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

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Abstract

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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Most cited references 24

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Clinical Characteristics of Coronavirus Disease 2019 in China

Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)

Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)

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The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies.

Erik von Elm, Douglas G. Altman, Matthias Egger … (2014)

Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September 2004, with methodologists, researchers, and journal editors to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE Statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. 18 items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies. A detailed Explanation and Elaboration document is published separately and is freely available on the Web sites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE Statement will contribute to improving the quality of reporting of observational studies.

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Pulmonary pathology of early phase 2019 novel coronavirus (COVID-19) pneumonia in two patients with lung cancer

Sufang Tian, Weidong Hu, Li Niu … (2020)

There is currently a lack of pathologic data on the novel coronavirus (SARS-CoV-2) pneumonia, or COVID-19, from autopsy or biopsy. Two patients who recently underwent lung lobectomies for adenocarcinoma were retrospectively found to have had COVID-19 at the time of surgery. These two cases thus provide important first opportunities to study the pathology of COVID-19. Pathologic examinations revealed that, apart from the tumors, the lungs of both patients exhibited edema, proteinaceous exudate, focal reactive hyperplasia of pneumocytes with patchy inflammatory cellular infiltration, and multinucleated giant cells. Hyaline membranes were not prominent. Since both patients did not exhibit symptoms of pneumonia at the time of surgery, these changes likely represent an early phase of the lung pathology of COVID-19 pneumonia.

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Author and article information

Contributors

Paola Faverio:

ORCID: http://orcid.org/0000-0002-0360-1237

paola.faverio@unimib.it

Journal

Journal ID (nlm-ta): Respir Res

Journal ID (iso-abbrev): Respir Res

Title: Respiratory Research

Publisher: BioMed Central (London )

ISSN (Print): 1465-9921

ISSN (Electronic): 1465-993X

Publication date (Electronic): 21 March 2022

Publication date PMC-release: 21 March 2022

Publication date (Print): 2022

Volume: 23

Electronic Location Identifier: 65

Affiliations

[1 ]GRID grid.415025.7, ISNI 0000 0004 1756 8604, Department of Medicine and Surgery, , Università degli Studi di Milano Bicocca, Respiratory Unit, San Gerardo Hospital, ASST di Monza, ; via Pergolesi 33, 20900 Monza, Italy

[2 ]GRID grid.7563.7, ISNI 0000 0001 2174 1754, Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, , University of Milano Bicocca, ; Monza, Italy

[3 ]Radiology Unit, Gerardo Hospital, ASST Monza, Monza, Italy

[4 ]GRID grid.452490.e, Department of Biomedical Sciences, , Humanitas University, ; Via Rita Levi Montalcini 4, Pieve Emanuele, 20072 Milan, Italy

[5 ]GRID grid.417728.f, ISNI 0000 0004 1756 8807, IRCCS Humanitas Research Hospital, Respiratory Unit, ; Via Manzoni 56, 20089 Rozzano, Milan Italy

[6 ]Division of Pulmonary Medicine, Civile Hospital, Vimercate, MB Italy

[7 ]GRID grid.419450.d, Division of Pulmonary Medicine, , Cremona Hospital, ASST Cremona, ; Cremona, Italy

[8 ]UOC Pulmonology, Department of Internal Medicine, Ospedale G. Salvini, ASST-Rhodense, Garbagnate Milanese, MI Italy

[9 ]GRID grid.416292.a, ISNI 0000 0004 1759 8897, Department of Pulmonology and Respiratory High-Dependency Unit, , Ospedale Maggiore, ; Crema, Italy

[10 ]GRID grid.412725.7, U.O. Pneumologia e Fisiopatologia Respiratoria-ASST Spedali Civili di Brescia, ; Brescia, Italy

[11 ]GRID grid.416367.1, ISNI 0000 0004 0485 6324, Department of Medical Sciences, , San Giuseppe Hospital, MultiMedica IRCCS, ; Milan, Italy

[12 ]GRID grid.4708.b, ISNI 0000 0004 1757 2822, Department of Clinical Sciences and Community Health, , Università degli Studi di Milano, ; Milan, Italy

[13 ]U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare. Ospedale San Giuseppe-MultiMedica IRCCS, via San Vittore 12, 20123 Milan, MI Italy

[14 ]U.O.C. Radiologia, Civile Hospital, Vimercate, MB Italy

[15 ]GRID grid.419450.d, U.O. Radiodiagnostica, Cremona Hospital, ASST Cremona, ; Cremona, Italy

[16 ]U.O.C. Radiodiagnostica, Ospedale G. Salvini, ASST-Rhodense, Garbagnate Milanese, MI Italy

[17 ]GRID grid.416292.a, ISNI 0000 0004 1759 8897, U.O.C. Radiologia, Ospedale Maggiore, ; Crema, Italy

[18 ]GRID grid.412725.7, U.O. Radiologia, ASST Spedali Civili di Brescia, ; Brescia, Italy

[19 ]GRID grid.6292.f, ISNI 0000 0004 1757 1758, Dipartimento di Radiologia, Policlinico di Sant’Orsola, Alma Mater Studiorum-Università di Bologna, ; Bologna, Italy

[20 ]GRID grid.7563.7, ISNI 0000 0001 2174 1754, School of Medicine and Surgery, University of Milano Bicocca, ; Monza, Italy

[21 ]Department of Anesthesia and Intensive Care Medicine, ASST Monza, Monza, Italy

Author information

Paola Faverio http://orcid.org/0000-0002-0360-1237

Article

Publisher ID: 1994

DOI: 10.1186/s12931-022-01994-y

PMC ID: 8934910

PubMed ID: 35313890

SO-VID: 2a0e76d5-6707-4134-9ed6-10e7b2be87c2

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 27 October 2021

Date accepted : 15 March 2022

Custom metadata

ScienceOpen disciplines: Respiratory medicine

Keywords: covid-19,pneumonia,pulmonary function test,pulmonary fibrosis,high resolution computed tomography (hrct)

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ScienceOpen disciplines: Respiratory medicine

Keywords: covid-19, pneumonia, pulmonary function test, pulmonary fibrosis, high resolution computed tomography (hrct)

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

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Abstract

Background

Methods

Results

Conclusion

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Novel Coronavirus Disease COVID-19

Most cited references 24

Clinical Characteristics of Coronavirus Disease 2019 in China

The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: guidelines for reporting observational studies.

Pulmonary pathology of early phase 2019 novel coronavirus (COVID-19) pneumonia in two patients with lung cancer

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