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. 2021 May:181:106383.
doi: 10.1016/j.rmed.2021.106383. Epub 2021 Apr 4.

Integrative respiratory follow-up of severe COVID-19 reveals common functional and lung imaging sequelae

Antoine Froidure  1 , Amin Mahsouli  2 , Giuseppe Liistro  3 , Julien De Greef  4 , Leila Belkhir  4 , Ludovic Gérard  5 , Aurélie Bertrand  6 , Sandra Koenig  7 , Lucie Pothen  4 , Halil Yildiz  4 , Benny Mwenge  3 , Frank Aboubakar  3 , Sophie Gohy  3 , Charles Pilette  3 , Gregory Reychler  3 , Emmanuel Coche  2 , Jean-Cyr Yombi  4 , Benoit Ghaye  2
Affiliations

Integrative respiratory follow-up of severe COVID-19 reveals common functional and lung imaging sequelae

Antoine Froidure et al. Respir Med. 2021 May.

Abstract

Background: COVID-19 pandemic resulted in an unprecedented number of hospitalizations in general wards and intensive care units (ICU). Severe and critical COVID-19 patients suffer from extensive pneumonia; therefore, long-term respiratory sequelae may be expected.

Research question: We conducted a cohort study to determine respiratory sequelae in patients with severe and critical COVID-19. We aimed at evaluating the proportion of patients with persisting respiratory symptoms and/or abnormalities in pulmonary function tests (PFT) or in lung imaging.

Study design: and methods: This is a single center cohort study including COVID-19 survivors who underwent a three-month follow-up with clinical evaluation, PFT and lung high-resolution computed tomography (HRCT). All clinical, functional, and radiological data were centrally reviewed. Multiple linear regression analysis was performed to identify factors associated with residual lesions on HRCT.

Results: Full clinical evaluation, PFT and lung HRCT were available for central review in 126, 122 and 107 patients, respectively. At follow-up, 25% of patients complained from dyspnea and 35% from fatigue, lung diffusion capacity (DLCO) was decreased in 45%, 17% had HRCT abnormalities affecting more than 5% of their lung parenchyma while signs of fibrosis were found in 21%. In multiple linear regression model, number of days in ICU were related to the extent of persisting lesions on HRCT, while intubation was associated with signs of fibrosis at follow-up (P = 0.0005, Fisher's exact test). In contrast, the severity of lung imaging or PFT changes were not predictive of fatigue and dyspnea.

Interpretation: Although most hospitalized COVID-19 patients recover, a substantial proportion complains from persisting dyspnea and fatigue. Impairment of DLCO and signs suggestive of fibrosis are common but are not strictly related to long-lasting symptoms.

Keywords: COVID19; Follow-up; Long COVID; Lung HRCT; Lung fibrosis; Pulmonary function tests.

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Conflict of interest statement

The authors have no conflict of interest in relationship with the present work.

Figures

Fig. 1
Fig. 1
Study flowchart.
Fig. 2
Fig. 2
Two examples of three-month follow-up HRCT. Patient 1 shows ground-glass opacities (GGO) and consolidations (lesions extent 25.2% of lung parenchyma) at baseline (A) resulting in combined extensive GGO and signs of fibrosis, namely traction bronchiectasis and reticulations (total lesions extent 88.47%) at three-month follow-up (B). Patient 2 shows GGO and consolidations (lesions extent 44.92%) at baseline (C) followed by almost complete recovery (lesions extent 0.7%) at follow-up (D). As described in the methods, the extension of lesions is provided by the software while radiologists perform qualitative assessment of lesions.
Fig. 3
Fig. 3
Patients clustering based on symptoms versus HRCT (3A) and symptoms versus DLCO (3B).
See this image and copyright information in PMC

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