School of Medicine and Surgery, University of Milano Bicocca, Respiratory Unit, San Gerardo Hospital, ASST Monza, Monza, Italy.
Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, University of Milano Bicocca, Monza, Italy.
Respiration. 2021;100(11):1078-1087. doi: 10.1159/000518141. Epub 2021 Aug 19.
Long-term pulmonary sequelae following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia are not yet confirmed; however, preliminary observations suggest a possible relevant clinical, functional, and radiological impairment.
The aim of this study was to identify and characterize pulmonary sequelae caused by SARS-CoV-2 pneumonia at 6-month follow-up.
In this multicentre, prospective, observational cohort study, patients hospitalized for SARS-CoV-2 pneumonia and without prior diagnosis of structural lung diseases were stratified by maximum ventilatory support ("oxygen only," "continuous positive airway pressure," and "invasive mechanical ventilation") and followed up at 6 months from discharge. Pulmonary function tests and diffusion capacity for carbon monoxide (DLCO), 6-min walking test, chest X-ray, physical examination, and modified Medical Research Council (mMRC) dyspnoea score were collected.
Between March and June 2020, 312 patients were enrolled (83, 27% women; median interquartile range age 61.1 [53.4, 69.3] years). The parameters that showed the highest rate of impairment were DLCO and chest X-ray, in 46% and 25% of patients, respectively. However, only a minority of patients reported dyspnoea (31%), defined as mMRC ≥1, or showed restrictive ventilatory defects (9%). In the logistic regression model, having asthma as a comorbidity was associated with DLCO impairment at follow-up, while prophylactic heparin administration during hospitalization appeared as a protective factor. The need for invasive ventilatory support during hospitalization was associated with chest imaging abnormalities.
DLCO and radiological assessment appear to be the most sensitive tools to monitor patients with the coronavirus disease 2019 (COVID-19) during follow-up. Future studies with longer follow-up are warranted to better understand pulmonary sequelae.
严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）肺炎后的长期肺部后遗症尚未得到证实；然而，初步观察表明可能存在相关的临床、功能和影像学损害。
本研究旨在确定并描述 SARS-CoV-2 肺炎在 6 个月随访时引起的肺部后遗症。
这是一项多中心、前瞻性、观察性队列研究，纳入了因 SARS-CoV-2 肺炎住院且无结构性肺部疾病既往诊断的患者，并根据最大通气支持（“仅吸氧”、“持续气道正压通气”和“有创机械通气”）进行分层，在出院后 6 个月进行随访。收集了肺功能检查和一氧化碳弥散量（DLCO）、6 分钟步行试验、胸部 X 线、体格检查和改良的英国医学研究理事会呼吸困难评分（mMRC）。
在 2020 年 3 月至 6 月期间，共纳入 312 名患者（83 名女性，占 27%；中位年龄为 61.1 [53.4，69.3] 岁）。DLCO 和胸部 X 线显示损害率最高，分别为 46%和 25%。然而，只有少数患者（31%）报告呼吸困难（定义为 mMRC≥1）或出现限制性通气缺陷（9%）。在逻辑回归模型中，合并哮喘作为合并症与随访时的 DLCO 损害相关，而住院期间预防性给予肝素则是一个保护因素。住院期间需要有创通气支持与胸部影像学异常有关。
DLCO 和影像学评估似乎是监测 COVID-19 患者在随访期间的最敏感工具。需要进行更长时间的随访研究，以更好地了解肺部后遗症。
