Pulmonary Sequelae at 4 Months After COVID-19 Infection: A Single-Centre Experience of a COVID Follow-Up Service

• Published in: Advances in therapy 2021-08, Vol.38 (8), p.4505-4519
• Main Authors: Robey, Rebecca C., Kemp, Katie, Hayton, Philip, Mudawi, Dalia, Wang, Ran, Greaves, Melanie, Yioe, Veronica, Rivera-Ortega, Pilar, Avram, Cristina, Chaudhuri, Nazia
• Format: Article
• Language: English
• Subjects: Aftercare; Cardiology; COVID-19; Endocrinology; Follow-Up Studies; Humans; Internal Medicine; Medicine; Medicine & Public Health; Oncology; Original Research; Pandemics; Patient Discharge; Pharmacology/Toxicology; Retrospective Studies; Rheumatology; SARS-CoV-2
• ISSN: 0741-238X; 1865-8652
• DOI: 10.1007/s12325-021-01833-4

Introduction At the end of the first year of the COVID-19 pandemic, more than 78 million known survivors were recorded. The long-term pulmonary sequelae of COVID-19 remain unknown. Methods We performed a retrospective analysis of a post-COVID follow-up service to estimate the burden of persistent pulmonary morbidity in hospitalised COVID survivors. Results A total of 221 patients were followed-up: 44 intensive care unit (ICU) and 177 ward patients. Further investigations were planned as per British Thoracic Society Guidelines: For all ICU patients ( n  = 44) and for 38 of 177 (21%) ward-based patients who had persistent symptoms and/or persistent radiographic changes on CXR at their initial 8-week follow-up visit. In the ward-based cohort, statistically significant associations with persistent symptoms were being an ex- or current smoker, having pre-existing diabetes, and having a longer length of stay. In patients requiring further investigations, pulmonary function tests (PFTs; n  = 67) at an average of 15 weeks post-discharge showed abnormalities in at least one PFT parameter in 79% (equating to 24% of the entire cohort). The most common abnormality was an abnormal diffusion capacity of carbon monoxide (TLCO), highest in the ICU cohort (64% ICU vs. 38% non-ICU). TLCO correlated negatively with length of stay and with maximum inspired FiO 2 in the patient group as a whole. In ICU patients, TLCO correlated negatively with maximum inspired positive airway pressure. Computed tomography scans ( n  = 72) at an average of 18 weeks post-discharge showed evidence of persistent ground glass opacities in 44% and fibrosis in 21% (equating to 7% of the entire cohort). Conclusion Our data add to the growing evidence that there will be pulmonary sequelae in a proportion of COVID survivors, providing some insight into what may become a significant chronic global health problem.