Result of one-year, prospective follow-up of intensive care unit survivors after SARS-CoV-2 pneumonia

Abstract

Introduction: Survivors of viral ARDS are at risk of long-term physical, functional and neuropsychological complications resulting from the lung injury itself, but also from potential multiorgan dysfunction, and the long stay in the intensive care unit (ICU). Recovery profiles after severe SARS-CoV-2 pneumonia in intensive care unit survivors have yet to be clearly defined.

Material and methods: The goal of this single-center, prospective, observational study was to systematically evaluate pulmonary and extrapulmonary function at 12 months after a stay in the ICU, in a prospectively identified cohort of patients who survived SARS-CoV-2 pneumonia. Eligible patients were assessed at 3, 6 and 12 months after onset of SARS-CoV-2. Patients underwent physical examination, pulmonary function testing, chest computed tomography (CT) scan, a standardized six-minute walk test with continuous oximetry, overnight home respiratory polygraphy and have completed quality of life questionnaire. The primary endpoint was alteration of the alveolar-capillary barrier compared to reference values as measured by DLCO, at 12 months after onset of SARS-CoV-2 symptoms.

Results: In total, 85 patients (median age 68.4 years, (interquartile range [IQR] = 60.1-72.9 years), 78.8% male) participated in the trial. The median length of hospital stay was 44 days (IQR: 20-60) including 17 days in ICU (IQR: 11-26). Pulmonary function tests were completed at 3 months (n = 85), 6 months (n = 80), and 12 months (n = 73) after onset of symptoms. Most patients showed an improvement in DLCO at each timepoint (3, 6, and 12 months). All patients who normalized their DLCO did not subsequently deteriorate, except one. Chest CT scans were abnormal in 77 patients (96.3%) at 3 months and although the proportion was the same at 12 months, but patterns have changed.

Conclusion: We report the results of a comprehensive evaluation of 85 patients admitted to the ICU for SARS-CoV-2, at one-year follow-up after symptom onset. We show that most patients had an improvement in DLCO at each timepoint.

Trial registration: Clinical trial registration number: NCT04519320.

Keywords: Acute respiratory distress syndrome; Pulmonary functional outcomes; SARS-CoV-2 pneumonia.

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s).

Figures

Fig. 1

Flowchart of patients with COVID-19. Enrollment of patients hospitalized in intensive care unit for severe Sars-COV-2 and follow-up for the first 12 months after symptoms onset

Fig. 2

Results of Quality of Life Assessments at 3, 6 and 12 months using the Medical Outcomes Study Short Form 36-item questionnaire. Graphic representation of medians MOS SF-36 subscales 3, 6 and 12 months after symptoms of Sars-Cov-2 onset

Fig. 3

Temporal changes in pulmonary function of ICU survivors of severe SARS-CoV-2 infection at 3, 6 and 12 months after symptoms onset. Graphs shows temporal changes in DLCO z-score (A), 6MWT walked distance (B) or SF36 General health (C) at 3, 6 and 12 months after SARS-CoV-2 symptoms onset. Data are median (IQR). Horizontal dotted line indicate the normal cutoff of z-score < LLN. DLCO diffusing capacity of the lung for carbon monoxide; 6MWT  six-minute-walk test; SF36 Short Form 36-item questionnaire