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. 2021 Jan 4;4(1):e2036142.
doi: 10.1001/jamanetworkopen.2020.36142.

Respiratory and Psychophysical Sequelae Among Patients With COVID-19 Four Months After Hospital Discharge

Mattia Bellan  1   2 , Daniele Soddu  1   2 , Piero Emilio Balbo  2 , Alessio Baricich  1   2 , Patrizia Zeppegno  1   2 , Gian Carlo Avanzi  1   2 , Giulia Baldon  1   2 , Giuseppe Bartolomei  1   2 , Marco Battaglia  1   2 , Sofia Battistini  1   2 , Valeria Binda  2 , Margherita Borg  1   2 , Vincenzo Cantaluppi  1   2 , Luigi Mario Castello  1   2 , Elisa Clivati  2 , Carlo Cisari  1   2 , Martina Costanzo  1   2 , Alessandro Croce  1   2 , Daria Cuneo  1   2 , Carla De Benedittis  1   2 , Simona De Vecchi  1   2 , Alessandro Feggi  2 , Martina Gai  1   2 , Eleonora Gambaro  1   2 , Eleonora Gattoni  2 , Carla Gramaglia  1   2 , Leonardo Grisafi  1   2 , Chiara Guerriero  1   2 , Eyal Hayden  1   2 , Amalia Jona  2 , Marco Invernizzi  1   2 , Luca Lorenzini  2 , Lucia Loreti  1   2 , Maria Martelli  1   2 , Paolo Marzullo  1   2 , Erica Matino  1   2 , Antonio Panero  1   2 , Elena Parachini  2 , Filippo Patrucco  1   2 , Giuseppe Patti  1   2 , Alice Pirovano  1   2 , Pierluigi Prosperini  2 , Riccardo Quaglino  1 , Cristina Rigamonti  1   2 , Pier Paolo Sainaghi  1   2 , Camilla Vecchi  1   2 , Erika Zecca  1   2 , Mario Pirisi  1   2
Affiliations

Respiratory and Psychophysical Sequelae Among Patients With COVID-19 Four Months After Hospital Discharge

Mattia Bellan et al. JAMA Netw Open. .

Abstract

Importance: Although plenty of data exist regarding clinical manifestations, course, case fatality rate, and risk factors associated with mortality in severe coronavirus disease 2019 (COVID-19), long-term respiratory and functional sequelae in survivors of COVID-19 are unknown.

Objective: To evaluate the prevalence of lung function anomalies, exercise function impairment, and psychological sequelae among patients hospitalized for COVID-19, 4 months after discharge.

Design, setting, and participants: This prospective cohort study at an academic hospital in Northern Italy was conducted among a consecutive series of patients aged 18 years and older (or their caregivers) who had received a confirmed diagnosis of severe acute respiratory coronavirus 2 (SARS-CoV-2) infection severe enough to require hospital admission from March 1 to June 29, 2020. SARS-CoV-2 infection was confirmed via reverse transcription-polymerase chain reaction testing, bronchial swab, serological testing, or suggestive computed tomography results.

Exposure: Severe COVID-19 requiring hospitalization.

Main outcomes and measures: The primary outcome of the study was to describe the proportion of patients with a diffusing lung capacity for carbon monoxide (Dlco) less than 80% of expected value. Secondary outcomes included proportion of patients with severe lung function impairment (defined as Dlco <60% expected value); proportion of patients with posttraumatic stress symptoms (measured using the Impact of Event Scale-Revised total score); proportion of patients with functional impairment (assessed using the Short Physical Performance Battery [SPPB] score and 2-minute walking test); and identification of factors associated with Dlco reduction and psychological or functional sequelae.

Results: Among 767 patients hospitalized for severe COVID-19, 494 (64.4%) refused to participate, and 35 (4.6%) died during follow-up. A total of 238 patients (31.0%) (median [interquartile range] age, 61 [50-71] years; 142 [59.7%] men; median [interquartile range] comorbidities, 2 [1-3]) consented to participate to the study. Of these, 219 patients were able to complete both pulmonary function tests and Dlco measurement. Dlco was reduced to less than 80% of the estimated value in 113 patients (51.6%) and less than 60% in 34 patients (15.5%). The SPPB score was suggested limited mobility (score <11) in 53 patients (22.3%). Patients with SPPB scores within reference range underwent a 2-minute walk test, which was outside reference ranges of expected performance for age and sex in 75 patients (40.5%); thus, a total of 128 patients (53.8%) had functional impairment. Posttraumatic stress symptoms were reported in a total of 41 patients (17.2%).

Conclusions and relevance: These findings suggest that at 4 months after discharge, respiratory, physical, and psychological sequelae were common among patients who had been hospitalized for COVID-19.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Pirisi reported receiving personal fees from Gilead Sciences, AbbVie, and Bayer outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Flowchart of the Study Population
COVID-19 indicate coronavirus disease 2019.
See this image and copyright information in PMC

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