Cluster analysis unveils a severe persistent respiratory impairment phenotype 3-months after severe COVID-19

Jeanne-Marie Perotin, Fabien Gierski, Lois Bolko, Sandra Dury, Sarah Barrière, Claire Launois, Maxime Dewolf, Stéphane Chouabe, Eric Bongrain, Davy Picard, Eric Tran, Yoann N'Guyen, Bruno Mourvillier, Amélie Servettaz, Amandine Rapin, Claude Marcus, François Lebargy, Arthur Kaladjian, Jean-Hugues Salmon, Gaetan Deslee, Jeanne-Marie Perotin, Fabien Gierski, Lois Bolko, Sandra Dury, Sarah Barrière, Claire Launois, Maxime Dewolf, Stéphane Chouabe, Eric Bongrain, Davy Picard, Eric Tran, Yoann N'Guyen, Bruno Mourvillier, Amélie Servettaz, Amandine Rapin, Claude Marcus, François Lebargy, Arthur Kaladjian, Jean-Hugues Salmon, Gaetan Deslee

Abstract

Background: The mid-term respiratory sequelae in survivors of severe COVID-19 appear highly heterogeneous. In addition, factors associated with respiratory sequelae are not known. In this monocentric prospective study, we performed a multidisciplinary assessment for respiratory and muscular impairment and psychological distress 3 months after severe COVID-19. We analysed factors associated with severe persistent respiratory impairment, amongst demographic, COVID-19 severity, and 3-month assessment.

Methods: Patients with severe SARS-CoV-2 pneumonia requiring ≥ 4L/min were included for a systematic 3-month visit, including respiratory assessment (symptoms, lung function, CT scan), muscular evaluation (body composition, physical function and activity, disability), psychopathological evaluation (anxiety, depression, post-traumatic stress disorder-PTSD) and quality of life. A cluster analysis was performed to identify subgroups of patients based on objective functional measurements: DLCO, total lung capacity and 6-min walking distance (6MWD).

Results: Sixty-two patients were analysed, 39% had dyspnea on exercise (mMRC ≥ 2), 72% had DLCO < 80%, 90% had CT-scan abnormalities; 40% had sarcopenia/pre-sarcopenia and 31% had symptoms of PTSD. Cluster analysis identified a group of patients (n = 18, 30.5%) with a severe persistent (SP) respiratory impairment (DLCO 48 ± 12%, 6MWD 299 ± 141 m). This SP cluster was characterized by older age, severe respiratory symptoms, but also sarcopenia/pre-sarcopenia, symptoms of PTSD and markedly impaired quality of life. It was not associated with initial COVID-19 severity or management.

Conclusions and clinical implication: We identified a phenotype of patients with severe persistent respiratory and muscular impairment and psychological distress 3 months after severe COVID-19. Our results highlight the need for multidisciplinary assessment and management after severe SARS-CoV-2 pneumonia. Trial registration The study was registered on ClinicalTrials.gov (May 6, 2020): NCT04376840.

Keywords: COVID-19; Clustering; DLCO; Post-traumatic stress disorder; Sarcopenia.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
CT-scan features at diagnosis and 3-month assessment in patients with decreased CT-score (a, b) and patients with increased CT-score (c) at 3 months
Fig. 2:
Fig. 2:
3-month CT-score (a) and CT-score change from admission (b) in patients in the severe persistent respiratory impairment (SP) cluster (red bars) and the non severe persistent respiratory impairment (NSP) cluster (green bars). Three patients were not included in the clustering analysis: DLCO was not available for 2 patients, 6MWD was not available for one patient (white bars; NA: not applicable)

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