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Multicenter Study
. 2023 Apr 1;61(4):2201532.
doi: 10.1183/13993003.01532-2022. Print 2023 Apr.

Respiratory recovery trajectories after severe-to-critical COVID-19: a 1-year prospective multicentre study

Frédéric Schlemmer  1   2 , Simon Valentin  3   4 , Laurent Boyer  2   5 , Anne Guillaumot  3 , François Chabot  3   4 , Clairelyne Dupin  6 , Pierre Le Guen  6 , Gwenael Lorillon  6 , Anne Bergeron  7 , Damien Basille  8 , Julia Delomez  8 , Claire Andrejak  8 , Valentine Bonnefoy  9 , Hélène Goussault  9 , Jean-Baptiste Assié  10 , Pascaline Choinier  11 , Anne-Marie Ruppert  11 , Jacques Cadranel  11 , Maria Chiara Mennitti  12 , Mehdi Roumila  12 , Charlotte Colin  12 , Sven Günther  13 , Olivier Sanchez  14 , Thomas Gille  15   16 , Lucile Sésé  15   16 , Yurdagul Uzunhan  16   17 , Morgane Faure  18 , Maxime Patout  18   19 , Capucine Morelot-Panzini  18   19 , Pierantonio Laveneziana  19   20 , Maeva Zysman  21   22 , Elodie Blanchard  21   22 , Chantal Raherison-Semjen  23   24 , Violaine Giraud  25 , Etienne Giroux-Leprieur  25   26 , Stéfanie Habib  27 , Nicolas Roche  27 , Anh Tuan Dinh-Xuan  28 , Islem Sifaoui  29 , Pierre-Yves Brillet  30 , Camille Jung  31 , Emmanuelle Boutin  32   33 , Richard Layese  32   33 , Florence Canoui-Poitrine  32   33   34   35 , Bernard Maitre  2   9   35 ; RE2COVERI Study Group
Affiliations
Multicenter Study

Respiratory recovery trajectories after severe-to-critical COVID-19: a 1-year prospective multicentre study

Frédéric Schlemmer et al. Eur Respir J. .

Abstract

Background: Survivors of severe-to-critical coronavirus disease 2019 (COVID-19) may have functional impairment, radiological sequelae and persistent symptoms requiring prolonged follow-up. This pragmatic study aimed to describe their clinical follow-up and determine their respiratory recovery trajectories, and the factors that could influence them and their health-related quality of life.

Methods: Adults hospitalised for severe-to-critical COVID-19 were evaluated at 3 months and up to 12 months post-hospital discharge in this prospective, multicentre, cohort study.

Results: Among 485 enrolled participants, 293 (60%) were reassessed at 6 months and 163 (35%) at 12 months; 89 (51%) and 47 (27%) of the 173 participants initially managed with standard oxygen were reassessed at 6 and 12 months, respectively. At 3 months, 34%, 70% and 56% of the participants had a restrictive lung defect, impaired diffusing capacity of the lung for carbon monoxide (D LCO) and significant radiological sequelae, respectively. During extended follow-up, both D LCO and forced vital capacity percentage predicted increased by means of +4 points at 6 months and +6 points at 12 months. Sex, body mass index, chronic respiratory disease, immunosuppression, pneumonia extent or corticosteroid use during acute COVID-19 and prolonged invasive mechanical ventilation (IMV) were associated with D LCO at 3 months, but not its trajectory thereafter. Among 475 (98%) patients with at least one chest computed tomography scan during follow-up, 196 (41%) had significant sequelae on their last images.

Conclusions: Although pulmonary function and radiological abnormalities improved up to 1 year post-acute COVID-19, high percentages of severe-to-critical disease survivors, including a notable proportion of those managed with standard oxygen, had significant lung sequelae and residual symptoms justifying prolonged follow-up.

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Conflict of interest statement

Conflict of interest: F. Schlemmer reports support for the present manuscript from Fondation du Souffle, consulting fees from Pfizer, lecture honoraria from Gilead, and travel support from Chiesi, GSK, Elivie, Boerhinger Ingelheim, Gilead and Roche, outside the submitted work. P. Le Guen reports support for attending ATS 2022 from Unimed, outside the submitted work. M. Roumila reports grants from Vivisol and AstraZeneca, outside the submitted work. T. Gille reports lecture honoraria from Boehringer Ingelheim and Roche/Genetech, and travel support from Oxyvie, LVL Medical and Vitalaire, outside the submitted work. L. Sésé reports consulting fees from AstraZeneca, lecture honoraria from Boehringer Ingelheim and Roche-Genentech, and travel support from Novartis and Sanofi Aventis, outside the submitted work. Y. Uzunhan reports personal fees from Boehringer Ingelheim, grants and non-financial support from Oxyvie, and personal fees from Roche, outside the submitted work. M. Patout reports grants from Fisher & Paykel, ResMed and Asten Santé, consulting fees from Philips Respironics, ResMed, Asten Santé and GSK, lecture honoraria from Philips Respironics, Asten Santé, ResMed, Air Liquide Medical, SOS Oxygène, Antadir, Chiesi and Jazz Pharmaceutical, travel support from Asten Santé, advisory board participation from ResMed, Philips Respironics and Asten Santé, stock/stock options from Kernel Biomedical, and receipt of equipment/materials from Philips Respironics, ResMed and Fisher & Paykel, outside the submitted work. M. Zysman reports grants from AVAD and INSERM U1045, lecture honoraria from CSL Behring, GSK, Boehringer Ingelheim and AstraZeneca, and travel support Chiesi and AstraZeneca, outside the submitted work. S. Habib reports lecture honoraria from GSK and AstraZeneca, travel support from GSK and Novartis, and advisory board participation with Pfizer, Novartis and Sanofi. C. Jung reports grants from Danone and Menarini, lecture honoraria from Adare and Nestle, and a leadership role and stock/stock options from Biofoodie, outside the submitted work. All other authors have nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Follow-up of the 485 participants included in the RE2COVERI cohort. Representation of follow-up visits completed by 485 study participants (All), further divided into three groups according to the World Health Organization (WHO) Clinical Progression Scale during their hospitalisation for acute COVID-19 (WHO 5: standard oxygen only; WHO 6: non-invasive ventilation (continuous or bi-level positive airway pressure ventilation) or high-flow oxygen; WHO 7–9: invasive mechanical ventilation with/without other organ support). Participants were assessed at month 3 (M3), month 6 (M6) and month 12 (M12) after hospital discharge for acute COVID-19.
FIGURE 2
FIGURE 2
a, b) Respiratory (diffusing capacity of the lung for carbon monoxide (DLCO) and forced vital capacity (FVC)) and c, d) health-related quality of life (36-item Short-Form Health Survey (SF-36) Physical Component Summary (PCS) and Mental Component Summary (MCS)) recovery trajectories up to month 12 (M12) after acute COVID-19 presented according to length of follow-up post-hospital discharge: up to month 3 (M3), month 6 (M6) (M3–M6) or M12 (M3–M6–M12). Data are presented as median (interquartile range). For patients followed until M12, chained-equation multiple imputation of missing M6 data used 30 imputation sets: n=19 for DLCO, n=19 for FVC, and n=22 for SF-36 PCS and MCS.
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Comment in

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