Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 May 26;49(3):e20220452.
doi: 10.36416/1806-3756/e20220452. eCollection 2023.

Impact of impaired pulmonary function on clinical outcomes in survivors of severe COVID-19 without pre-existing respiratory disease

[Article in English, Portuguese]
Igor Gorski Benedetto  1 , Ravena Maya Cardoso da Silva  1 , Guilherme Moreira Hetzel  1 , Gabriel da Silva Viana  1 , Amanda Reis Guimarães  1 , Luciano Folador  1 , Vicente Bohrer Brentano  1 , Tiago Severo Garcia  1 , Sergio Pinto Ribeiro  1 , Paulo de Tarso Roth Dalcin  1 , Marcelo Basso Gazzana  1 , Danilo Cortozi Berton  1
Affiliations

Impact of impaired pulmonary function on clinical outcomes in survivors of severe COVID-19 without pre-existing respiratory disease

[Article in English, Portuguese]
Igor Gorski Benedetto et al. J Bras Pneumol. .

Abstract
in English, Portuguese

Objective: To investigate the impact of impaired pulmonary function on patient-centered outcomes after hospital discharge due to severe COVID-19 in patients without preexisting respiratory disease.

Methods: This is an ongoing prospective cohort study evaluating patients (> 18 years of age) 2-6 months after hospital discharge due to severe COVID-19. Respiratory symptoms, health-related quality of life, lung function, and the six-minute walk test were assessed. A restrictive ventilatory defect was defined as TLC below the lower limit of normal, as assessed by plethysmography. Chest CT scans performed during hospitalization were scored for the presence and extent of parenchymal abnormalities.

Results: At a mean follow-up of 17.2 ± 5.9 weeks after the diagnosis of COVID-19, 120 patients were assessed. Of those, 23 (19.2%) reported preexisting chronic respiratory diseases and presented with worse lung function and exertional dyspnea at the follow-up visit in comparison with their counterparts. When we excluded the 23 patients with preexisting respiratory disease plus another 2 patients without lung volume measurements, a restrictive ventilatory defect was observed in 42/95 patients (44%). This subgroup of patients (52.4% of whom were male; mean age, 53.9 ± 11.3 years) showed reduced resting gas exchange efficiency (DLCO), increased daily-life dyspnea, increased exertional dyspnea and oxygen desaturation, and reduced health-related quality of life in comparison with those without reduced TLC (50.9% of whom were male; mean age, 58.4 ± 11.3 years). Intensive care need and higher chest CT scores were associated with a subsequent restrictive ventilatory defect.

Conclusions: The presence of a restrictive ventilatory defect approximately 4 months after severe COVID-19 in patients without prior respiratory comorbidities implies worse clinical outcomes.

Objetivo:: Investigar o impacto do comprometimento da função pulmonar nos desfechos centrados no paciente após a alta hospitalar em pacientes sem doenças respiratórias preexistentes que foram hospitalizados em virtude de COVID-19 grave.

Métodos:: Trata-se de um estudo prospectivo de coorte em andamento, no qual pacientes com COVID-19 grave (com idade > 18 anos) são avaliados 2-6 meses depois da alta hospitalar. Avaliamos os sintomas respiratórios, a qualidade de vida relacionada à saúde, a função pulmonar e a distância percorrida no teste de caminhada de seis minutos. A definição de distúrbio ventilatório restritivo foi CPT abaixo do limite inferior da normalidade na pletismografia. As imagens de TC de tórax realizadas durante a hospitalização foram avaliadas quanto à presença e extensão de alterações parenquimatosas.

Resultados:: Em média 17,2 ± 5,9 semanas depois do diagnóstico de COVID-19, foram avaliados 120 pacientes. Destes, 23 (19,2%) relataram doenças respiratórias crônicas preexistentes e apresentaram pior função pulmonar e maior dispneia aos esforços na consulta de acompanhamento quando comparados aos outros participantes. Quando excluímos os 23 pacientes com doenças respiratórias preexistentes e mais 2 pacientes (sem medidas de volumes pulmonares), observamos distúrbio ventilatório restritivo em 42/95 pacientes (44%). Esse subgrupo de pacientes (52,4% dos quais eram do sexo masculino, com média de idade de 53,9 ± 11,3 anos) apresentou menor eficiência das trocas gasosas (DLCO), maior dispneia na vida diária e dessaturação de oxigênio ao exercício e redução da qualidade de vida relacionada à saúde em comparação com aqueles sem redução da CPT (50,9% dos quais eram do sexo masculino, com média de idade de 58,4 ± 11,3 anos). A necessidade de terapia intensiva e pontuações mais altas no escore de alterações parenquimatosas na TC de tórax apresentaram relação com distúrbio ventilatório restritivo subsequente.

Conclusões:: A presença de distúrbio ventilatório restritivo aproximadamente 4 meses depois da COVID-19 grave em pacientes sem comorbidades respiratórias prévias implica piores desfechos clínicos.

Trial registration: ClinicalTrials.gov NCT04410107.

PubMed Disclaimer

Conflict of interest statement

CONFLICTS OF INTEREST: None declared.

Figures

Figure 1
Figure 1. Flow chart of the patient inclusion process.
Figure 2
Figure 2. Comparison of general health-related quality of life (as assessed by Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36^ domain scores) between patients with and without a restrictive ventilatory defect (RVD) at the follow-up visit, after exclusion of those with prior respiratory comorbidities. The red dotted lines represent the mean reference values for each SF-36 domain, derived from randomly selected Brazilian men and women who were in the same age bracket as were the patients included in the present study (i.e., the 55- to 64-year age bracket).
Figure 3
Figure 3. Comparison of respiratory symptoms between patients without prior respiratory comorbidities presenting with a restrictive ventilatory defect (RVD) at the follow-up visit and those not presenting with an RVD at the follow-up visit. mMRC: modified Medical Research Council.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Torres-Castro R, Vasconcello-Castillo L, Alsina-Restoy X, Solis-Navarro L, Burgos F, Puppo H. Respiratory function in patients post-infection by COVID-19 a systematic review and meta-analysis. Pulmonology. 2021;27(4):328–337. doi: 10.1016/j.pulmoe.2020.10.013. - DOI - PMC - PubMed
    1. Townsend L, Dowds J, O'Brien K, Sheill G, Dyer AH, O'Kelly B, et al. Persistent Poor Health after COVID-19 Is Not Associated with Respiratory Complications or Initial Disease Severity. Ann Am Thorac Soc. 2021;18(6):997–1003. doi: 10.1513/AnnalsATS.202009-1175OC. - DOI - PMC - PubMed
    1. van der Sar-van der Brugge S, Talman S, Boonman-de Winter L, de Mol M, Hoefman E, van Etten RW, et al. Pulmonary function and health-related quality of life after COVID-19 pneumonia. Respir Med. 2021;176:106272–106272. doi: 10.1016/j.rmed.2020.106272. - DOI - PMC - PubMed
    1. Huang L, Li X, Gu X, Zhang H, Ren L, Guo L. Health outcomes in people 2 years after surviving hospitalisation with COVID-19 a longitudinal cohort study. Lancet Respir Med. 2022;10(9):863–876. doi: 10.1016/S2213-2600(22)00126-6. - DOI - PMC - PubMed
    1. Stanojevic S, Kaminsky DA, Miller MR, Thompson B, Aliverti A, Barjaktarevic I. ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J. 2022;60(1):2101499–2101499. doi: 10.1183/13993003.01499-2021. - DOI - PubMed

Associated data