Faverio Paola, Luppi Fabrizio, Rebora Paola, D'Andrea Gabriele, Stainer Anna, Busnelli Sara, Catalano Martina, Modafferi Giuseppe, Franco Giovanni, Monzani Anna, Galimberti Stefania, Scarpazza Paolo, Oggionni Elisa, Betti Monia, Oggionni Tiberio, De Giacomi Federica, Bini Francesco, Bodini Bruno Dino, Parati Mara, Bilucaglia Luca, Ceruti Paolo, Modina Denise, Harari Sergio, Caminati Antonella, Intotero Marcello, Sergio Pietro, Monzillo Giuseppe, Leati Giovanni, Borghesi Andrea, Zompatori Maurizio, Corso Rocco, Valsecchi Maria Grazia, Bellani Giacomo, Foti Giuseppe, Pesci Alberto
Department of Medicine and Surgery, Università degli Studi di Milano Bicocca, Respiratory Unit, San Gerardo Hospital, ASST di Monza, via Pergolesi 33, 20900, Monza, Italy.
Bicocca Bioinformatics Biostatistics and Bioimaging B4 Center, University of Milano Bicocca, Monza, Italy.
Respir Res. 2022 Mar 21;23(1):65. doi: 10.1186/s12931-022-01994-y.
Long-term pulmonary sequelae following hospitalization for SARS-CoV-2 pneumonia is largely unclear. The aim of this study was to identify and characterise pulmonary sequelae caused by SARS-CoV-2 pneumonia at 12-month from discharge.
In this multicentre, prospective, observational study, patients hospitalised 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 (CPAP)" and "invasive mechanical ventilation (IMV)") and followed up at 12 months from discharge. Pulmonary function tests and diffusion capacity for carbon monoxide (DLCO), 6 min walking test, high resolution CT (HRCT) scan, and modified Medical Research Council (mMRC) dyspnea scale were collected.
Out of 287 patients hospitalized with SARS-CoV-2 pneumonia and followed up at 1 year, DLCO impairment, mainly of mild entity and improved with respect to the 6-month follow-up, was observed more frequently in the "oxygen only" and "IMV" group (53% and 49% of patients, respectively), compared to 29% in the "CPAP" group. Abnormalities at chest HRCT were found in 46%, 65% and 80% of cases in the "oxygen only", "CPAP" and "IMV" group, respectively. Non-fibrotic interstitial lung abnormalities, in particular reticulations and ground-glass attenuation, were the main finding, while honeycombing was found only in 1% of cases. Older patients and those requiring IMV were at higher risk of developing radiological pulmonary sequelae. Dyspnea evaluated through mMRC scale was reported by 35% of patients with no differences between groups, compared to 29% at 6-month follow-up.
DLCO alteration and non-fibrotic interstitial lung abnormalities are common after 1 year from hospitalization due to SARS-CoV-2 pneumonia, particularly in older patients requiring higher ventilatory support. Studies with longer follow-ups are needed.
SARS-CoV-2肺炎住院后的长期肺部后遗症在很大程度上尚不清楚。本研究的目的是在出院12个月时识别并描述由SARS-CoV-2肺炎引起的肺部后遗症。
在这项多中心、前瞻性、观察性研究中，因SARS-CoV-2肺炎住院且既往无结构性肺病诊断的患者，根据最大通气支持方式（“仅吸氧”、“持续气道正压通气（CPAP）”和“有创机械通气（IMV）”）进行分层，并在出院12个月时进行随访。收集肺功能测试、一氧化碳弥散量（DLCO）、6分钟步行试验、高分辨率CT（HRCT）扫描以及改良医学研究委员会（mMRC）呼吸困难量表。
在287例因SARS-CoV-2肺炎住院并随访1年的患者中，与“CPAP”组的29%相比，“仅吸氧”组和“IMV”组更频繁地观察到DLCO损害，主要为轻度损害且相对于6个月随访有所改善（分别为53%和49%的患者）。“仅吸氧”组、“CPAP”组和“IMV”组胸部HRCT异常的病例分别为46%、65%和80%。非纤维化间质性肺异常，特别是网状影和磨玻璃样衰减，是主要发现，而蜂窝状改变仅在1%的病例中发现。老年患者和需要IMV的患者发生放射性肺部后遗症的风险更高。通过mMRC量表评估的呼吸困难在35%的患者中出现，各亚组之间无差异，而在6个月随访时为29%。
SARS-CoV-2肺炎住院1年后，DLCO改变和非纤维化间质性肺异常很常见，尤其是在需要更高通气支持的老年患者中。需要进行更长时间随访的研究。
