Vargas Centanaro Gianna, Calle Rubio Myriam, Álvarez-Sala Walther José Luis, Martinez-Sagasti Fernando, Albuja Hidalgo Andrea, Herranz Hernández Rafael, Rodríguez Hermosa Juan Luis
Pulmonology Department, Hospital Clínico San Carlos, Madrid, Spain.
Medical Department, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
Open Forum Infect Dis. 2022 Feb 25;9(4):ofac098. doi: 10.1093/ofid/ofac098. eCollection 2022 Apr.
LUNG INJURY COVID-19 (clinicaltrials.gov NCT 21/399-E) is a registry-based prospective observational cohort study to evaluate long-term outcomes and recovery 12 months after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection according to severity.
Three hundred five coronavirus disease 2019 (COVID-19) survivors were included (moderate, 162; severe, 143). Twelve months after SARS-CoV-2 infection, there was resolution of respiratory symptoms (37.9% in severe vs 27.3% in moderate pneumonia; = .089).
Exertional dyspnea was present (20% in severe vs 18.4% in moderate; = .810). Abnormalities on chest radiology imaging were detected more often in severe COVID-19 infection vs moderate infection (29% vs 8.8%; < .001). Pulmonary function testing (forced spirometry or diffusion) performed at 12 months of mean follow-up according to protocol detected anomalies in 31.4% of patients with severe COVID-19 courses and in 27.7% of moderate patients. Risk factors associated with diffusion impairment at 12 months were age (odds ratio [OR], 1.05; 95% CI, 1.01-1.10; = .008), forced expiratory volume in 1 second predicted at follow-up (OR, 0.96; 95% CI, 0.93-0.99; = .017), and dyspnea score at follow-up (OR, 3.16; 95% CI, 1.43-6.97; = .004). Computed tomography (CT) scans performed at 12 months of mean follow-up showed evidence of fibrosis in almost half of patients with severe COVID-19 courses, who underwent CT according to protocol.
At 12 months from infection onset, most patients refer to symptoms, particularly muscle weakness and dyspnea, and almost one-third of patients with severe COVID-19 pneumonia had impaired pulmonary diffusion and abnormalities on chest radiology imaging. These results emphasize the importance of systematic follow-up after severe COVID-19, with appropriate management of pulmonary sequelae.
新型冠状病毒肺炎肺损伤研究（clinicaltrials.gov NCT 21/399 - E）是一项基于注册的前瞻性观察性队列研究，旨在根据严重程度评估严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染12个月后的长期结局和恢复情况。
纳入305例2019冠状病毒病（COVID-19）幸存者（中度162例；重度143例）。SARS-CoV-2感染12个月后，呼吸道症状有所缓解（重度肺炎患者中为37.9%，中度肺炎患者中为27.3%；P = 0.089）。
存在运动性呼吸困难（重度患者中为20%，中度患者中为18.4%；P = 0.810）。与中度感染相比，重度COVID-19感染患者胸部放射影像学异常检出率更高（29%对8.8%；P < 0.001）。根据方案在平均随访12个月时进行的肺功能测试（用力肺活量或弥散功能）发现，重度COVID-19病程患者中有31.4%、中度患者中有27.7%存在异常。与12个月时弥散功能受损相关的危险因素包括年龄（比值比[OR]，1.05；95%置信区间[CI]，1.01 - 1.10；P = 0.008）、随访时预测的1秒用力呼气量（OR，0.96；95% CI，0.93 - 0.99；P = 0.017）以及随访时的呼吸困难评分（OR，3.16；95% CI，1.43 - 6.97；P = 0.004）。在平均随访12个月时进行的计算机断层扫描（CT）显示，按照方案接受CT检查的重度COVID-19病程患者中，近一半有纤维化迹象。
感染发病12个月时，大多数患者有症状，尤其是肌肉无力和呼吸困难，重度COVID-19肺炎患者中近三分之一存在肺弥散功能受损和胸部放射影像学异常。这些结果强调了重度COVID-19后系统随访以及对肺部后遗症进行适当管理的重要性。
