Long-Term Cardiopulmonary Function After COVID-19-Associated Acute Respiratory Distress Syndrome: A Multicenter Case-Control Study.
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Scolari Fernando Luis, Rover Marciane Maria, Trott Geraldine, Dias da Silva Mariana Motta, de Souza Denise, Miozzo Aline Paula, de Souza Jennifer Menna Barreto, Nunes da Silva Gabrielle, Schardosim Raíne Fogliati De Carli, de Souza Roldão Emelyn, Dos Santos Rosa da Rosa Minho, Mocellin Duane, Rech Gabriela Soares, Itaqui Carolina Rothmann, Gobetti da Luz Lucas, Rieth Gabriel Beilfuss, Lisboa Thiago Costa, Mardini Ana Carolina, Fernandes Juliana Cardozo, Lago Bruna Oliveira, Facchi Luciane, Donelli da Silveira Anderson, Benedetto Igor Gorski, Draghetti Marcelle Klein, Pacheco Tiago, Fogazzi Debora Vaccaro, Marcolino Milena Soriano, Antonio Ana Carolina Peçanha, Schvartzman Paulo Roberto, Barreto Bruna Brandao, Robinson Caroline Cabral, Falavigna Maicon, Nasi Luiz Antonio, Teixeira Cassiano, Polanczyk Carisi Anne, Rosa Regis Goulart, Pos-COVID Brazil 3 Group Investigators
Аннотация
DESIGN, SETTING, AND PATIENTS: This is a multicentric case-control study conducted from February 2023 to December of 2023. Pulmonary function tests, cardiopulmonary exercise testing (CPET), chest CT, and HRQoL (using EuroQol 5D three-level [EQ-5D-3L]) were performed at least 12 months after hospital discharge among cases (COVID-19 complicated by ARDS) and at the time of inclusion among controls (family members/friends matched for sex and age).
INTERVENTIONS: None.
MEASUREMENTS AND MAIN RESULTS: A total of 114 COVID-19 ARDS survivors and 115 controls were included. The mean age was 54 years and 52.4% of the participants were men. Time from hospital discharge to evaluation was 22 months (20.99-41.41 mo) among cases. Persistent symptoms, including memory loss (48.2%), fatigue (42.1%), and anxiety (31.6%), were reported by 73.6% of the COVID-19 ARDS survivors. Cases had significantly reduced pulmonary function, with lower diffusing capacity for carbon monoxide (DLCO) of 6.85 mmol/min/Kpa (5.44-8.37 mmol/min/Kpa) vs. 7.36 mmol/min/Kpa (6.43-8.96 mmol/min/Kpa; p = 0.012) and % of predicted DLCO of 81.0% (70.2-90.4%) vs. 89.3% (78.9-99.9%; p < 0.001), compared with controls, as well as a higher frequency of moderate to severe DLCO impairment (10.5% vs. 0.8%; p = 0.002). In CPET, cases demonstrated lower peak oxygen consumption (21.9 mL/kg/min [18.2-29 mL/kg/min] vs. 25.8 mL/kg/min [21.6-31.9 mL/kg/min]; p < 0.001). Chest CT revealed a greater prevalence of ground-glass opacities in cases (53.5% vs. 16.5%; p < 0.001) and emphysema (6.1% vs. 0%; p = 0.043). HRQoL, using EQ-5D-3L utility scores, were significantly lower in cases, with worse mobility (p < 0.001), self-care (p < 0.001), and anxiety/depression (p = 0.04) dimension scores compared with controls.
CONCLUSIONS: COVID-19 ARDS survivors exhibit significant long-term impairments in pulmonary function, exercise capacity, and quality of life and abnormal chest CT findings compared with family controls with same sex and age.