Division of Medicine, Covid-19 Unit M, Spedali Civili di Brescia, Montichiari, Brescia, Italy.
Department of Medical and Surgical Sciences, University of Brescia, Brescia, Italy.
High Blood Press Cardiovasc Prev. 2021 Jul;28(4):373-381. doi: 10.1007/s40292-021-00454-w. Epub 2021 Apr 28.
The aim of the study was to assess the short-term consequences of SARS-CoV-2-related pneumonia, also in relation to radiologic/laboratory/clinical indices of risk at baseline. This prospective follow-up cohort study included 94 patients with confirmed COVID-19 admitted to a medical ward at the Montichiari Hospital, Brescia, Italy from February 28th to April 30th, 2020. Patients had COVID-19 related pneumonia with respiratory failure. Ninety-four patients out of 193 survivors accepted to be re-evaluated after discharge, on average after 4 months. In ¼ of the patients an evidence of pulmonary fibrosis was detected, as indicated by an altered diffusing capacity of the lung for carbon monoxide (DLCO); in 6-7% of patients the alteration was classified as of moderate/severe degree. We also evaluated quality of life thorough a structured questionnaire: 52% of the patients still lamented fatigue, 36% effort dyspnea, 10% anorexia, 14% dysgeusia or anosmia, 31% insomnia and 21% anxiety. Finally, we evaluated three prognostic indices (the Brixia radiologic score, the Charlson Comorbidity Index and the 4C mortality score) in terms of prediction of the clinical consequences of the disease. All of them significantly predicted the extent of short-term lung involvement. In conclusion, our study demonstrated that SARS-CoV-2-related pneumonia is associated to relevant short-term clinical consequences, both in terms of persistence of symptoms and in terms of impairment of DLCO (indicator of a possible development of pulmonary fibrosis); some severity indices of the disease may predict short-term clinical outcome. Further studies are needed to ascertain whether such manifestations may persist long-term.
本研究旨在评估 SARS-CoV-2 相关肺炎的短期后果，同时还与基线时的放射学/实验室/临床风险指数相关。这项前瞻性随访队列研究纳入了 2020 年 2 月 28 日至 4 月 30 日期间，因 COVID-19 相关呼吸衰竭而入住意大利布雷西亚蒙泰奇亚里医院内科病房的 94 例确诊 COVID-19 患者。94 例存活患者中有 94 例出院后接受了重新评估，平均在 4 个月后。四分之一的患者出现了肺纤维化的证据，这表现为一氧化碳弥散量（DLCO）的改变；在 6-7%的患者中，这种改变被归类为中重度。我们还通过一个结构化问卷评估了生活质量：52%的患者仍有疲劳感，36%的患者有呼吸困难，10%的患者有厌食，14%的患者有味觉障碍或嗅觉障碍，31%的患者有失眠，21%的患者有焦虑。最后，我们评估了三个预后指数（Brixia 放射评分、Charlson 合并症指数和 4C 死亡率评分）在预测疾病临床后果方面的表现。所有这些都显著预测了短期肺部受累的程度。总之，我们的研究表明，SARS-CoV-2 相关肺炎与相关的短期临床后果相关，无论是在症状持续存在方面，还是在 DLCO 受损（提示可能发生肺纤维化）方面；疾病的一些严重程度指数可预测短期临床结局。需要进一步的研究来确定这些表现是否会长期持续存在。
