Abstract
To describe the long-term health outcomes of patients with COVID-19 and investigate the potential risk factors. Clinical data during hospitalization and at a mean (SD) day of 249 (15) days after discharge from 40 survivors with confirmed COVID-19 (including 25 severe cases) were collected and analyzed retrospectively. At follow-up, severe cases had higher incidences of persistent symptoms, DLCO impairment, and higher abnormal CT score as compared with mild cases. CT score at follow-up was positively correlated with age, LDH level, cumulative days of oxygen treatment, total dosage of glucocorticoids used, and CT peak score during hospitalization. DLCO% at follow-up was negatively correlated with cumulative days of oxygen treatment during hospitalization. DLCO/VA% at follow-up was positively correlated with BMI, and TNF-α level. Among the three groups categorized as survivors with normal DLCO, abnormal DLCO but normal DLCO/VA, and abnormal DLCO and DLCO/VA, survivors with abnormal DLCO and DLCO/VA had the lowest serum IL-2R, IL-8, and TNF-α level, while the survivors with abnormal DLCO but normal DLCO/VA had the highest levels of inflammatory cytokines during hospitalization. Altogether, COVID-19 had a greater long-term impact on the lung physiology of severe cases. The long-term radiological abnormality maybe relate to old age and the severity of COVID-19. Either absent or excess of inflammation during COVID-19 course would lead to the impairment of pulmonary diffusion function.
Highlights
To describe the long-term health outcomes of patients with COVID-19 and investigate the potential risk factors
MMEF75/25 Maximal midexpiratory flow between 75 and 25% of forced vital capacity (FVC) maximum voluntary ventilation (MVV) Maximum voluntary ventilation residual volume (RV) Residual volume DLCO/VA Ratio of carbon monoxide diffusion capacity to alveolar ventilation Z at 5 Hz Impedance at 5 Hz Rperipheral Resistance in the peripheral airways X at 5 Hz Reactance at 5 Hz corrected by predicted value 6MWT Six-minute walk test PostCOVID-19 Functional Status (PCFS) The Post-COVID-19 Functional Status social functioning (SF)-36 The MOS 36-item Short-Form Health Survey standard deviation (SD) Standard deviation interquartile range (IQR) Interquartile range ANOVA One-way analysis of variance body mass index (BMI) Body mass index chronic obstructive pulmonary disease (COPD) Chronic obstructive pulmonary disease noninvasive positive pressure ventilation (NIPPV) Noninvasive positive pressure ventilation lactate dehydrogenase (LDH) Lactate dehydrogenase PCT Procalcitonin IL Interleukin tumor necrosis factor (TNF) Tumor necrosis factor NAC N-acetylcysteine ICS/LABA Combination inhaled corticosteroids plus long-acting β-agonists idiopathic pulmonary fibrosis (IPF) Idiopathic pulmonary fibrosis
The overall case-fatality rate (CFR) of COVID-19 is lower than that of severe acute respiratory syndrome (SARS) (9.6%) and Middle East respiratory syndrome (MERS) (34.4%)[2], radiology and lung function abnormalities can be found in a considerable proportion of COVID-19 survivors at time of hospital discharge, in early convalescence phase, and even at three and six months after d ischarge[3,4,5,6,7].Severe patients had a higher incidence of diffusion capacity of the lung for carbon monoxide (DLCO) impairment and encountered more total lung capacity (TLC) decrease and six-minute walk distance (6MWD) decline compared with non-severe patients at 30 days after discharged[4]
Summary
To describe the long-term health outcomes of patients with COVID-19 and investigate the potential risk factors. The overall CFR of COVID-19 is lower than that of severe acute respiratory syndrome (SARS) (9.6%) and Middle East respiratory syndrome (MERS) (34.4%)[2], radiology and lung function abnormalities can be found in a considerable proportion of COVID-19 survivors at time of hospital discharge, in early convalescence phase, and even at three and six months after d ischarge[3,4,5,6,7].Severe patients had a higher incidence of diffusion capacity of the lung for carbon monoxide (DLCO) impairment and encountered more total lung capacity (TLC) decrease and six-minute walk distance (6MWD) decline compared with non-severe patients at 30 days after discharged[4]. While there is lack of clinical evidence for the long-term follow up of pulmonary function and physiological disorder in severe COVID-19 patients
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