RADIOGRAPHIC AND CLINICAL CORRELATIONS IN SURVIVORS WITH POST-ARDS RELATED COVID-19: WHAT ARE RISK FACTORS FOR RESIDUAL PULMONARY ABNORMALITIES?

Abstract

SESSION TITLE: Acute COVID-19 and Beyond: from Hospital to HomeboundSESSION TYPE: Original InvestigationsPRESENTED ON: 10/18/2022 02:45 pm - 03:45 pmPURPOSE: The aim of this study was to determine risk factors for residual pulmonary radiological and functional abnormalities and assessment of possible treatment approaches for reducing such complications in survivors with post-ARDS related to COVID-19.METHODS: There were 97 survivors enrolled, 12 weeks after severe ARDS who were intubated in COVID-19. All survivors admitted to pulmonary and critical care departments of university hospital from 30 August to 30 November 2021. 39 patients with lung radiographic abnormalities between 50-75%; 58 patients with lung abnormalities more than 75%.RESULTS: At 12 weeks after discharge all patients reported persistent symptoms: dyspnea 100.0%, cough 42.3%, chest pain 51.1%, fever 29.0%, and hemoptysis 18.5%. More severe dyspnea (increased by exertion and at rest) was found with lung involvement more than 75%(OR 4.25[0.94-10.34]95%CI;p<0.0001).Pulmonary function tests were abnormal in all patients ,however,more severe functional abnormalities were with lung involvement more than 75% and median FVC predicted was (46.3+_11.9 vs 64.7+_10.6;p<0.001),DLCO also was significantly lower (54.6+_9.3 vs 70.4+_8.4;p<0.01).Comorbidities such as diabetes milletus (DM) (OR 2.87[0.86-7.34]95%CI;p<0.002), obesity(OR2.44[0.79-6.98]95%CI;p=0.003), older age (OR 2.12[0.72-5.88]95%CI;p<0.004), and kidney failure (OR2.01[0.70-5.22]95%CI;p=0.005) were common in lung involvement more than 75%. Lack of dexamethasone at ICU admission with ARDS was significantly associated with more severe residual pulmonary abnormaliries: organizing pneumonia (OR 4.82[0.99-12.32]95%CI;p<0.0001),usual interstitial pneumonia(UIP)(OR 3.22[0.85-9.23]95%CI;p<0.0004),traction bronchiectasis(OR2.38[0.74-6.12]95%CI;p<0.001),and cystic changes (p<0.001) were commonest. In contrast, ground galss opacity (GGO) was commonest in use of dexamethasone (OR 2.95[0.79-7.54]95%CI;p<0.001). Multi-drug-resistant (MDR) pahtogen caused ventilator associated pneumonia (VAP) at the time intubation was significantly associated with residual OP (OR 4.76[0.91-11.66]95%CI;p<0.0001).CONCLUSIONS: There were several risk factors found for development of more severe residual pulmonary functional and radiological abnormalities: older age, and comorbidities such as DM, obesity, and kidney failure. Lack of use of dexamethasone was associated with development OP,UIP,traction bronchiectasis,and cystic changes.OP was common in patients with history of MDR-pathogen-caused VAP at intubation.The use of dexamethasone was associated with non-severe residual pulmonary functional and radiological abnormalities.CLINICAL IMPLICATIONS: The result of our investigation might be helpful for clinicians in COVID-19 practice.Our findings also may be helpful for pulmonologists ,respiratory therapist, and nurses. Also our discussion may aid in correct management of ARDS and minimalizing of residual pulmonary functional and radiological abnormalities.DISCLOSURES: No relevant relationships by Alizamin Sadigov SESSION TITLE: Acute COVID-19 and Beyond: from Hospital to Homebound SESSION TYPE: Original Investigations PRESENTED ON: 10/18/2022 02:45 pm - 03:45 pm PURPOSE: The aim of this study was to determine risk factors for residual pulmonary radiological and functional abnormalities and assessment of possible treatment approaches for reducing such complications in survivors with post-ARDS related to COVID-19. METHODS: There were 97 survivors enrolled, 12 weeks after severe ARDS who were intubated in COVID-19. All survivors admitted to pulmonary and critical care departments of university hospital from 30 August to 30 November 2021. 39 patients with lung radiographic abnormalities between 50-75%; 58 patients with lung abnormalities more than 75%. RESULTS: At 12 weeks after discharge all patients reported persistent symptoms: dyspnea 100.0%, cough 42.3%, chest pain 51.1%, fever 29.0%, and hemoptysis 18.5%. More severe dyspnea (increased by exertion and at rest) was found with lung involvement more than 75%(OR 4.25[0.94-10.34]95%CI;p<0.0001).Pulmonary function tests were abnormal in all patients ,however,more severe functional abnormalities were with lung involvement more than 75% and median FVC predicted was (46.3+_11.9 vs 64.7+_10.6;p<0.001),DLCO also was significantly lower (54.6+_9.3 vs 70.4+_8.4;p<0.01).Comorbidities such as diabetes milletus (DM) (OR 2.87[0.86-7.34]95%CI;p<0.002), obesity(OR2.44[0.79-6.98]95%CI;p=0.003), older age (OR 2.12[0.72-5.88]95%CI;p<0.004), and kidney failure (OR2.01[0.70-5.22]95%CI;p=0.005) were common in lung involvement more than 75%. Lack of dexamethasone at ICU admission with ARDS was significantly associated with more severe residual pulmonary abnormaliries: organizing pneumonia (OR 4.82[0.99-12.32]95%CI;p<0.0001),usual interstitial pneumonia(UIP)(OR 3.22[0.85-9.23]95%CI;p<0.0004),traction bronchiectasis(OR2.38[0.74-6.12]95%CI;p<0.001),and cystic changes (p<0.001) were commonest. In contrast, ground galss opacity (GGO) was commonest in use of dexamethasone (OR 2.95[0.79-7.54]95%CI;p<0.001). Multi-drug-resistant (MDR) pahtogen caused ventilator associated pneumonia (VAP) at the time intubation was significantly associated with residual OP (OR 4.76[0.91-11.66]95%CI;p<0.0001). CONCLUSIONS: There were several risk factors found for development of more severe residual pulmonary functional and radiological abnormalities: older age, and comorbidities such as DM, obesity, and kidney failure. Lack of use of dexamethasone was associated with development OP,UIP,traction bronchiectasis,and cystic changes.OP was common in patients with history of MDR-pathogen-caused VAP at intubation.The use of dexamethasone was associated with non-severe residual pulmonary functional and radiological abnormalities. CLINICAL IMPLICATIONS: The result of our investigation might be helpful for clinicians in COVID-19 practice.Our findings also may be helpful for pulmonologists ,respiratory therapist, and nurses. Also our discussion may aid in correct management of ARDS and minimalizing of residual pulmonary functional and radiological abnormalities. DISCLOSURES: No relevant relationships by Alizamin Sadigov