Six-Month Pulmonary Impairment after Severe COVID-19: A Prospective, Multicentre Follow-Up Study

Faverio, Paola; Luppi, Fabrizio; Rebora, Paola; Busnelli, Sara; Stainer, Anna; Catalano, Martina; Parachini, Luca; Monzani, Anna; Galimberti, Stefania; Bini, Francesco; Bodini, Bruno Dino; Betti, Monia; Giacomi, Federica De; Scarpazza, Paolo; Oggionni, Elisa; Scartabellati, Alessandro; Bilucaglia, Luca; Ceruti, Paolo; Modina, Denise; Harari, Sergio; Caminati, Antonella; Valsecchi, Maria Grazia; Bellani, Giacomo; Pesci, Alberto

doi:10.1159/000518141

Cited by 42 publications

(52 citation statements)

References 24 publications

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“…Therefore, our results can more accurately investigate the correlation between long-term lung damage caused by COVID-19 infection and autonomic dysfunction. In addition, our results agreed with previous followup studies that autonomic long-term lung injury in patients with COVID-19 is dominated by diffusion dysfunction and pulmonary fibrosis (Faverio et al, 2021;Huang et al, 2021;Shah et al, 2021).…”

Section: Discussionsupporting

confidence: 92%

Alternation of the Autonomic Nervous System Is Associated With Pulmonary Sequelae in Patients With COVID-19 After Six Months of Discharge

et al. 2022

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Previous studies suggest that autonomic dysfunction is associated with disease severity in acute phase in patients with coronavirus disease 2019 (COVID-19). However, the association between autonomic dysfunction and pulmonary sequelae in patients with COVID-19 is unknown. We conducted a prospective study to investigate the association between autonomic dysfunction and pulmonary sequelae in patients with COVID-19 discharged for 6 months. We included 40 eligible participants and collected the following indicators: heart rate variability (HRV), pulmonary function tests (PFTs), lung X-ray computed tomography (CT), routine blood parameters, liver function parameters, and lymphocyte subsets. We found that at 6 months post-discharge, HRV still had a tight correlation with pulmonary fibrosis. There was a significant difference in HRV between patients with and without diffusion dysfunction, but HRV did not differ between patients with or without ventilatory dysfunction. Diffusion dysfunction and pulmonary fibrosis were tightly associated, and HRV index changes in patients with diffusion dysfunction had the same trend as that of patients with pulmonary fibrosis. They had a lower standard deviation of NN intervals (SDNN), the standard deviation of the average NN intervals (SDANN), and the triangular index, but a higher ratio between LF and HF power (LF/HF). In addition, WBC, neutrophils, and CD4/CD8 were correlated with pulmonary fibrosis and HRV. We concluded that autonomic dysfunction is closely associated with pulmonary fibrosis and diffusion dysfunction, and immune mechanisms may potentially contribute to this process.

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Section: Discussionsupporting

confidence: 92%

Alternation of the Autonomic Nervous System Is Associated With Pulmonary Sequelae in Patients With COVID-19 After Six Months of Discharge

et al. 2022

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“…Results from 6 months follow-up, as well as inclusion and exclusion criteria and study procedures, are summarised in the manuscript by Faverio et al . [ 4 ]. In the present paper we report results from the 12-month follow-up visit (visits were conducted in a time span ranging from 11 to 13 months after discharge with no differences between groups).…”

Section: Methodsmentioning

confidence: 99%

“…Pneumonia and acute respiratory distress syndrome (ARDS), frequent manifestations of COVID-19, may cause pulmonary sequelae including pulmonary fibrosis [ 2 , 3 ]. Short-term pulmonary sequelae have been described in cohorts of patients followed up between 3 and 6 months after discharge and range from mild respiratory impairment, with moderately reduced DLCO in asymptomatic patients, to more significant restrictive ventilatory dysfunction in patients suffering persistent pulmonary symptoms, mainly exertional dyspnea [ 4 , 5 ]. The severity of respiratory failure and the need of higher respiratory support (endotracheal intubation and invasive mechanical ventilation (IMV)) during pneumonia together with the extension of the radiological involvement were identified as factors associated to the development of pulmonary sequelae both functional and radiological [ 4 – 6 ].…”

Section: Introductionmentioning

confidence: 99%

One-year pulmonary impairment after severe COVID-19: a prospective, multicenter follow-up study

et al. 2022

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Background Long-term pulmonary sequelae following hospitalization for SARS-CoV-2 pneumonia is largely unclear. The aim of this study was to identify and characterise pulmonary sequelae caused by SARS-CoV-2 pneumonia at 12-month from discharge. Methods In this multicentre, prospective, observational study, patients hospitalised for SARS-CoV-2 pneumonia and without prior diagnosis of structural lung diseases were stratified by maximum ventilatory support (“oxygen only”, “continuous positive airway pressure (CPAP)” and “invasive mechanical ventilation (IMV)”) and followed up at 12 months from discharge. Pulmonary function tests and diffusion capacity for carbon monoxide (DLCO), 6 min walking test, high resolution CT (HRCT) scan, and modified Medical Research Council (mMRC) dyspnea scale were collected. Results Out of 287 patients hospitalized with SARS-CoV-2 pneumonia and followed up at 1 year, DLCO impairment, mainly of mild entity and improved with respect to the 6-month follow-up, was observed more frequently in the “oxygen only” and “IMV” group (53% and 49% of patients, respectively), compared to 29% in the “CPAP” group. Abnormalities at chest HRCT were found in 46%, 65% and 80% of cases in the “oxygen only”, “CPAP” and “IMV” group, respectively. Non-fibrotic interstitial lung abnormalities, in particular reticulations and ground-glass attenuation, were the main finding, while honeycombing was found only in 1% of cases. Older patients and those requiring IMV were at higher risk of developing radiological pulmonary sequelae. Dyspnea evaluated through mMRC scale was reported by 35% of patients with no differences between groups, compared to 29% at 6-month follow-up. Conclusion DLCO alteration and non-fibrotic interstitial lung abnormalities are common after 1 year from hospitalization due to SARS-CoV-2 pneumonia, particularly in older patients requiring higher ventilatory support. Studies with longer follow-ups are needed.

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“…Few studies have addressed the problem of clinical and functional aftermath in patients after hospitalization for COVID-19 Pneumonia [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 ]. Most of these studies have assessed only one aspect of lung sequelae, such as symptoms [ 1 ], pulmonary function tests (PFTs) [ 2 , 3 , 4 ], and high-resolution computed tomography (HRCT) [ 5 , 6 ].…”

Section: Introductionmentioning

confidence: 99%

Spontaneous Evolution of COVID-19 Lung Sequelae: Results from a Double-Step Follow-Up

et al. 2022

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Background: Few studies have reported a double-step follow-up of patients after hospitalization for COVID-19. Objectives: We designed an observational double-step follow-up study with a clinical, functional, and radiological evaluation at 2 and 6 months after COVID-19. The primary outcome was to describe symptoms, spirometry, and 6-minute walking test (6MWT) at 2 and 6 months. Secondary outcomes were to identify if the lowest PaO2/FiO2 during hospitalization is related with functional and radiological evolution and to assess the correlation between radiological and functional abnormalities at 6 months. Methods: Symptoms, spirometry, and 6MWT were assessed at 2 and 6 months; arterial blood gas, chest x-ray, and lung ultrasound were performed at 2 months; body plethysmography, diffusing capacity for carbon monoxide (DLCO), and CT scan were performed at 6 months. Results: Sixty-four per cent and 42% of patients reported at least one symptom at 2 and 6 months, respectively. The most common 6-month functional alteration was DLCO impairment (57% of patients). An improvement of FEV1, FVC, and 6MWT was observed between 2 and 6 months (p < 0.001). Patients with PaO2/FiO2 <200 during hospitalization performed worse at 6MWT at 2 and 6 months (p < 0.05) and reported more extended radiological abnormalities at 6 months (p < 0.001) compared with patients with PaO2/FiO2>200. At 6 months, more extended radiological abnormalities were related with worse 6MWT, DLCO, and total lung capacity (p < 0.05). Discussion: DLCO and 6MWT impairment seem to be the functional hallmark of COVID-19 and are related with the severity of acute pneumonia. At 6 months, radiological abnormalities were related to functional impairment.

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Six-Month Pulmonary Impairment after Severe COVID-19: A Prospective, Multicentre Follow-Up Study

Cited by 42 publications

References 24 publications

Alternation of the Autonomic Nervous System Is Associated With Pulmonary Sequelae in Patients With COVID-19 After Six Months of Discharge

Alternation of the Autonomic Nervous System Is Associated With Pulmonary Sequelae in Patients With COVID-19 After Six Months of Discharge

One-year pulmonary impairment after severe COVID-19: a prospective, multicenter follow-up study

Spontaneous Evolution of COVID-19 Lung Sequelae: Results from a Double-Step Follow-Up

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