1. Post-COVID-19 respiratory sequelae two years after hospitalization: an ambidirectional studyResearch in context
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Carlos Roberto Ribeiro Carvalho, Celina de Almeida Lamas, Luis Augusto Visani de Luna, Rodrigo Caruso Chate, João Marcos Salge, Marcio Valente Yamada Sawamura, Carlos Toufen, Michelle Louvaes Garcia, Paula Gobi Scudeller, Cesar Higa Nomura, Marco Antonio Gutierrez, and Bruno Guedes Baldi more...
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Ambidirectional cohort ,COVID-19 ,PASC ,Fibrosis ,Small airways disease ,Lung CT ,Public aspects of medicine ,RA1-1270 - Abstract
Summary: Background: COVID-19 lung sequelae can impact the course of patient lives. We investigated the evolution of pulmonary abnormalities in post-COVID-19 patients 18–24 months after hospital discharge. Methods: A cohort of COVID-19 patients admitted to the Hospital das Clínicas da Faculdade de Medicina da USP in São Paulo, Brazil, between March and August of 2020, were followed-up 6–12 months after hospital discharge. A subset of patients with pulmonary involvement and chest computed tomography (CT) scans were eligible to participate in this second follow-up (18–24 months). Data was analyzed in an ambidirectional manner, including retrospective data from the hospitalization, and from the first follow-up (6–12 months after discharge), and compared with the prospective data collected in this new follow-up. Findings: From 348 patients eligible, 237 (68%) participated in this follow-up. Among participants, 139 (58%) patients presented ground-glass opacities and reticulations, and 80 (33%) presented fibrotic-like lesions (traction bronchiectasis and architectural distortion). Five (2%) patients improved compared to the 6-12-month assessment, but 20 (25%) of 80 presented worsening of lung abnormalities. For those with relevant assessments on both occasions, comparing the CT findings between this follow-up with the previous assessment, there was an increase in patients with architectural distortion (43 [21%] of 204 vs 57 [28%] of 204, p = 0.0093), as well as in traction bronchiectasis (55 [27%] of 204 vs 69 [34%] of 204, p = 0.0043). Patients presented a persistent functional impairment with demonstrated restrictive pattern in both follow-ups (87 [42%] of 207 vs 91 [44%] of 207, p = 0.76), as well as for the reduced diffusion capacity (88 [42%] of 208 vs 87 [42%] of 208, p = 1.0). Length of hospitalization (OR 1.04 [1.01–1.07], p = 0.0040), invasive mechanical ventilation (OR 3.11 [1.3–7.5] p = 0.011), patient's age (OR 1.03 [1.01–1.06] p = 0.0074 were consistent predictors for development of fibrotic-like lung lesions in post-COVID-19 patients. Interpretation: Post-COVID-19 lung sequelae can persist and progress after hospital discharge, suggesting airways involvement and formation of new fibrotic-like lesions, mainly in patients who were in intensive care unit (ICU). Funding: São Paulo Research Foundation (22/01769-5) and Instituto Todos pela Saúde (C1721). more...
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- 2024
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