Abstract
Radiological and functional sequelae of Coronavirus Disease 2019 (COVID-19) pneumonia are still poorly understood. This was a prospective, observational, physiological, cohort study on consecutive adult patients with COVID-19 pneumonia admitted in April–May 2020 in the high dependency respiratory unit of L. Sacco University Hospital in Milan (Italy). During hospitalization, patients underwent chest computed tomography (CT), blood gas analysis, spirometry, and lung diffusion capacity for carbon monoxide (DLco), which were repeated 6 weeks post-discharge. Chest CTs were individually read by two expert radiologists, that calculated the total severity score (TSS). Twenty patients completed the study (mean age 58.2 years, 70% males). During the acute phase, mean DLco, alveolar volume (VA), and vital capacity (VC) were 56.0 (16.3), 64.8 (14.0), and 71.7 (16.9) % predicted, respectively, and were inversely associated with PaO2/FiO2 ratio. Fifty percent of patients had a restrictive ventilatory pattern; mean TSS was 7.9 (4.0). At follow up, gas exchange parameters were normalized; consolidations persisted in 10% of cases, while DLco was <80% predicted in 65% of patients and was independently predicted by Log10D-dimer at admission (β −18.675; 95%CI, −28.373–−9.076; p = 0.001). In conclusion, functional abnormalities in COVID-19 pneumonia survivors can persist during follow up and are associated with the severity of the disease.
Highlights
Since the initial outbreak in Wuhan (China), the Coronavirus Disease 2019 (COVID19) pandemic has caused more than 1,200,000 deaths worldwide [1], leading to an unprecedented burden on healthcare systems with hundreds of thousands patients needing hospitalization [2]
Continuous Positive Airway Pressure (CPAP) was employed in 13 patients (65%); four of them eventually required invasive mechanical ventilation and were subsequently re-admitted in the high dependency respiratory care unit (HDRU) once weaned from invasive mechanical ventilation (IMV)
The main results of the present study can be summarized as follows: (1) during the acute phase patients with COVID-19 pneumonia showed a prevalent restrictive functional pattern, characterized by a concomitant reduction in vital capacity (VC) and FEV1 and paralleled by an impairment in DLco; (2) the reduction in dynamic volumes and DLco was correlated with disease severity and was associated with the presence of lung consolidations both during the acute phase and after 6 weeks of follow up; (3) at 6 weeks post-discharge, DLco was at least mildly reduced in 65% of cases, while respiratory failure was completely resolved in all patients; and (4) D-dimer at admission was the only parameter that predicted the DLco value during the recovery phase
Summary
Since the initial outbreak in Wuhan (China), the Coronavirus Disease 2019 (COVID19) pandemic has caused more than 1,200,000 deaths worldwide [1], leading to an unprecedented burden on healthcare systems with hundreds of thousands patients needing hospitalization [2]. The few available studies conducted on recovering COVID-19 patients have shown that the main lung function complications are represented by reduced lung diffusion capacity for carbon monoxide (DLCO) and, more rarely, by impaired static and dynamic volumes [10,11,12,13,15,16]. These observations are in line with previous studies conducted in Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) [17,18] and Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
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