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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.
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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.
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Catarata MJ, Creamer AW, Dias M, Toland S, Chaabouni M, Verbeke K, Vieira Naia J, Hassan M, Naidu SB, Lynch GA, Blyth KG, Rahman NM, Hardavella G. ERS International Congress 2023: highlights from the Thoracic Oncology Assembly. ERJ Open Res 2024; 10:00860-2023. [PMID: 38410708 PMCID: PMC10895436 DOI: 10.1183/23120541.00860-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 02/28/2024] Open
Abstract
Lung cancer is the leading cause of cancer mortality in the world. It greatly affects the patients' quality of life, and is thus a challenge for the daily practice in respiratory medicine. Advances in the genetic knowledge of thoracic tumours' mutational landscape, and the development of targeted therapies and immune checkpoint inhibitors, have led to a paradigm shift in the treatment of lung cancer and pleural mesothelioma. During the 2023 European Respiratory Society Congress in Milan, Italy, experts from all over the world presented their high-quality research and reviewed best clinical practices. Lung cancer screening, management of early stages of lung cancer, application of artificial intelligence and biomarkers were discussed and they will be summarised here.
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Affiliation(s)
- Maria Joana Catarata
- Pulmonology Department, Hospital de Braga, Braga, Portugal
- Tumour and Microenvironment Interactions Group, I3S – Institute for Health Research and Innovation, University of Porto, Porto, Portugal
| | | | - Margarida Dias
- Pulmonology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Sile Toland
- Department of Medicine, Letterkenny University Hospital, Letterkenny, Ireland
| | - Malek Chaabouni
- Asklepios Klinik Altona, Department of Internal Medicine II, Pulmonology and Thoracic Oncology Section, Hamburg, Germany
| | - Koen Verbeke
- Department of Respiratory Medicine, University Hospital Saint-Pierre, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Maged Hassan
- Chest Diseases Department, Alexandria University Faculty of Medicine, Alexandria, Egypt
| | | | - Geraldine A. Lynch
- Academic Respiratory Unit, University of Bristol Medical School, Bristol, UK
| | - Kevin G. Blyth
- Queen Elizabeth University Hospital, Glasgow, UK
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Najib M. Rahman
- Oxford University Hospitals NHS Foundation Trust, Oxford NIHR Biomedical Research Centre, John Radcliffe Hospital, Headington, UK
| | - Georgia Hardavella
- 9th Department of Respiratory Medicine, Sotiria Athens Chest Diseases Hospital, Athens, Greece
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Alilou S, Zangiabadian M, Pouramini A, Jaberinezhad M, Shobeiri P, Ghozy S, Haseli S, Beizavi Z. Radiological Findings as Predictors of COVID-19 Lung Sequelae: A Systematic Review and Meta-analysis. Acad Radiol 2023; 30:3076-3085. [PMID: 37491177 PMCID: PMC10242153 DOI: 10.1016/j.acra.2023.06.002] [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: 05/06/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 07/27/2023]
Abstract
RATIONALE AND OBJECTIVES This systematic review and meta-analysis aimed to investigate the radiological predictors of post-coronavirus disease 19 (COVID-19) pulmonary fibrosis and incomplete absorption of pulmonary lesions. MATERIALS AND METHODS We systematically searched PubMed, EMBASE, and Web of Science for studies reporting the predictive value of radiological findings in patients with post-COVID-19 lung residuals published through November 11, 2022. The pooled odds ratios with a 95% confidence interval (CI) were assessed. The random-effects model was used due to the heterogeneity of the true effect sizes. RESULTS We included 11 studies. There were 1777 COVID-19-positive patients, and 1014 (57%) were male. All studies used chest computed tomography (CT) as a radiologic tool. Moreover, chest X-ray (CXR) and lung ultrasound were used in two studies, along with a CT scan. CT severity score (CTSS), Radiographic Assessment of Lung Edema score (RALE), interstitial score, lung ultrasound score (LUS), patchy opacities, abnormal CXR, pleural traction, and subpleural abnormalities were found to be predictors of post-COVID-19 sequels. CTSS and consolidations were the most common predictors among included studies. Pooled analysis revealed that pulmonary residuals in patients with initial consolidation are about four times more likely than in patients without this finding (odds ratio: 3.830; 95% CI: 1.811-8.102, I2: 4.640). CONCLUSION Radiological findings can predict the long-term pulmonary sequelae of COVID-19 patients. CTSS is an important predictor of lung fibrosis and COVID-19 mortality. Lung fibrosis can be diagnosed and tracked using the LUS. Changes in RALE score during hospitalization can be used as an independent predictor of mortality.
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Affiliation(s)
- Sanam Alilou
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran (S.A.); Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran (S.A.)
| | - Moein Zangiabadian
- Endocrinology and Metabolism Research Center, Institute of Basic and Clinical Physiology Sciences, Kerman University of Medical Sciences, Kerman, Iran (M.Z.); School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran (M.Z.)
| | - Alireza Pouramini
- School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran (A.P.)
| | - Mehran Jaberinezhad
- Clinical Research Development Unit of Tabriz Valiasr Hospital, Tabriz University of Medical Sciences, Tabriz, Iran (M.J.)
| | - Parnian Shobeiri
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran (P.S.); Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran (P.S.)
| | - Sherief Ghozy
- Department of Radiology, Mayo Clinic, Rochester, Minnesota (S.G.)
| | - Sara Haseli
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran (S.H.)
| | - Zahra Beizavi
- Department of Radiology, Mayo Clinic, 5777 E Mayo Blvd, Phoenix, AZ 85054 (Z.B.).
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Colombi D, Petrini M, Risoli C, Mangia A, Milanese G, Silva M, Franco C, Sverzellati N, Michieletti E. Quantitative CT at Follow-Up of COVID-19 Pneumonia: Relationship with Pulmonary Function Tests. Diagnostics (Basel) 2023; 13:3328. [PMID: 37958224 PMCID: PMC10648873 DOI: 10.3390/diagnostics13213328] [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: 08/31/2023] [Revised: 10/20/2023] [Accepted: 10/26/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND The role of quantitative chest computed tomography (CT) is controversial in the follow-up of patients with COVID-19 pneumonia. The aim of this study was to test during the follow-up of COVID-19 pneumonia the association between pulmonary function tests (PFTs) and quantitative parameters extrapolated from follow-up (FU) CT scans performed at least 6 months after COVID-19 onset. METHODS The study included patients older than 18 years old, admitted to the emergency department of our institution between 29 February 2020 and 31 December 2020, with a diagnosis of COVID-19 pneumonia, who underwent chest CT at admission and FU CT at least 6 months later; PFTs were performed within 6 months of FU CT. At FU CT, quantitative parameters of well-aerated lung and pneumonia extent were identified both visually and by software using CT density thresholds. The association between PFTs and quantitative parameters was tested by the calculation of the Spearman's coefficient of rank correlation (rho). RESULTS The study included 40 patients (38% females; median age 63 years old, IQR, 56-71 years old). A significant correlation was identified between low attenuation areas% (%LAAs) <950 Hounsfield units (HU) and both forced expiratory volume in 1s/forced vital capacity (FEV1/FVC) ratio (rho -0.410, 95% CIs -0.639--0.112, p = 0.008) and %DLCO (rho -0.426, 95% CIs -0.678--0.084, p = 0.017). The remaining quantitative parameters failed to demonstrate a significant association with PFTs (p > 0.05). CONCLUSIONS At follow-up, CT scans performed at least 6 months after COVID-19 pneumonia onset showed %LAAs that were inversely associated with %DLCO and could be considered a marker of irreversible lung damage.
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Affiliation(s)
- Davide Colombi
- Radiology Unit, Department of Radiological Functions, AUSL Piacenza, Via Taverna 49, 29121 Piacenza, Italy; (M.P.); (C.R.)
| | - Marcello Petrini
- Radiology Unit, Department of Radiological Functions, AUSL Piacenza, Via Taverna 49, 29121 Piacenza, Italy; (M.P.); (C.R.)
| | - Camilla Risoli
- Radiology Unit, Department of Radiological Functions, AUSL Piacenza, Via Taverna 49, 29121 Piacenza, Italy; (M.P.); (C.R.)
| | - Angelo Mangia
- Pulmonology Unit, Department of Emergency, AUSL Piacenza, Via Taverna 49, 29121 Piacenza, Italy; (A.M.); (C.F.)
| | - Gianluca Milanese
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Via Gramsci 14, 43126 Parma, Italy; (G.M.); (M.S.)
| | - Mario Silva
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Via Gramsci 14, 43126 Parma, Italy; (G.M.); (M.S.)
| | - Cosimo Franco
- Pulmonology Unit, Department of Emergency, AUSL Piacenza, Via Taverna 49, 29121 Piacenza, Italy; (A.M.); (C.F.)
| | - Nicola Sverzellati
- Scienze Radiologiche, Department of Medicine and Surgery (DiMeC), University of Parma, Via Gramsci 14, 43126 Parma, Italy; (G.M.); (M.S.)
| | - Emanuele Michieletti
- Radiology Unit, Department of Radiological Functions, AUSL Piacenza, Via Taverna 49, 29121 Piacenza, Italy; (M.P.); (C.R.)
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Patrucco F, Solidoro P, Gavelli F, Apostolo D, Bellan M. Idiopathic Pulmonary Fibrosis and Post-COVID-19 Lung Fibrosis: Links and Risks. Microorganisms 2023; 11:microorganisms11040895. [PMID: 37110318 PMCID: PMC10146995 DOI: 10.3390/microorganisms11040895] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/26/2023] [Accepted: 03/28/2023] [Indexed: 03/31/2023] Open
Abstract
Idiopathic pulmonary fibrosis (IPF) is considered the paradigmatic example of chronic progressive fibrosing disease; IPF does not result from a primary immunopathogenic mechanism, but immune cells play a complex role in orchestrating the fibrosing response. These cells are activated by pathogen-associated or danger-associated molecular patterns generating pro-fibrotic pathways or downregulating anti-fibrotic agents. Post-COVID pulmonary fibrosis (PCPF) is an emerging clinical entity, following SARS-CoV-2 infection; it shares many clinical, pathological, and immune features with IPF. Similarities between IPF and PCPF can be found in intra- and extracellular physiopathological pro-fibrotic processes, genetic signatures, as well as in the response to antifibrotic treatments. Moreover, SARS-CoV-2 infection can be a cause of acute exacerbation of IPF (AE-IPF), which can negatively impact on IPF patients’ prognosis. In this narrative review, we explore the pathophysiological aspects of IPF, with particular attention given to the intracellular signaling involved in the generation of fibrosis in IPF and during the SARS-CoV-2 infection, and the similarities between IPF and PCPF. Finally, we focus on COVID-19 and IPF in clinical practice.
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Affiliation(s)
- Filippo Patrucco
- Respiratory Diseases Unit, Medical Department, AOU Maggiore della Carità Hospital, 28100 Novara, Italy
- Correspondence:
| | - Paolo Solidoro
- Medical Sciences Department, University of Turin, 10126 Turin, Italy
- Respiratory Diseases Unit, Cardiovascular and Thoracic Department, AOU Città della Salute e della Scienza di Torino, 10126 Turin, Italy
| | - Francesco Gavelli
- Translational Medicine Department, University of Eastern Piedmont, 28100 Novara, Italy
- Emergency Medicine Department, Maggiore della Carità Hospital, 28100 Novara, Italy
| | - Daria Apostolo
- Translational Medicine Department, University of Eastern Piedmont, 28100 Novara, Italy
| | - Mattia Bellan
- Translational Medicine Department, University of Eastern Piedmont, 28100 Novara, Italy
- Division of Internal Medicine, Medical Department, AOU Maggiore della Carità di Novara, 28100 Novara, Italy
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Long-term outcomes of COVID-19 convalescents: An 18.5-month longitudinal study in Wuhan. Int J Infect Dis 2023; 127:85-92. [PMID: 36509334 PMCID: PMC9733963 DOI: 10.1016/j.ijid.2022.12.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 11/17/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES This study aimed to describe the full scope of long-term outcomes and the ongoing pathophysiological alterations among COVID-19 survivors. METHODS We established a longitudinal cohort of 208 COVID-19 convalescents and followed them at 3.3 (interquartile range [IQR]: 1.3, 4.4, visit 1), 9.2 (IQR: 9.0, 9.6, visit 2), and 18.5 (IQR: 18.2, 19.1, visit 3) months after infection, respectively. Serial changes in multiple physical and psychological outcomes were comprehensively characterized. We, in addition, explored the potential risk factors of SARS-CoV-2 antibody response and sequelae symptoms. RESULTS We observed continuous improvement of sequelae symptoms, lung function, chest computed tomography (CT), 6-minute walk test, and the Borg dyspnea scale, whereas sequelae symptoms (at least one) and abnormal chest CT patterns still existed in 45.2% and about 30% of participants at 18.5 months, respectively. Anxiety and depression disorders were alleviated for the convalescents, although depression status was sustained for a longer duration. CONCLUSIONS Most COVID-19 convalescents had an overall improved physical and psychological health status, whereas sequelae symptoms, residual lesions on lung function, exercise impairment, and mental health disorders were still observed in a small proportion of participants at 18.5 months after infection. Implementing appropriate preventive and management strategies for the ever-growing COVID-19 population is warranted.
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Karampitsakos T, Sotiropoulou V, Katsaras M, Tsiri P, Georgakopoulou VE, Papanikolaou IC, Bibaki E, Tomos I, Lambiri I, Papaioannou O, Zarkadi E, Antonakis E, Pandi A, Malakounidou E, Sampsonas F, Makrodimitri S, Chrysikos S, Hillas G, Dimakou K, Tzanakis N, Sipsas NV, Antoniou K, Tzouvelekis A. Post-COVID-19 interstitial lung disease: Insights from a machine learning radiographic model. Front Med (Lausanne) 2023; 9:1083264. [PMID: 36733935 PMCID: PMC9886681 DOI: 10.3389/fmed.2022.1083264] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023] Open
Abstract
Introduction Post-acute sequelae of COVID-19 seem to be an emerging global crisis. Machine learning radiographic models have great potential for meticulous evaluation of post-COVID-19 interstitial lung disease (ILD). Methods In this multicenter, retrospective study, we included consecutive patients that had been evaluated 3 months following severe acute respiratory syndrome coronavirus 2 infection between 01/02/2021 and 12/5/2022. High-resolution computed tomography was evaluated through Imbio Lung Texture Analysis 2.1. Results Two hundred thirty-two (n = 232) patients were analyzed. FVC% predicted was ≥80, between 60 and 79 and <60 in 74.2% (n = 172), 21.1% (n = 49), and 4.7% (n = 11) of the cohort, respectively. DLCO% predicted was ≥80, between 60 and 79 and <60 in 69.4% (n = 161), 15.5% (n = 36), and 15.1% (n = 35), respectively. Extent of ground glass opacities was ≥30% in 4.3% of patients (n = 10), between 5 and 29% in 48.7% of patients (n = 113) and <5% in 47.0% of patients (n = 109). The extent of reticulation was ≥30%, 5-29% and <5% in 1.3% (n = 3), 24.1% (n = 56), and 74.6% (n = 173) of the cohort, respectively. Patients (n = 13, 5.6%) with fibrotic lung disease and persistent functional impairment at the 6-month follow-up received antifibrotics and presented with an absolute change of +10.3 (p = 0.01) and +14.6 (p = 0.01) in FVC% predicted at 3 and 6 months after the initiation of antifibrotic. Conclusion Post-COVID-19-ILD represents an emerging entity. A substantial minority of patients presents with fibrotic lung disease and might experience benefit from antifibrotic initiation at the time point that fibrotic-like changes are "immature." Machine learning radiographic models could be of major significance for accurate radiographic evaluation and subsequently for the guidance of therapeutic approaches.
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Affiliation(s)
| | - Vasilina Sotiropoulou
- Department of Respiratory Medicine, University General Hospital of Patras, Patras, Greece
| | - Matthaios Katsaras
- Department of Respiratory Medicine, University General Hospital of Patras, Patras, Greece
| | - Panagiota Tsiri
- Department of Respiratory Medicine, University General Hospital of Patras, Patras, Greece
| | | | | | - Eleni Bibaki
- Laboratory of Molecular and Cellular Pneumonology, Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Ioannis Tomos
- 5th Department of Respiratory Medicine, Hospital for Thoracic Diseases, ‘SOTIRIA’, Athens, Greece
| | - Irini Lambiri
- Laboratory of Molecular and Cellular Pneumonology, Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Ourania Papaioannou
- Department of Respiratory Medicine, University General Hospital of Patras, Patras, Greece
| | - Eirini Zarkadi
- Department of Respiratory Medicine, University General Hospital of Patras, Patras, Greece
| | | | - Aggeliki Pandi
- Department of Respiratory Medicine, Corfu General Hospital, Corfu, Greece
| | - Elli Malakounidou
- Department of Respiratory Medicine, University General Hospital of Patras, Patras, Greece
| | - Fotios Sampsonas
- Department of Respiratory Medicine, University General Hospital of Patras, Patras, Greece
| | - Sotiria Makrodimitri
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, Athens, Greece
| | - Serafeim Chrysikos
- 5th Department of Respiratory Medicine, Hospital for Thoracic Diseases, ‘SOTIRIA’, Athens, Greece
| | - Georgios Hillas
- 5th Department of Respiratory Medicine, Hospital for Thoracic Diseases, ‘SOTIRIA’, Athens, Greece
| | - Katerina Dimakou
- 5th Department of Respiratory Medicine, Hospital for Thoracic Diseases, ‘SOTIRIA’, Athens, Greece
| | - Nikolaos Tzanakis
- Laboratory of Molecular and Cellular Pneumonology, Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Nikolaos V. Sipsas
- Department of Infectious Diseases-COVID-19 Unit, Laiko General Hospital, Athens, Greece,Medical School, National and Kapodistrian University of Athens, Zografou, Greece
| | - Katerina Antoniou
- Laboratory of Molecular and Cellular Pneumonology, Department of Thoracic Medicine, Medical School, University of Crete, Heraklion, Greece
| | - Argyris Tzouvelekis
- Department of Respiratory Medicine, University General Hospital of Patras, Patras, Greece,*Correspondence: Argyris Tzouvelekis, ,
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Sonnweber T, Birgit S, Weiss G, Löffler-Ragg J. Pulmonary recovery after COVID-19 - a review. Expert Rev Respir Med 2023; 17:447-457. [PMID: 37449405 DOI: 10.1080/17476348.2023.2210837] [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: 12/29/2022] [Accepted: 05/02/2023] [Indexed: 07/18/2023]
Abstract
INTRODUCTION COVID-19 is caused by infection with the severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). As the respiratory tract is the primary site of infection and host-mediated inflammatory responses, pathologies and dysfunction of the respiratory system characterize the severe disease and are typically associated with the need for oxygen supply or even ventilator support. In survivors of severe COVID-19, computed tomography follow-up frequently reveals structural lung abnormalities, and one-third of individuals who were hospitalized during acute COVID-19 demonstrate persisting lung abnormalities for at least 12 months after disease onset. AREAS COVERED This review summarizes current evidence on pulmonary recovery after COVID-19, focusing on adult patients who suffered from COVID-19 pneumonia. EXPERT OPINION Severe COVID-19 is associated with a high frequency of persisting lung abnormalities at follow-up. The long-term consequences of these findings remain elusive and urge further evaluation to identify individuals at risk for COVID-19 long-term consequences.
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Affiliation(s)
- Thomas Sonnweber
- Department of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
| | - Sailer Birgit
- Department of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
| | - Günter Weiss
- Department of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
- Christian Doppler Laboratory for Iron Metabolism and Anaemia Research, Medical University Innsbruck, Innsbruck, Austria
| | - Judith Löffler-Ragg
- Department of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
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Ambrosino P, Sanduzzi Zamparelli S, Mosella M, Formisano R, Molino A, Spedicato GA, Papa A, Motta A, Di Minno MND, Maniscalco M. Clinical assessment of endothelial function in convalescent COVID-19 patients: a meta-analysis with meta-regressions. Ann Med 2022; 54:3234-3249. [PMID: 36382632 PMCID: PMC9673781 DOI: 10.1080/07853890.2022.2136403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Endothelial dysfunction has been proposed to play a key role in the pathogenesis of coronavirus disease 2019 (COVID-19) and its post-acute sequelae. Flow-mediated dilation (FMD) is recognized as an accurate clinical method to assess endothelial function. Thus, we performed a meta-analysis of the studies evaluating FMD in convalescent COVID-19 patients and controls with no history of COVID-19. METHODS A systematic literature search was conducted in the main scientific databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Using the random effects method, differences between cases and controls were expressed as mean difference (MD) with 95% confidence intervals (95% CI). The protocol was registered on PROSPERO with reference number CRD42021289684. RESULTS Twelve studies were included in the final analysis. A total of 644 convalescent COVID-19 patients showed significantly lower FMD values as compared to 662 controls (MD: -2.31%; 95% CI: -3.19, -1.44; p < 0.0001). Similar results were obtained in the sensitivity analysis of the studies that involved participants in either group with no cardiovascular risk factors or history of coronary artery disease (MD: -1.73%; 95% CI: -3.04, -0.41; p = 0.010). Interestingly, when considering studies separately based on enrolment within or after 3 months of symptom onset, results were further confirmed in both short- (MD: -2.20%; 95% CI: -3.35, -1.05; p < 0.0001) and long-term follow-up (MD: -2.53%; 95% CI: -4.19, -0.86; p = 0.003). Meta-regression models showed that an increasing prevalence of post-acute sequelae of COVID-19 was linked to a higher difference in FMD between cases and controls (Z-score: -2.09; p = 0.037). CONCLUSIONS Impaired endothelial function can be documented in convalescent COVID-19 patients, especially when residual clinical manifestations persist. Targeting endothelial dysfunction through pharmacological and rehabilitation strategies may represent an attractive therapeutic option.Key messagesThe mechanisms underlying the post-acute sequelae of coronavirus disease 2019 (COVID-19) have not been fully elucidated.Impaired endothelial function can be documented in convalescent COVID-19 patients for up to 1 year after infection, especially when residual clinical manifestations persist.Targeting endothelial dysfunction may represent an attractive therapeutic option in the post-acute phase of COVID-19.
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Affiliation(s)
- Pasquale Ambrosino
- Cardiac Rehabilitation Unit of Telese Terme Institute, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | | | - Marco Mosella
- Neurological Rehabilitation Unit of Telese Terme Institute, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Roberto Formisano
- Cardiac Rehabilitation Unit of Telese Terme Institute, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Antonio Molino
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | - Antimo Papa
- Cardiac Rehabilitation Unit of Telese Terme Institute, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
| | - Andrea Motta
- Institute of Biomolecular Chemistry, National Research Council, Pozzuoli, Italy
| | | | - Mauro Maniscalco
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.,Pulmonary Rehabilitation Unit of Telese Terme Institute, Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy
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