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. 2023 May 29;120(5):e20220642.
doi: 10.36660/abc.20220642. eCollection 2023.

Post-COVID-19 Cardiopulmonary Symptoms: Predictors and Imaging Features in Patients after Hospital Discharge

[Article in English, Portuguese]
Roberto Kalil-Filho  1   2 , Roberta Saretta  1 , André Franci  1 , Luciano M Baracioli  1   2 , Filomena R B G Galas  1 , Juliana S Gil  1 , Amanda Ferino  1 , Camilla Giacovone  1 , Isabella Oliveira  1 , Johnatan Souza  1 , Vanessa Batista  1 , Augusto Scalabrini Neto  1 , Livia do Valle Costa  1 , Amanda Danieleto Ruiz  1 , Carla B Ledo  1 , Teresa Cristina D C Nascimento  1 , Luciano F Drager  1   2
Affiliations

Post-COVID-19 Cardiopulmonary Symptoms: Predictors and Imaging Features in Patients after Hospital Discharge

[Article in English, Portuguese]
Roberto Kalil-Filho et al. Arq Bras Cardiol. .

Abstract
in English, Portuguese

Background: Most of the evidence about the impact of the post-acute COVID-19 Syndrome (PACS) reports individual symptoms without correlations with related imaging.

Objectives: To evaluate cardiopulmonary symptoms, their predictors and related images in COVID-19 patients discharged from hospital.

Methods: Consecutive patients who survived COVID-19 were contacted 90 days after discharge. The Clinic Outcome Team structured a questionnaire evaluating symptoms and clinical status (blinded for hospitalization data). A multivariate analysis was performed to address the course of COVID-19, comorbidities, anxiety, depression, and post-traumatic stress during hospitalization, and cardiac rehabilitation after discharge. The significance level was set at 5%.

Results: A total of 480 discharged patients with COVID-19 (age: 59±14 years, 67.5% males) were included; 22.3% required mechanical ventilation. The prevalence of patients with PACS-related cardiopulmonary symptoms (dyspnea, tiredness/fatigue, cough, and chest discomfort) was 16.3%. Several parameters of chest computed tomography and echocardiogram were similar in patients with and without cardiopulmonary symptoms. The multivariate analysis showed that PACS-related cardiopulmonary-symptoms were independently related to female sex (OR 3.023; 95% CI 1.319-6.929), in-hospital deep venous thrombosis (OR 13.689; 95% CI 1.069-175.304), elevated troponin I (OR 1.355; 95% CI 1.048-1.751) and C-reactive protein during hospitalization (OR 1.060; 95% CI 1.023-1.097) and depression (OR 6.110; 95% CI 2.254-16.558).

Conclusion: PACS-related cardiopulmonary symptoms 90 days post-discharge are common and multifactorial. Beyond thrombotic and markers of inflammation/myocardial injury during hospitalization, female sex and depression were independently associated with cardiopulmonary-related PACS. These results highlighted the need for a multifaceted approach targeting susceptible patients.

Fundamento: A maioria da evidência sobre o impacto da síndrome COVID pós-aguda (PACS, do inglês, post-acute COVID-19 syndrome) descreve sintomas individuais sem correlacioná-los com exames de imagens.

Objetivos: Avaliar sintomas cardiopulmonares, seus preditores e imagens relacionadas em pacientes com COVID-19 após alta hospitalar.

Métodos: Pacientes consecutivos, que sobreviveram à COVID-19, foram contatados 90 dias após a alta hospitalar. A equipe de desfechos clínicos (cega quanto aos dados durante a internação) elaborou um questionário estruturado avaliando sintomas e estado clínico. Uma análise multivariada foi realizada abordando a evolução da COVID-19, comorbidades, ansiedade, depressão, e estresse pós-traumático durante a internação, e reabilitação cardíaca após a alta. O nível de significância usado nas análises foi de 5%.

Resultados: Foram incluídos 480 pacientes (idade 59±14 anos, 67,5% do sexo masculino) que receberam alta hospitalar por COVID-19; 22,3% necessitaram de ventilação mecânica. A prevalência de pacientes com sintomas cardiopulmonares relacionados à PACS (dispneia, cansaço/fadiga, tosse e desconforto no peito) foi de 16,3%. Vários parâmetros de tomografia computadorizada do tórax e de ecocardiograma foram similares entre os pacientes com e sem sintomas cardiopulmonares. A análise multivariada mostrou que sintomas cardiopulmonares foram relacionados de maneira independente com sexo feminino (OR 3,023; IC95% 1,319-6,929), trombose venosa profunda durante a internação (OR 13,689; IC95% 1,069-175,304), nível elevado de troponina (OR 1,355; IC95% 1,048-1,751) e de proteína C reativa durante a internação (OR 1,060; IC95% 1,023-1,097) e depressão (OR 6,110; IC95% 2,254-16,558).

Conclusão: Os sintomas cardiopulmonares relacionados à PACS 90 dias após a alta hospitalar são comuns e multifatoriais. Além dos marcadores trombóticos, inflamatórios e de lesão miocárdica durante a internação, sexo feminino e depressão foram associados independentemente com sintomas cardiopulmonares relacionados à PACS. Esses resultados destacaram a necessidade de uma abordagem multifacetada direcionada a pacientes susceptíveis.

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Conflict of interest statement

Potencial conflito de interesse

Não há conflito com o presente artigo

Figures

Figura 1
Figura 1. – Fluxograma do estudo.
Figura 2
Figura 2. – Frequência de sintomas relatados pelos pacientes 90 dias após a alta hospitalar por COVID-19.
Figura 3
Figura 3. – Porcentagem de envolvimento pulmonar em pacientes com COVID-19 durante a internação hospitalar e após a alta.
Figura Central
Figura Central. : Sintomas Cardiopulmonares Pós-COVID-19: Preditores e Características de Imagem de Pacientes após a Alta Hospitalar
Central Illustration
Central Illustration. : Post-COVID-19 Cardiopulmonary Symptoms: Predictors and Imaging Features in Patients after Hospital Discharge
Figure 1
Figure 1. – Study flowchart.
Figure 2
Figure 2. – Frequency of symptoms reported by the patients 90 days after hospital discharge for COVID-19.
Figure 3
Figure 3. – Percentage of lung involvement in patients with COVID-19 during hospital say and after discharge.
See this image and copyright information in PMC

Comment in

References

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