Abstract P547: Post Acute COVID Syndrome: Clinical and Laboratory Evaluation of Survivors in a Longitudinal Cohort Study

Introduction: The infection by the SARS-CoV-2 virus, initially described as an acute disease that only affected the pulmonary system, is now known to chronically affect other systems after the resolution of the acute phase. As a result, a hidden pandemic was born. Still with no clear consensus about its definition and management, post-acute Covid syndrome (PACS) is expected to be the next great burden of health services.

Hypothesis: Whether sociodemographic, acute infection, current health, and physical examination variables are associated with PACS in survivors of the different forms of acute COVID-19.

Methods: multicentric and observational study, patients from the city of Curitiba and its outskirts diagnosed with COVID-19 between June/2020 and Feb/2022 were referred due to persistent symptoms and evaluated with questionnaires on their acute infection and current symptoms, along with an interdisciplinary physical examination. A telephone consultation also investigated the quality of life. Patients were classified into two groups according to the National Institute for Health and Care Excellence: subacute infection (SI) and PACS. Individuals without sociodemographic and acute infection-related variables were excluded. The primary outcomes included current symptoms, modified Medical Research Council Dyspnea Scale, mini-mental state examination, multisystemic physical exam, quality of life, and new diagnoses variables, which were used in a univariate analysis to evaluate their significance in between groups.

Results: 113 COVID-19 survivors were included, 63.71% were diagnosed with PACS. The mean follow-up time from the onset of acute symptoms was 104 days (IQR 46 - 163) and the overall median number of sequelae was of 9.0 (IQR 5.0 - 11.0). In the overall sample, 53.1% were women and the mean age was 51.7 ± 13.2 years. 83% were admitted to the intensive care unit and those were more likely to present with PACS (65.0%) (p=0.037). The same was observed when the use of supplementary oxygen by cannula (SI 67.5%; PACS 87.7%; p=0.022) and non-invasive ventilation were analyzed (SI 47.0%; PACS 69.7%; p=0.026). Sequelae that presented with significantly prevalence in the PACS population were (% SI; % PACS; p): dyspnea (80.5%; 59.7%; 0.036), hair loss (48.8%; 19.4%; 0.001), and upper limbs paresthesia (14.6%; 2.8%; 0.049). Meanwhile, sequelae that were found to have higher prevalence within the PACS population were: cough (17.1%; 44.4%; 0.004), gait issues (9.8%; 34.7%; 0.003); dysgeusia (2.4%; 22.2%; 0.005); anosmia (4.9%; 19.4%; 0.047); tremors (2.4%; 15.3%; 0.053); and nail alterations (2.4%; 15.3%; 0.053).

Conclusion: Patients with PACS were generally also the most severe cases of acute infection, also presenting a higher prevalence of specific sequelae. These data should be reproduced in other settings and countries to help define determinants of PACS in a high-risk population.

Abstract P544: Post-COVID-19: Predictors of Pulmonary Fibrosis

Introduction: From observational studies, it is known that some survivors of COVID-19 pneumonia have developed fibrotic pulmonary remodeling, restrictive lung abnormalities, associated with impaired exercise tolerance and poor quality of life at follow-up. Post-COVID-19 pulmonary fibrosis may be defined as the presence of persistent fibrotic changes identified on follow-up CT scans, such as traction bronchiectasis. It is important to identify the potential risk factors for the occurrence of pulmonary fibrosis in this context, although they have not yet been completely defined.

Hypothesis: We hypothesize that lung fibrosis may be also a possible long-term consequence of COVID-19 pneumonia and the risk factors associated with the acute phase that enhance the risk of pulmonary sequelae, such as duration of hospitalization and intensive care stay, of high-flow oxygen support, and need for mechanical ventilation.

Methods: We undertook a cohort study of COVID-19 survivors, that required supplemental oxygenation during the acute phase, who had been discharged from hospitals April 2020 to March 2022 in public hospitals of Curitiba/PR (BRAZIL). At 1-month and 6-month follow-up visit, survivors were interviewed with questionnaires symptoms, received a physical examination, sit-to-stand test, laboratory test ant chest CT scan was performed between two visits. The primary outcomes were persistent fibrotic changes, such as traction bronchiectasis, on follow-up chest CT. Multivariable adjusted logistic regression models were used to evaluate the risk factors of CT scan outcomes.

Results: We followed 63 COVID-19 survivors with CT scan follow-up. The median age of patients was 52 years (±13.3) and 37 (58.7%) were women. The median CT scan follow-up time was 151 days (38-428). The median hospitalization time during acute phase was 13 (3-48) days. The proportion of patients with persistent dyspnoea, characterized by mMRC score of 1 or more, was 52 (82,5%). The proportion of patients with at least one fibrotic change on CT scan was 35 (55.6%), traction bronchiectasis was identified on 16 (25.4%). Hospitalization time during acute phase was associated with traction bronchiectasis, main persistent fibrotic change on CT scan (OR, 1.19; 95% CI:1.036, 1.207; p=0,004).

Conclusion: In a follow-up, the duration of hospitalization COVID-19 acute phase was associated with higher odds of traction bronchiectasis on chest CT follow-up.

Abstract P446: Physical Inactivity and Chronic Conditions Are Associated With Lower Functioning in Older Adults With Osteoarthritis

Introduction: Population aged >60 years compose the age group that grows the most disproportionately. Despite several positive individual and social aspects an increase in the prevalence of chronic non-communicable diseases, including OA is observed.

Hypothesis: Whether physical activity (PA) levels and number of chronic diseases are associated with handgrip strength (HGS), chair stand test (CST) results, and difficulties to dressing among older adults presenting with hip pain and diagnosed with hip osteoarthritis (OA).

Methods: We analyzed Wave 5 of the Survey of Health, Ageing and Retirement in Europe. We analyzed two age groups of individuals diagnosed with hip OA: 60-79 and 80-100 year groups. Univariate and multivariate logistic models were constructed considering the poor performance cut-offs in the strength, functioning, and mobility tests as the dependent variables, and physical inactivity, number of chronic diseases, body mass index (BMI), gender and education as the exposure variables.

Results: We included 2.088 participants (mean age 73.1±8.5 years). The majority (89.3%) reportedly had two or more chronic diseases, the most prevalent being hypertension. The participants were mostly overweight or obese (69.8%); however, two of three (75%) participants reported moderate-to-vigorous daily activity. Low levels of moderate-to-vigorous PA were significantly and independently associated with muscle weakness, dysfunctioning, and poor mobility in both age groups (p<0.05). Having five or more chronic diseases was significantly associated with disability in individuals with hip OA aged ≥60 years (p<0.05).

Conclusions: Low PA levels and chronic conditions are significantly associated with reduced functioning in individuals aged ≥60 years with symptomatic hip OA, especially in the 80-100 year subgroup. These findings are important for stakeholders to maintain adequate PA levels in older individuals despite their hip OA diagnoses.