Integrative respiratory follow-up of severe COVID-19 reveals common functional and lung imaging sequelae.
Integrative respiratory follow-up of severe COVID-19 reveals common functional and lung imaging sequelae.
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DOI：
10.1016/j.rmed.2021.106383
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发表时间：
2021-05
影响因子：
4.3
通讯作者：
Ghaye B
中科院分区：
文献类型：
--
作者：
Froidure A;Mahsouli A;Liistro G;De Greef J;Belkhir L;Gérard L;Bertrand A;Koenig S;Pothen L;Yildiz H;Mwenge B;Aboubakar F;Gohy S;Pilette C;Reychler G;Coche E;Yombi JC;Ghaye B
2019冠状病毒病大流行导致普通病房和重症监护室（ICU）的住院人数达到前所未有的水平。严重和危重的COVID-19患者患有广泛性肺炎;因此，可能会出现长期呼吸道后遗症。我们进行了一项队列研究，以确定严重和危重COVID-19患者的呼吸系统后遗症。我们的目的是评估持续存在呼吸道症状和/或肺功能检查（PFT）或肺部影像学异常的患者比例。和方法：这是一项单中心队列研究，包括COVID-19幸存者，他们接受了为期三个月的临床评估、PFT和肺部高分辨率计算机断层扫描（HRCT）随访。集中审查了所有临床、功能和放射学数据。采用多元线性回归分析确定HRCT上残留病灶的相关因素。分别有126、122和107例患者的完整临床评价、PFT和肺部HRCT可供中心审查。随访时，25%的患者主诉呼吸困难，35%的患者主诉疲劳，45%的患者肺弥散量（DLCO）降低，17%的患者HRCT异常影响超过5%的肺实质，21%的患者发现纤维化体征。在多元线性回归模型中，ICU天数与HRCT上持续病变的程度相关，而插管与随访时的纤维化体征相关（P = 0.0005，Fisher精确检验）。相反，肺部影像学或PFT变化的严重程度不能预测疲劳和呼吸困难。尽管大多数住院的COVID-19患者康复，但很大一部分患者抱怨持续的呼吸困难和疲劳。DLCO受损和提示纤维化的体征很常见，但与长期症状无严格相关性。
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. 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. 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. 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. 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.
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