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Severe COVID-19 pneumonia: clinical, functional, and imaging outcomes at 4 months - 28/04/21

Doi : 10.1016/j.resmer.2021.100822 
Elise Noel-Savina 1, , Thibault Viatgé 1, Guillaume Faviez 1, Benoît Lepage 2, Laurent Mhanna 1, Sandrine Pontier 1, Marion Dupuis 1, Samia Collot 3, Pascal. Thomas 4, Jon Idoate Lacasia 1, Laure Crognier 5, Sihem Bouharaoua 5, Stein Silva Sifontes 4, Julien Mazières 1, Grégoire Prévot 1, Alain Didier 1
1 Department of Pneumology, Larrey Hospital, CHU Toulouse, Toulouse, France 
2 Department of Epidemiology, CHU Toulouse, Toulouse, France 
3 Department of Medical Imaging, Rangueil Hospital, CHU Toulouse, Toulouse, France 
4 Department of Nuclear Medicine, Rangueil Hospital, CHU Toulouse, Toulouse, France 
5 Adult Intensive Care Unit, CHU Toulouse, Toulouse, France 

Correspondence: Department of Pneumology and respiratory intensive care unit, Toulouse University Hospital, Larrey Hospital, Chemin de Pouvourville, 31400 Toulouse, FranceDepartment of Pneumology and respiratory intensive care unit, Toulouse University Hospital, Larrey Hospital, Chemin de PouvourvilleToulouse31400France

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En prensa. Manuscrito Aceptado. Disponible en línea desde el Wednesday 28 April 2021

ABSTRACT

Introduction: Given the pathophysiology of coronavirus disease 19 (COVID-19), persistent pulmonary abnormalities are likely.

Methods:We conducted a prospective cohort study in severe COVID-19 patients who had oxygen saturation <94% and were primarily admitted to hospital. We aimed to describe persistent gas exchange abnormalities at 4 months, defined as decreased diffusing capacity of the lungs for carbon monoxide (DLco) and/or desaturation on the 6-minute walk test (6MWT), along with associated mechanisms and risk factors

Results: Of the 72 patients included, 76.1% required admission to the intensive care unit (ICU), while 68.5% required invasive mechanical ventilation (MV). 39.1% developed venous thromboembolism (VTE). At 4 months, 61.4% were still symptomatic. Functionally, 39.1% had abnormal carbon monoxide test results and/or desaturation on 6MWT; high-flow oxygen, MV, and VTE during the acute phase were significantly associated. Restrictive lung disease was observed in 23.6% of cases, obstructive lung disease in 16.7%, and respiratory muscle dysfunction in 18.1%. A severe initial presentation with admission to ICU (p=.0181), and VTE occurrence during the acute phase (p=.0089) were associated with these abnormalities. 41% had interstitial lung disease in computed tomography (CT) of the chest. Four patients (5.5%) displayed residual defects on lung scintigraphy, only one of whom had developed VTE during the acute phase (5.5%). The main functional respiratory abnormality (31.9%) was reduced capillary volume (Vc<70%).

Conclusion: Among patients with severe COVID-19 pneumonia who were admitted to hospital, 61% were still symptomatic, 39% of patients had persistent functional abnormalities and 41% radiological abnormalities after 4 months. Embolic sequelae were rare but the main functional respiratory abnormality was reduced capillary volume. A respiratory check-up after severe COVID-19 pneumonia may be relevant to improve future management of these patients.

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Keywords : COVID-19, follow-up, sequelae: pulmonary embolism, fibrosis



© 2021  SPLF and Elsevier Masson SAS. Reservados todos los derechos.
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