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Observational Study
. 2023 Apr;59(4):205-215.
doi: 10.1016/j.arbres.2022.12.017. Epub 2023 Jan 7.

Key Factors Associated With Pulmonary Sequelae in the Follow-Up of Critically Ill COVID-19 Patients

[Article in English, Spanish]
Jessica González  1 , Jordi de Batlle  1 , Iván D Benítez  1 , Gerard Torres  1 , Sally Santisteve  2 , Adriano D S Targa  1 , Clara Gort-Paniello  1 , Anna Moncusí-Moix  1 , Maria Aguilà  2 , Fatty Seck  1 , Adrián Ceccato  3 , Ricard Ferrer  4 , Anna Motos  5 , Jordi Riera  4 , Laia Fernández  5 , Rosario Menéndez  6 , José Ángel Lorente  7 , Oscar Peñuelas  7 , Dario Garcia-Gasulla  8 , Yhivian Peñasco  9 , Pilar Ricart  10 , Elena Abril Palomares  11 , Luciano Aguilera  12 , Alejandro Rodríguez  13 , Maria Victoria Boado Varela  14 , Belén Beteré  15 , Juan Carlos Pozo-Laderas  16 , Jordi Solé-Violan  17 , Inmaculada Salvador-Adell  18 , Mariana Andrea Novo  19 , José Barberán  20 , Rosario Amaya Villar  21 , José Garnacho-Montero  22 , José M Gómez  23 , Aaron Blandino Ortiz  24 , Luis Tamayo Lomas  25 , Alejandro Úbeda  26 , Mercedes Catalán-González  27 , Angel Sánchez-Miralles  28 , Ignacio Martínez Varela  29 , Ruth Noemí Jorge García  30 , Nieves Franco  31 , Víctor D Gumucio-Sanguino  32 , Elena Bustamante-Munguira  33 , Luis Jorge Valdivia  34 , Jesús Caballero  35 , Elena Gallego  36 , Covadonga Rodríguez  37 , Álvaro Castellanos-Ortega  38 , Josep Trenado  39 , Judith Marin-Corral  40 , Guillermo M Albaiceta  41 , Maria Del Carmen de la Torre  42 , Ana Loza-Vázquez  43 , Pablo Vidal  44 , Jose M Añón  45 , Cristina Carbajales Pérez  46 , Victor Sagredo  47 , Nieves Carbonell  48 , Lorenzo Socias  49 , Carme Barberà  50 , Angel Estella  51 , Emili Diaz  52 , David de Gonzalo-Calvo  1 , Antoni Torres  5 , Ferran Barbé  53 ; CIBERESUCICOVID Project
Collaborators, Affiliations
Observational Study

Key Factors Associated With Pulmonary Sequelae in the Follow-Up of Critically Ill COVID-19 Patients

[Article in English, Spanish]
Jessica González et al. Arch Bronconeumol. 2023 Apr.

Abstract

Introduction: Critical COVID-19 survivors have a high risk of respiratory sequelae. Therefore, we aimed to identify key factors associated with altered lung function and CT scan abnormalities at a follow-up visit in a cohort of critical COVID-19 survivors.

Methods: Multicenter ambispective observational study in 52 Spanish intensive care units. Up to 1327 PCR-confirmed critical COVID-19 patients had sociodemographic, anthropometric, comorbidity and lifestyle characteristics collected at hospital admission; clinical and biological parameters throughout hospital stay; and, lung function and CT scan at a follow-up visit.

Results: The median [p25-p75] time from discharge to follow-up was 3.57 [2.77-4.92] months. Median age was 60 [53-67] years, 27.8% women. The mean (SD) percentage of predicted diffusing lung capacity for carbon monoxide (DLCO) at follow-up was 72.02 (18.33)% predicted, with 66% of patients having DLCO<80% and 24% having DLCO<60%. CT scan showed persistent pulmonary infiltrates, fibrotic lesions, and emphysema in 33%, 25% and 6% of patients, respectively. Key variables associated with DLCO<60% were chronic lung disease (CLD) (OR: 1.86 (1.18-2.92)), duration of invasive mechanical ventilation (IMV) (OR: 1.56 (1.37-1.77)), age (OR [per-1-SD] (95%CI): 1.39 (1.18-1.63)), urea (OR: 1.16 (0.97-1.39)) and estimated glomerular filtration rate at ICU admission (OR: 0.88 (0.73-1.06)). Bacterial pneumonia (1.62 (1.11-2.35)) and duration of ventilation (NIMV (1.23 (1.06-1.42), IMV (1.21 (1.01-1.45)) and prone positioning (1.17 (0.98-1.39)) were associated with fibrotic lesions.

Conclusion: Age and CLD, reflecting patients' baseline vulnerability, and markers of COVID-19 severity, such as duration of IMV and renal failure, were key factors associated with impaired DLCO and CT abnormalities.

Keywords: COVID-19; CT abnormalities; ICU; Lung function; Sequelae.

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Figures

None
Graphical abstract
Fig. 1
Fig. 1
Flowchart of the study.
Fig. 2
Fig. 2
Hospital factors related to diffusion capacity impairment (DLCO < 80%) at the follow-up visit. Logistic LASSO regression. Abbreviations: DLCO: lung diffusing capacity; NIMV, non-invasive mechanic ventilation; IMV, invasive mechanic ventilation; EGFR, Estimated Glomerular Filtration Rate; LASSO, least absolute shrinkage and selection operator.
Fig. 3
Fig. 3
Hospital factors related to diffusion capacity impairment (DLCO < 60%) at the follow-up visit. Logistic LASSO regression. Abbreviations: DLCO: lung diffusing capacity; IMV, invasive mechanic ventilation; EGFR, Estimated Glomerular Filtration Rate; LASSO, least absolute shrinkage and selection operator.
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