Long-term bone and lung consequences associated with hospital-acquired severe acute respiratory syndrome: a 15-year follow-up from a prospective cohort study

Peixun Zhang, Jia Li, Huixin Liu, Na Han, Jiabao Ju, Yuhui Kou, Lei Chen, Mengxi Jiang, Feng Pan, Yali Zheng, Zhancheng Gao, Baoguo Jiang, Peixun Zhang, Jia Li, Huixin Liu, Na Han, Jiabao Ju, Yuhui Kou, Lei Chen, Mengxi Jiang, Feng Pan, Yali Zheng, Zhancheng Gao, Baoguo Jiang

Abstract

The most severe sequelae after rehabilitation from SARS are femoral head necrosis and pulmonary fibrosis. We performed a 15-year follow-up on the lung and bone conditions of SARS patients. We evaluated the recovery from lung damage and femoral head necrosis in an observational cohort study of SARS patients using pulmonary CT scans, hip joint MRI examinations, pulmonary function tests and hip joint function questionnaires. Eighty medical staff contracted SARS in 2003. Two patients died of SARS, and 78 were enrolled in this study from August 2003 to March 2018. Seventy-one patients completed the 15-year follow-up. The percentage of pulmonary lesions on CT scans diminished from 2003 (9.40 ± 7.83)% to 2004 (3.20 ± 4.78)% (P < 0.001) and remained stable thereafter until 2018 (4.60 ± 6.37)%. Between 2006 and 2018, the proportion of patients with interstitial changes who had improved pulmonary function was lower than that of patients without lesions, as demonstrated by the one-second ratio (FEV1/FVC%, t = 2.21, P = 0.04) and mid-flow of maximum expiration (FEF25%-75%, t = 2.76, P = 0.01). The volume of femoral head necrosis decreased significantly from 2003 (38.83 ± 21.01)% to 2005 (30.38 ± 20.23)% (P = 0.000 2), then declined slowly from 2005 to 2013 (28.99 ± 20.59)% and plateaued until 2018 (25.52 ± 15.51)%. Pulmonary interstitial damage and functional decline caused by SARS mostly recovered, with a greater extent of recovery within 2 years after rehabilitation. Femoral head necrosis induced by large doses of steroid pulse therapy in SARS patients was not progressive and was partially reversible.

Keywords: Bone; Calcium and phosphate metabolic disorders.

Conflict of interest statement

Competing interestsThe authors declare no competing interests.

© The Author(s) 2020.

Figures

Fig. 1
Fig. 1
Flow diagram of the follow-up examinations
Fig. 2
Fig. 2
Trends in percentage change of lesion area on pulmonary CT scan. a Changes in percentage in the injured lung CT. b Bubble plots and linear regression of changes in the percentage of injured lung on CT
Fig. 3
Fig. 3
Trends in percentage change of osteonecrotic volume on hip MRI scan. a Change in the percentage of osteonecrotic volume. b Bubble plots and linear regression of the percentage of osteonecrotic volume

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Source: PubMed

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