Follow up of patients with severe coronavirus disease 2019 (COVID-19): Pulmonary and extrapulmonary disease sequelae

Respir Med. Nov-Dec 2020;174:106197. doi: 10.1016/j.rmed.2020.106197. Epub 2020 Oct 20.

Abstract

Background: Since December 2019 the novel coronavirus disease 2019 (COVID-19) has been burdening all health systems worldwide. However, pulmonary and extrapulmonary sequelae of COVID-19 after recovery from the acute disease are unknown.

Material and methods: Hospitalized COVID-19 patients not requiring mechanical ventilation were included and followed 6 weeks after discharge. Body plethysmography, lung diffusion capacity (DLco), blood gas analysis (ABG), 6-min walk test (6MWT), echocardiography, and laboratory tests were performed. Quality of life (QoL), depression, and anxiety were assessed using validated questionnaires.

Results: 33 patients with severe disease were included. Patients were discharged without prophylactic anticoagulation. At follow-up there were no thromboembolic complications in any patient. 11 patients (33%) had dyspnea, 11 (33%) had cough, and 15 (45%) suffered from symptoms of fatigue. Pulmonary function tests including ABG did not reveal any limitations (TLC: median=94% of predicted {IQR:85-105}; VC: 93% {78-101}; FEV1: 95% {72-103}; FEV1/FVC 79% {76-85}; PaO2: 72 mmHg {67-79}; PaCO2: 38 mmHg {35-38}), except for slightly reduced DLco (77% {69-95}). There were no echocardiographic impairments. 6MWT distance was reduced in most patients without oxygen desaturation. According to standardized questionnaires, patients suffered from reduced QoL, mainly due to decreased mobility (SGRQ activity score: 54 {19-78}). There were no indicators for depression or anxiety (PHQ-9: 7 {4-11}, GAD-7: 4 {1-9}, respectively).

Conclusions: Hospitalized patients with severe COVID-19, who did not require mechanical ventilation, are unlikely to develop pulmonary long-term impairments, thromboembolic complications or cardiac impairments after discharge but frequently suffer from symptoms of fatigue.

Keywords: COVID-19; Echocardiography; Fatigue; Follow up; Pulmonary functions; Quality of life.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anxiety / epidemiology
  • Anxiety / etiology
  • Blood Gas Analysis / methods
  • COVID-19 / complications*
  • COVID-19 / epidemiology
  • COVID-19 / physiopathology
  • COVID-19 / virology
  • Cough / epidemiology
  • Depression / epidemiology
  • Depression / etiology
  • Dyspnea / epidemiology
  • Echocardiography / methods
  • Fatigue / epidemiology
  • Female
  • Follow-Up Studies
  • Heart Diseases / epidemiology
  • Heart Diseases / etiology
  • Humans
  • Lung Diseases / epidemiology
  • Lung Diseases / etiology*
  • Lung Diseases / physiopathology
  • Male
  • Middle Aged
  • Patient Discharge
  • Plethysmography, Whole Body / methods
  • Prospective Studies
  • Pulmonary Diffusing Capacity / methods
  • Quality of Life
  • Respiratory Function Tests / methods
  • SARS-CoV-2 / genetics*
  • Severity of Illness Index
  • Thromboembolism / epidemiology
  • Thromboembolism / etiology
  • Walk Test / methods