Long-term respiratory follow-up of ICU hospitalized COVID-19 patients: Prospective cohort study

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Carvalho, Carlos Roberto Ribeiro ; Lamas, Celina Almeida ; Chate, Rodrigo Caruso ; Salge, Joao Marcos ; Sawamura, Marcio Valente Yamada ; de Albuquerque, Andre L. P. ; Toufen Jr, Carlos ; Lima, Daniel Mario ; Garcia, Michelle Louvaes ; Scudeller, Paula Gobi ; Nomura, Cesar Higa ; Gutierrez, Marco Antonio ; Baldi, Bruno Guedes ; HCFMUSP Covid-19 Study Grp

• Document type: Journal article
• Source: PLoS One; v. 18, n. 1, p. 16-pg., 2023-01-20.

Abstract

BackgroundCoronavirus disease (COVID-19) survivors exhibit multisystemic alterations after hospitalization. Little is known about long-term imaging and pulmonary function of hospitalized patients intensive care unit (ICU) who survive COVID-19. We aimed to investigate long-term consequences of COVID-19 on the respiratory system of patients discharged from hospital ICU and identify risk factors associated with chest computed tomography (CT) lesion severity. MethodsA prospective cohort study of COVID-19 patients admitted to a tertiary hospital ICU in Brazil (March-August/2020), and followed-up six-twelve months after hospital admission. Initial assessment included: modified Medical Research Council dyspnea scale, SpO(2) evaluation, forced vital capacity, and chest X-Ray. Patients with alterations in at least one of these examinations were eligible for CT and pulmonary function tests (PFTs) approximately 16 months after hospital admission. Primary outcome: CT lesion severity (fibrotic-like or non-fibrotic-like). Baseline clinical variables were used to build a machine learning model (ML) to predict the severity of CT lesion. ResultsIn total, 326 patients (72%) were eligible for CT and PFTs. COVID-19 CT lesions were identified in 81.8% of patients, and half of them showed mild restrictive lung impairment and impaired lung diffusion capacity. Patients with COVID-19 CT findings were stratified into two categories of lesion severity: non-fibrotic-like (50.8%-ground-glass opacities/reticulations) and fibrotic-like (49.2%-traction bronchiectasis/architectural distortion). No association between CT feature severity and altered lung diffusion or functional restrictive/obstructive patterns was found. The ML detected that male sex, ICU and invasive mechanic ventilation (IMV) period, tracheostomy and vasoactive drug need during hospitalization were predictors of CT lesion severity(sensitivity,0.78 +/- 0.02;specificity,0.79 +/- 0.01;F1-score,0.78 +/- 0.02;positive predictive rate,0.78 +/- 0.02; accuracy,0.78 +/- 0.02; and area under the curve,0.83 +/- 0.01). ConclusionICU hospitalization due to COVID-19 led to respiratory system alterations six-twelve months after hospital admission. Male sex and critical disease acute phase, characterized by a longer ICU and IMV period, and need for tracheostomy and vasoactive drugs, were risk factors for severe CT lesions six-twelve months after hospital admission. (AU)

• FAPESP's process: 14/50889-7 - National Institute of Science and Technology Medicine Assisted by Scientific Computing (INCT-MACC)
• Grantee: José Eduardo Krieger
• Support Opportunities: Research Projects - Thematic Grants
• FAPESP's process: 16/17078-0 - Mining, indexing and visualizing Big Data in clinical decision support systems (MIVisBD)
• Grantee: Agma Juci Machado Traina
• Support Opportunities: Research Projects - Thematic Grants