Abstract

ObjectiveEvaluation of pulmonary function impairment after COVID-19 in persistently symptomatic and asymptomatic patients of all disease severities and characterisation of risk factors.MethodsPatients with confirmed SARS-CoV-2 infection underwent prospective follow-up with pulmonary function testing and blood gas analysis during steady-state cycle exercise 4 months after acute illness. Pulmonary function impairment (PFI) was defined as reduction below 80% predicted of DLCOcSB, TLC, FVC, or FEV1. Clinical data were analyzed to identify risk factors for impaired pulmonary function.Results76 patients were included, hereof 35 outpatients with mild disease and 41 patients hospitalized due to COVID-19. Sixteen patients had critical disease requiring mechanical ventilation, 25 patients had moderate–severe disease. After 4 months, 44 patients reported persisting respiratory symptoms. Significant PFI was prevalent in 40 patients (52.6%) occurring among all disease severities. The most common cause for PFI was reduced DLCOcSB (n = 39, 51.3%), followed by reduced TLC and FVC. The severity of PFI was significantly associated with mechanical ventilation (p < 0.001). Further risk factors for DLCO impairment were COPD (p < 0.001), SARS-CoV-2 antibody-Titer (p = 0.014) and in hospitalized patients CT score. A decrease of paO2 > 3 mmHg during cycle exercise occurred in 1/5 of patients after mild disease course.ConclusionWe characterized pulmonary function impairment in asymptomatic and persistently symptomatic patients of different severity groups of COVID-19 and identified further risk factors associated with persistently decreased pulmonary function. Remarkably, gas exchange abnormalities were revealed upon cycle exercise in some patients with mild disease courses and no preexisting pulmonary condition.

Highlights

  • The coronavirus disease 2019 (COVID-19) pandemic has put considerable strain on the health systems globally [1]

  • COPD was associated with reduced differences in lung function parameters (DLCO), TLC, FVC, FEV1 after correcting for influences by other variables in multivariate regression analysis and SARS-CoV-2 Immunoglobulin G (IgG) titer at 4 months was negatively correlated with DLCO among all subgroups (MLR: p = 0.014, p = 0.042, Table 3b)

  • Recent studies reported reduced DLCO, TLC, and FVC one to six months after COVID-19 disease in selected patients; so far, most studies focused on hospitalized cohorts [21,22,23,24,25,26]

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Summary

Introduction

The coronavirus disease 2019 (COVID-19) pandemic has put considerable strain on the health systems globally [1]. COVID-19 pneumonia and the severe inflammatory process are hypothesized to cause lasting parenchymal damage. Patients after Acute Respiratory Distress Syndrome (ARDS) suffer from long-term physical problems and lung function deterioration [6]. An unknown proportion of patients may develop subclinical COVID-19 pneumonia with a mild disease course without hospitalization. It is essential to identify risk factors for lasting pulmonary damage and define patients at risk who should receive specialized respiratory follow-up care after infection. We evaluate pulmonary function impairment after COVID-19 disease among all severity groups in persistently symptomatic and asymptomatic patients four months after infection. This study investigates predictors for lung function impairment according to disease severity in a highly diverse COVID-19 patient group, including ergometry assessment in a pulmonary aftercare setting

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