy
| | - Lucrezia De Michele
- Policlinico Hospital – University of Bari Aldo Moro – Cardiology Unit, Bari, Italy
| | - Silvio Tafuri
- Dipartimento Interdisciplinare di Medicina, Università degli Studi di Bari Aldo Moro, Bari, Italy
| | - Onofrio Resta
- Policlinico Hospital – University of Bari Aldo Moro – Post-COVID Unit Service of Respiratory Medicine, Bari, Italy
| | - Gennaro Mariano Lenato
- Policlinico Hospital – University of Bari Aldo Moro – “Frugoni” Internal Medicine and Geriatric Unit, Bari, Italy
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Pálfi A, Balogh ÁL, Polónyi G, Schulcz D, Zöllei É, Bari G, Fodor GH, Baráth K, Somfay A, Peták F, Babik B. Post-COVID changes in lung function 6 months after veno-venous extracorporeal membrane oxygenation: a prospective observational clinical trial. Front Med (Lausanne) 2023; 10:1288679. [PMID: 38173937 PMCID: PMC10761408 DOI: 10.3389/fmed.2023.1288679] [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: 09/08/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Background Severe coronavirus disease 2019 (COVID-19) may require veno-venous extracorporeal membrane oxygenation (V-V ECMO). While V-V ECMO is offered in severe lung injury to COVID-19, long-term respiratory follow-up in these patients is missing. Therefore, we aimed at providing comprehensive data on the long-term respiratory effects of COVID-19 requiring V-V ECMO support during the acute phase of infection. Methods In prospective observational cohort study design, patients with severe COVID-19 receiving invasive mechanical ventilation and V-V ECMO (COVID group, n = 9) and healthy matched controls (n = 9) were evaluated 6 months after hospital discharge. Respiratory system resistance at 5 and 19 Hz (R5, R19), and the area under the reactance curve (AX5) was evaluated using oscillometry characterizing total and central airway resistances, and tissue elasticity, respectively. R5 and R19 difference (R5-R19) reflecting small airway function was also calculated. Forced expired volume in seconds (FEV1), forced expiratory vital capacity (FVC), functional residual capacity (FRC), carbon monoxide diffusion capacity (DLCO) and transfer coefficient (KCO) were measured. Results The COVID group had a higher AX5 and R5-R19 than the healthy matched control group. However, there was no significant difference in terms of R5 or R19. The COVID group had a lower FEV1 and FVC on spirometry than the healthy matched control group. Further, the COVID group had a lower FRC on plethysmography than the healthy matched control group. Meanwhile, the COVID group had a lower DLCO than healthy matched control group. Nevertheless, its KCO was within the normal range. Conclusion Severe acute COVID-19 requiring V-V ECMO persistently impairs small airway function and reduces respiratory tissue elasticity, primarily attributed to lung restriction. These findings also suggest that even severe pulmonary pathologies of acute COVID-19 can manifest in a moderate but still persistent lung function impairment 6 months after hospital discharge. Trial registration NCT05812196.
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Affiliation(s)
- Alexandra Pálfi
- Department of Anesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
| | - Ádám L. Balogh
- Department of Anesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
| | - Gabriella Polónyi
- Department of Anesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
| | - Domonkos Schulcz
- Department of Anesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
| | - Éva Zöllei
- Department of Anesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
| | - Gábor Bari
- Cardiac Surgery Unit, Department of Internal Medicine, University of Szeged, Szeged, Hungary
| | - Gergely H. Fodor
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Kristóf Baráth
- Department of Pulmonology, University of Szeged, Szeged, Hungary
| | - Attila Somfay
- Department of Pulmonology, University of Szeged, Szeged, Hungary
| | - Ferenc Peták
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Barna Babik
- Department of Anesthesiology and Intensive Therapy, University of Szeged, Szeged, Hungary
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Cecchetto A, Guarnieri G, Torreggiani G, Vianello A, Baroni G, Palermo C, Bertagna De Marchi L, Lorenzoni G, Bartolotta P, Bertaglia E, Donato F, Aruta P, Iliceto S, Mele D. Dyspnea in Post-Acute COVID-19: A Multi-Parametric Cardiopulmonary Evaluation. J Clin Med 2023; 12:4658. [PMID: 37510773 PMCID: PMC10380208 DOI: 10.3390/jcm12144658] [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: 06/08/2023] [Revised: 07/01/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Post-acute COVID-19 is characterized by the persistence of dyspnea, but the pathophysiology is unclear. We evaluated the prevalence of dyspnea during follow-up and factors at admission and follow-up associated with dyspnea persistence. After five months from discharge, 225 consecutive patients hospitalized for moderate to severe COVID-19 pneumonia were assessed clinically and by laboratory tests, echocardiography, six-minute walking test (6MWT), and pulmonary function tests. Fifty-one patients reported persistent dyspnea. C-reactive protein (p = 0.025, OR 1.01 (95% CI 1.00-1.02)) at admission, longer duration of hospitalization (p = 0.005, OR 1.05 (95% CI 1.01-1.10)) and higher body mass index (p = 0.001, OR 1.15 (95% CI 1.06-1.28)) were independent predictors of dyspnea. Absolute drop in SpO2 at 6MWT (p = 0.001, OR 1.37 (95% CI 1.13-1.69)), right ventricular (RV) global longitudinal strain (p = 0.016, OR 1.12 (95% CI 1.02-1.25)) and RV global longitudinal strain/systolic pulmonary artery pressure ratio (p = 0.034, OR 0.14 (95% CI 0.02-0.86)) were independently associated with post-acute COVID-19 dyspnea. In conclusion, dyspnea is present in many patients during follow-up after hospitalization for COVID-19 pneumonia. While higher body mass index, C-reactive protein at admission, and duration of hospitalization are predictors of persistent dyspnea, desaturation at 6MWT, and echocardiographic RV dysfunction are associated with this symptom during the follow-up period.
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Affiliation(s)
- Antonella Cecchetto
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Gabriella Guarnieri
- Respiratory Pathophysiology Division, University of Padua, 35128 Padua, Italy
| | - Gianpaolo Torreggiani
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Andrea Vianello
- Respiratory Pathophysiology Division, University of Padua, 35128 Padua, Italy
| | - Giulia Baroni
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Chiara Palermo
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | | | - Giulia Lorenzoni
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Patrizia Bartolotta
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Emanuele Bertaglia
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Filippo Donato
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Patrizia Aruta
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Sabino Iliceto
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
| | - Donato Mele
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padua, Italy
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