Severe SARS-CoV-2 pneumonia: Clinical, functional and imaging outcomes at 4 months.
COVID-19
Fibrosis
Follow-up
Sequelae: Pulmonary embolism
Journal
Respiratory medicine and research
ISSN: 2590-0412
Titre abrégé: Respir Med Res
Pays: France
ID NLM: 101746324
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
received:
29
12
2020
revised:
27
03
2021
accepted:
20
04
2021
pubmed:
10
7
2021
medline:
15
12
2021
entrez:
9
7
2021
Statut:
ppublish
Résumé
Given the pathophysiology of coronavirus disease 19 (COVID-19), persistent pulmonary abnormalities are likely. We conducted a prospective cohort study in severe COVID-19 patients who had oxygen saturation<94% and were primarily admitted to hospital. We aimed to describe persistent gas exchange abnormalities at 4 months, defined as decreased diffusing capacity of the lungs for carbon monoxide (DLco) and/or desaturation on the 6-minute walk test (6MWT), along with associated mechanisms and risk factors. Of the 72 patients included, 76.1% required admission to an intensive care unit (ICU), while 68.5% required invasive mechanical ventilation (MV). A total of 39.1% developed venous thromboembolism (VTE). After 4 months, 61.4% were still symptomatic. Functionally, 39.1% had abnormal carbon monoxide test results and/or desaturation on 6MWT; high-flow oxygen, MV, and VTE during the acute phase were significantly associated. Restrictive lung disease was observed in 23.6% of cases, obstructive lung disease in 16.7%, and respiratory muscle dysfunction in 18.1%. A severe initial presentation with admission to ICU (P=0.0181), and VTE occurrence during the acute phase (P=0.0089) were associated with these abnormalities. 41% had interstitial lung disease in computed tomography (CT) of the chest. Four patients (5.5%) displayed residual defects on lung scintigraphy, only one of whom had developed VTE during the acute phase (5.5%). The main functional respiratory abnormality (31.9%) was reduced capillary volume (Vc<70%). Among patients with severe COVID-19 pneumonia who were admitted to hospital, 61% were still symptomatic, 39% of patients had persistent functional abnormalities and 41% radiological abnormalities after 4 months. Embolic sequelae were rare but the main functional respiratory abnormality was reduced capillary volume. A respiratory check-up after severe COVID-19 pneumonia may be relevant to improve future management of these patients.
Identifiants
pubmed: 34242974
pii: S2590-0412(21)00011-8
doi: 10.1016/j.resmer.2021.100822
pmc: PMC8080504
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
100822Informations de copyright
Copyright © 2021 SPLF and Elsevier Masson SAS. All rights reserved.
Références
Thromb Haemost. 2020 Jun;120(6):998-1000
pubmed: 32316063
N Engl J Med. 2020 Apr 30;382(18):1708-1720
pubmed: 32109013
J Thromb Haemost. 2020 Jun;18(6):1421-1424
pubmed: 32271988
Chest. 2012 Sep;142(3):583-592
pubmed: 22948576
Eur J Radiol. 2020 Jul;128:109017
pubmed: 32387924
Am J Respir Crit Care Med. 2002 Jan 15;165(2):277-304
pubmed: 11790668
Thromb Res. 2019 Dec;184:67-76
pubmed: 31710860
Thromb Res. 2020 Jul;191:145-147
pubmed: 32291094
Thorax. 2020 Nov;75(11):1009-1016
pubmed: 32839287
Clin Chest Med. 2004 Sep;25(3):455-65, v-vi
pubmed: 15331186
Pulm Med. 2020 Aug 10;2020:6175964
pubmed: 32850151
Eur Respir J. 2003 Dec;22(6):1026-41
pubmed: 14680096
Anasth Intensivther Notfallmed. 1980 Aug;15(4):340-9
pubmed: 7416450
Am J Respir Crit Care Med. 1994 Jul;150(1):90-4
pubmed: 8025779
J Nucl Med. 2000 Jun;41(6):1043-8
pubmed: 10855632
Thorax. 2005 May;60(5):401-9
pubmed: 15860716
Chest. 1991 May;99(5):1232-7
pubmed: 2019184
Thorax. 2021 Apr;76(4):402-404
pubmed: 33273023
ERJ Open Res. 2020 Oct 26;6(4):
pubmed: 33257910
New Horiz. 1993 Nov;1(4):563-77
pubmed: 8087576
Thorax. 2021 Apr;76(4):399-401
pubmed: 33273026