Respiratory and Psychophysical Sequelae Among Patients With COVID-19 Four Months After Hospital Discharge
Mattia Bellan, Daniele Soddu, Piero Emilio Balbo, Alessio Baricich, Patrizia Zeppegno, Gian Carlo Avanzi, Giulia Baldon, Giuseppe Bartolomei, Marco Battaglia, Sofia Battistini, Valeria Binda, Margherita Beatrice Borg, Vincenzo Cantaluppi, Luigi Mario Castello, Elisa Clivati, Carlo Cisari, Martina Costanzo, Alessandro Croce, Daria Cuneo, Carla De Benedittis, Simona De Vecchi, A. Feggi, Martina Gai, Eleonora Gambaro, E. Gattoni, Carla Gramaglia, Leonardo Grisafi, C. Guerriero, Eyal Hayden, Amalia Jona, Marco Invernizzi, Luca Lorenzini, Lucia Loreti, María Martelli, Paolo Marzullo, Erica Matino, Antonio Panero, Elena Parachini, Filippo Patrucco, Giuseppe Patti, Alice Pirovano, P. Prosperini, Riccardo Quaglino, Cristina Rigamonti, Pier Paolo Sainaghi, Camilla Vecchi, Erika Zecca, Mario Pirisi
Abstract
Importance: Although plenty of data exist regarding clinical manifestations, course, case fatality rate, and risk factors associated with mortality in severe coronavirus disease 2019 (COVID-19), long-term respiratory and functional sequelae in survivors of COVID-19 are unknown. Objective: To evaluate the prevalence of lung function anomalies, exercise function impairment, and psychological sequelae among patients hospitalized for COVID-19, 4 months after discharge. Design, Setting, and Participants: This prospective cohort study at an academic hospital in Northern Italy was conducted among a consecutive series of patients aged 18 years and older (or their caregivers) who had received a confirmed diagnosis of severe acute respiratory coronavirus 2 (SARS-CoV-2) infection severe enough to require hospital admission from March 1 to June 29, 2020. SARS-CoV-2 infection was confirmed via reverse transcription-polymerase chain reaction testing, bronchial swab, serological testing, or suggestive computed tomography results. Exposure: Severe COVID-19 requiring hospitalization. Main Outcomes and Measures: The primary outcome of the study was to describe the proportion of patients with a diffusing lung capacity for carbon monoxide (Dlco) less than 80% of expected value. Secondary outcomes included proportion of patients with severe lung function impairment (defined as Dlco <60% expected value); proportion of patients with posttraumatic stress symptoms (measured using the Impact of Event Scale-Revised total score); proportion of patients with functional impairment (assessed using the Short Physical Performance Battery [SPPB] score and 2-minute walking test); and identification of factors associated with Dlco reduction and psychological or functional sequelae. Results: Among 767 patients hospitalized for severe COVID-19, 494 (64.4%) refused to participate, and 35 (4.6%) died during follow-up. A total of 238 patients (31.0%) (median [interquartile range] age, 61 [50-71] years; 142 [59.7%] men; median [interquartile range] comorbidities, 2 [1-3]) consented to participate to the study. Of these, 219 patients were able to complete both pulmonary function tests and Dlco measurement. Dlco was reduced to less than 80% of the estimated value in 113 patients (51.6%) and less than 60% in 34 patients (15.5%). The SPPB score was suggested limited mobility (score <11) in 53 patients (22.3%). Patients with SPPB scores within reference range underwent a 2-minute walk test, which was outside reference ranges of expected performance for age and sex in 75 patients (40.5%); thus, a total of 128 patients (53.8%) had functional impairment. Posttraumatic stress symptoms were reported in a total of 41 patients (17.2%). Conclusions and Relevance: These findings suggest that at 4 months after discharge, respiratory, physical, and psychological sequelae were common among patients who had been hospitalized for COVID-19.