Severe SARS-CoV-2 pneumonia: Clinical, functional and imaging outcomes at 4 months

E Noel-Savina; T Viatgé; G Faviez; B Lepage; L T Mhanna; S Pontier; M Dupuis; S Collot; P Thomas; J Idoate Lacasia; L Crognier; S Bouharaoua; S Silva Sifontes; J Mazieres; G Prévot; A Didier

doi:10.1016/j.resmer.2021.100822

Severe SARS-CoV-2 pneumonia: Clinical, functional and imaging outcomes at 4 months

Respir Med Res. 2021 Nov:80:100822. doi: 10.1016/j.resmer.2021.100822. Epub 2021 Apr 28.

Authors

E Noel-Savina¹, T Viatgé², G Faviez², B Lepage³, L T Mhanna², S Pontier², M Dupuis², S Collot⁴, P Thomas⁵, J Idoate Lacasia², L Crognier⁶, S Bouharaoua⁶, S Silva Sifontes⁵, J Mazieres², G Prévot², A Didier²

Affiliations

¹ Department of Pneumology, Larrey Hospital, CHU Toulouse, Toulouse, France. Electronic address: noel-savina.e@chu-toulouse.fr.
² Department of Pneumology, Larrey Hospital, CHU Toulouse, Toulouse, France.
³ Department of Epidemiology, CHU Toulouse, Toulouse, France.
⁴ Department of Medical Imaging, Rangueil Hospital, CHU Toulouse, Toulouse, France.
⁵ Department of Nuclear Medicine, Rangueil Hospital, CHU Toulouse, Toulouse, France.
⁶ Adult Intensive Care Unit, CHU Toulouse, Toulouse, France.

Abstract

Introduction: Given the pathophysiology of coronavirus disease 19 (COVID-19), persistent pulmonary abnormalities are likely.

Methods: We conducted a prospective cohort study in severe COVID-19 patients who had oxygen saturation<94% and were primarily admitted to hospital. We aimed to describe persistent gas exchange abnormalities at 4 months, defined as decreased diffusing capacity of the lungs for carbon monoxide (DLco) and/or desaturation on the 6-minute walk test (6MWT), along with associated mechanisms and risk factors.

Results: Of the 72 patients included, 76.1% required admission to an intensive care unit (ICU), while 68.5% required invasive mechanical ventilation (MV). A total of 39.1% developed venous thromboembolism (VTE). After 4 months, 61.4% were still symptomatic. Functionally, 39.1% had abnormal carbon monoxide test results and/or desaturation on 6MWT; high-flow oxygen, MV, and VTE during the acute phase were significantly associated. Restrictive lung disease was observed in 23.6% of cases, obstructive lung disease in 16.7%, and respiratory muscle dysfunction in 18.1%. A severe initial presentation with admission to ICU (P=0.0181), and VTE occurrence during the acute phase (P=0.0089) were associated with these abnormalities. 41% had interstitial lung disease in computed tomography (CT) of the chest. Four patients (5.5%) displayed residual defects on lung scintigraphy, only one of whom had developed VTE during the acute phase (5.5%). The main functional respiratory abnormality (31.9%) was reduced capillary volume (Vc<70%).

Conclusion: Among patients with severe COVID-19 pneumonia who were admitted to hospital, 61% were still symptomatic, 39% of patients had persistent functional abnormalities and 41% radiological abnormalities after 4 months. Embolic sequelae were rare but the main functional respiratory abnormality was reduced capillary volume. A respiratory check-up after severe COVID-19 pneumonia may be relevant to improve future management of these patients.

Keywords: COVID-19; Fibrosis; Follow-up; Sequelae: Pulmonary embolism.

MeSH terms

COVID-19*
Humans
Lung Diseases, Interstitial*
Oxygen Saturation
Pneumonia*
Prospective Studies
SARS-CoV-2