Faculty of Medicine, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand.
College of Nursing and Health, Suan Sunandha Rajabhat University, Bangkok, Thailand.
PLoS One. 2023 Aug 15;18(8):e0286832. doi: 10.1371/journal.pone.0286832. eCollection 2023.
Pulmonary complications are common after SARS-CoV2- infection. However, data on pulmonary sequelae of COVID-19 after recovery in dialysis patients are limited. We determined the prevalence of abnormal lung function tests and CT findings and investigate the association factors impacting pulmonary dysfunction. This prospective observational cohort study enrolled 100 patients with stage 5 chronic kidney disease (CKD) undergoing dialysis who had recovered from COVID-19 for ≥3 months. Pulmonary function test (PFT) and chest computed tomography (CT) were performed. Demographic data and laboratory results were recorded. The mean patient age was 55.15 ± 12.84 years. Twenty-one patients (21%) had severe COVID-19, requiring mechanical ventilation or oxygen supplementation. Pulmonary function tests revealed a restrictive pattern in 41% (95% confidence interval [CI], 31.73-50.78;) and an obstructive pattern in 7.29% (95% CI, 3.19-13.25) patients. The severe group showed PFT test results similar to the non-severe group, with three patients showing severe obstructive lung disease. The CT scan findings included reticulation (64%), multifocal parenchymal band (43%), ground glass opacities (32%), and bronchiectasis (28%). The median total CT score was 3 (interquartile range, 1-8.5). The CT score and PFT findings showed no association with pulmonary dysfunction extent, except in bronchiectasis. Lung function indices were associated with abnormal CT findings. Abnormal CT findings (bronchiectasis, reticulation, and ground-glass opacities) was associated with higher oxygen requirements than normal CT findings (p = 0.008, bronchiectasis; p = 0.041, reticulation; p = 0.032, ground-glass appearance). Aside from CT findings and CRP levels, no significant lung abnormalities were observed in severe and non-severe patients. Some patients had residual symptoms at follow-up. The findings indicate persistence of both radiological and physiological abnormalities in dialysis patients after COVID-19. However, the prevalence of these abnormalities was comparable to that in the normal population; few patients experienced ongoing symptoms. Follow-up observations and evaluations are warranted. Trial registration. Clinicaltrials.gov Identifier: NCT05348759.
新冠病毒感染后常发生肺部并发症。然而，关于透析患者 COVID-19 后肺部后遗症的数据有限。我们旨在确定异常肺功能检查和 CT 结果的发生率，并探讨影响肺功能障碍的相关因素。这项前瞻性观察队列研究纳入了 100 名患有 5 期慢性肾脏病（CKD）且已从 COVID-19 中康复至少 3 个月的透析患者。进行了肺功能检查（PFT）和胸部计算机断层扫描（CT）。记录了人口统计学数据和实验室结果。患者的平均年龄为 55.15 ± 12.84 岁。21 名（21%）患者患有严重 COVID-19，需要机械通气或氧疗。肺功能检查显示 41%（95%置信区间 [CI]，31.73-50.78）的患者表现为限制性模式，7.29%（95% CI，3.19-13.25）的患者表现为阻塞性模式。重症组的 PFT 检查结果与非重症组相似，有 3 名患者表现为严重阻塞性肺病。CT 扫描结果包括网状影（64%）、多灶性肺实质带（43%）、磨玻璃影（32%）和支气管扩张（28%）。中位数总 CT 评分为 3（四分位距，1-8.5）。除了支气管扩张外，CT 评分和 PFT 结果与肺功能障碍程度无关。肺功能指数与异常 CT 发现有关。异常 CT 发现（支气管扩张、网状影和磨玻璃影）与正常 CT 发现（p=0.008，支气管扩张；p=0.041，网状影；p=0.032，磨玻璃样外观）相比，需要更高的氧气需求。除 CT 发现和 CRP 水平外，重症和非重症患者均未观察到明显的肺部异常。一些患者在随访时仍有残留症状。这些发现表明，透析患者在 COVID-19 后既有放射学异常，也有生理学异常。然而，这些异常的发生率与普通人群相似；很少有患者持续存在症状。需要进行随访观察和评估。临床试验注册。Clinicaltrials.gov 标识符：NCT05348759。
