BackgroundCoronavirus disease 2019 (COVID-19) has spread worldwide determining a dramatic impact on the healthcare system. Aim of this study is to evaluate mid-term clinical impact of COVID-19 on respiratory function.Methods379 patients were evaluated 4 months after SARS-COV-2 diagnosis. Patients were divided in two groups based on the presence of pneumonia during COVID. Clinical conditions, quality of life, symptomatology, 6-min walking test, pulmonary function test with spirometry and diffusing capacity of carbon monoxide were analysed. Data were compared to clinical evolution during COVID (development of acute respiratory distress syndrome [ARDS], needing of invasive mechanical ventilation [IMV], partial oxygen saturation/ fraction of inspired oxygen [SpO2/FiO2] ratio and pneumonia severity index [PSI]).ResultsAfter a median of 135 days, 260 (68.6%) of 379 patients referred almost one symptom. Patients who developed pneumonia during COVID-19 showed lower SpO2 at rest (p<0.001), SpO2 during 6-min walking test (p<0.001), total lung capacity (p<0.001), airway occlusion pressure after 0.1 s [P0.1] (p=0.02), P0.1/maximal inspiratory pressure [MIP] ratio (p=0.005) and higher Borg category-ratio scale (p=0.006) and modified Medical Research Council breathlessness scale (p=0.003), compared to patients without pneumonia. SpO2/FiO2 ratio and PSI during SARS-COV-2 pneumonia were directly associated with mid-term alteration of partial oxygen saturation at rest (p<0.001), SpO2 during 6-min walking test (p<0.001), residual volume (p<0.001), total lung capacity (respectively p<0.001 and p=0.003) and forced vital capacity (respectively p=0.004, p=0.03).ConclusionLung damage during COVID-19 correlates to the reduction of pulmonary function after 4 months from acute infection.

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Background:The pathogenesis of novel coronavirus disease (COVID-19) includes virus-induced systemic endothelial dysfunction, cytokine storm, and complement cascade hyperactivation, creating massive inflammatory and pro-coagulative states with diffuse vascular thrombosis. Objective: Our observational cohort study analyzed the effectiveness of corticosteroids and anticoagulant combined treatment in patients affected by COVID-19. Design and patients: 423 patients were retrospectively included in the analysis. Patients were divided into four groups: Group 1 (G1, n = 135): No treated; group 2 (G2, n = 8): Treated by methylprednisolone; group 3 (G3, n = 214): Those received low-molecular-weight heparin (LMWH); group 4 (G4, n = 66): Patients treated with combined methylprednisolone plus LMWH. The study outcome was the treatment failure, defined as all-cause of death or Intensive Care Unit (ICU) admission.Results: Mortality and ICU admission rates were 20.6% and 15.1%, respectively. The per-group analysis showed an increased prognosis for G3 (HR 0.59, 95%CI 0.36-0.95, p = 0.03) and G4 (HR 0.47, 95%CI 0.27-0.82, p = 0.007) vs. non-treated group (G1). Combined therapy was especially successful in those patients with the worst respiratory function (SpO 2 / FiO 2 ratio ≤ 220) (HR 0.43, 95%CI 0.24-0.77, p = 0.004). Conclusions:LMWH treatment alone and/or in combination with methylprednisolone seems to be associated with a better outcome, reducing the rate of treatment failure in patients affected by COVID-19 pneumonia.