Coronavirus Disease 2019: COSeSco – A Risk Assessment Score to Predict the Risk of Pulmonary Sequelae in COVID-19 Patients

Abstract

<b><i>Background:</i></b> The presence of interstitial pneumonia in coronavirus disease 2019 (COVID-19) patients, as diagnosed through laboratory, functional, and radiological data, provides potential predicting factors of pulmonary sequelae. <b><i>Objectives:</i></b> The objectives were the creation of a risk assessment score for pulmonary sequelae at high-resolution computed tomography (HRCT) through the assessment of laboratory data, lung function, and radiological changes in patients after the onset of COVID-19 interstitial pneumonia and the identification of predictive factors. <b><i>Methods:</i></b> We enrolled 121 subjects hospitalized due to COVID-19 pneumonia in our study. Clinical features, Charlson Comorbidity Index (CCI) score, HRCT score, and blood chemistry data at hospital admission, as well as HRCT score, pulmonary function testing values, exercise capacity by means of a 6-Minute Walk Test (6MWT), and dyspnea perception by the modified Medical Research Council (mMRC) at 4-month follow-up, were all recorded. The variables were elaborated in order to create a predictive model to identify patients at high risk of pulmonary sequelae at HRCT. <b><i>Results:</i></b> At the time of follow-up visit, 63% of patients had functional abnormality (diffusion lung capacity and/or total lung capacity <80% of predicted). Age, BMI, CCI, D-dimer, 6MWT, and mMRC were included in the COVID-19 Sequelae Score (COSeSco, ranging 0–15), which was able to individuate COVID-19 patients with radiologic sequelae (HRCT score >10%) at follow-up. The most revelatory COSeSco value that was found to intercept the highest sensitivity (100%) and specificity (77%) was 2. <b><i>Conclusion:</i></b> The COSeSco – comprising age, BMI, comorbidities, D-dimer, walking distance, and dyspnea perception – makes it possible to identify particularly at-risk COVID-19 patients who are likely to develop pulmonary sequelae assessed by HRCT.

One Year Overview and Follow-Up in a Post-COVID Consultation of Critically Ill Patients

“…These data are even more worrisome than ours, probably because this group focused on invasively ventilated patients. Further studies are needed to create or validate scores to identify patients at high risk of pulmonary sequelae on chest CT ( 22 ).…”

“…These prospective cohorts of patients already point to a high prevalence of pulmonary involvement represented by an abnormal DLCO and many chest CT findings. This is especially important in those with the most severe disease in the acute phase, where 54% of patients (22). Although all of these studies assessed pulmonary sequelae after COVID-19 at 12 months (8,10,20), none of them provided information about the clinical management and follow-up in a real post-COVID consultation.…”

“…Focusing on the survivors, the median (IQR) ICU stay was 9 (5-24.2) days, and the overall hospitalization duration was 22 (13-37) days. During the ICU stay, 50.7% of patients required IMV with a median (IQR) duration of 17 (10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25) days. Prone positioning was needed in 47.2% of the patients.…”

Effects of SARS-CoV-2 Infection on Pulmonary Function Tests and Exercise Tolerance

“…Previous studies have shown that in COVID-19 survivors, the main pulmonary function abnormalities were a reduction in DLco with an almost normal DLco/VA and a reduction in FVC and TLC with an increase in the FEV 1 /FVC ratio [ 2 , 3 , 7 , 8 , 10 , 11 , 12 , 27 ].…”

A Key to Unlocking the Mysteries of COVID-19 Pulmonary Sequelae: Are We There?

“…In this issue of Respiration, Aiello et al [ 13 ] reported the results of a prospective, observational, single-center study of a large cohort of subjects who suffered from COVID-19 pneumonia during their follow-up post-hospital admission. They collected changes in clinical and functional data to identify risk factors for high-resolution computer tomography (HRCT) sequelae in COVID-19 patients after hospitalization and to test the usefulness and clinical relevance of the COSeSco score (COVID-19 Sequelae Score), which includes age, body mass index, comorbidities, and D-dimer at the time of hospitalization, as well as exercise capacity and dyspnea at follow-up, for the prediction of developing pulmonary sequelae at HRCT.…”