Six-month pulmonary impairment after severe COVID-19: a prospective, multicenter follow-up study

  1. Paola Faverio
  2. Fabrizio Luppi
  3. Paola Rebora
  4. Sara Busnelli
  5. Anna Stainer
  6. Martina Catalano
  7. Luca Parachini
  8. Anna Monzani
  9. Stefania Galimberti
  10. Francesco Bini
  11. Bruno Dino Bodini
  12. Monia Betti
  13. Federica De Giacomi
  14. Paolo Scarpazza
  15. Elisa Oggionni
  16. Alessandro Scartabellati
  17. Luca Bilucaglia
  18. Paolo Ceruti
  19. Denise Modina
  20. Sergio Harari
  21. Antonella Caminati
  22. Maria Grazia Valsecchi
  23. Giacomo Bellani
  24. Giuseppe Foti
  25. Alberto Pesci
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Abstract

Background and objective

Long-term pulmonary sequelae following SARS-CoV-2 pneumonia are not yet confirmed, however preliminary observations suggests a possible relevant clinical, functional and radiological impairment. The aim of this study was to identify and characterise pulmonary sequelae caused by SARS-CoV-2 pneumonia at 6-month follow-up.

Methods

In this multicenter, prospective, observational cohort 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 6 months from discharge. Pulmonary function tests and diffusion capacity for carbon monoxide (DLCO), 6 minutes walking test, chest X-ray, physical exam and modified Medical Research Council (mMRC) dyspnoea score were collected.

Results

Between March and June 2020, 312 patients were enrolled (83, 27% women; median [IQR] age 61.1 [53.4,69.3] years). The parameters that showed the highest rate of impairment were DLCO and chest-X-ray, in 46% and 25% of patients, respectively. However, only a minority of patients reported dyspnoea (31%), defined as mMRC ≥ 1, or showed a restrictive ventilatory defects (9%). In the logistic regression model, having asthma as comorbidity was associated with DLCO impairment at follow-up, while prophylactic heparin administration during hospitalisation appeared as a protective factor. Need for invasive ventilatory support during hospitalisation was associated with chest imaging abnormalities.

Conclusion

DLCO and radiological assessment appear to be the most sensitive tools to monitor patients with COVID-19 during follow-up. Future studies with longer follow-up are warranted to better understand pulmonary sequelae.

Summary at a glance

DLCO and radiological assessment are the most sensitive tools to monitor COVID-19 patients at 6-month follow-up. Invasive ventilatory support is a risk factor for detection of radiological abnormalities, but not for DLCO impairment, at follow-up. Whileuse of prophylactic heparin acts as a protective factor on the development of DLCOimpairment.

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