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

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

Abstract

Background: Long-term pulmonary sequelae following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia are not yet confirmed; however, preliminary observations suggest a possible relevant clinical, functional, and radiological impairment.

Objectives: The aim of this study was to identify and characterize pulmonary sequelae caused by SARS-CoV-2 pneumonia at 6-month follow-up.

Methods: In this multicentre, prospective, observational cohort study, patients hospitalized 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," and "invasive mechanical ventilation") and followed up at 6 months from discharge. Pulmonary function tests and diffusion capacity for carbon monoxide (DLCO), 6-min walking test, chest X-ray, physical examination, and modified Medical Research Council (mMRC) dyspnoea score were collected.

Results: Between March and June 2020, 312 patients were enrolled (83, 27% women; median interquartile range 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 restrictive ventilatory defects (9%). In the logistic regression model, having asthma as a comorbidity was associated with DLCO impairment at follow-up, while prophylactic heparin administration during hospitalization appeared as a protective factor. The need for invasive ventilatory support during hospitalization was associated with chest imaging abnormalities.

Conclusions: DLCO and radiological assessment appear to be the most sensitive tools to monitor patients with the coronavirus disease 2019 (COVID-19) during follow-up. Future studies with longer follow-up are warranted to better understand pulmonary sequelae.

Keywords: COVID-19; Follow-up; Pneumonia; Pulmonary fibrosis; Radiology and other imaging; Respiratory function tests.

Conflict of interest statement

The authors have no conflicts of interest to declare.

© 2021 S. Karger AG, Basel.

Figures

Fig. 1
Fig. 1
Study flowchart. CPAP, continuous positive airway pressure; IMV, invasive mechanical ventilation.
Fig. 2
Fig. 2
Distribution of obstructive and restrictive ventilatory patterns according to study group. Restrictive ventilatory impairment was defined as a reduction in TLC with a normal FEV1/VC. CPAP, continuous positive airway pressure; IMV, invasive mechanical ventilation; TLC, total lung capacity; FEV1, forced expiratory volume in the 1st second; VC, vital capacity.

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