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Sanchez Sanchez, MiguelAuthorGarcia Alcaide, FelipeAuthorBadia Jobal, Joan RamonAuthorGabarrús Barri, AlbertAuthorCilloniz Campos, CatiaAuthorTorres Marti, AntoniAuthorAndrea Riba, RutAuthorCastro Revollo, PedroAuthorBarbera Mir, Joan AlbertAuthorDiaz Ramos, Maria Del CarmenAuthorRodriguez Bruna, DavidAuthorKiarostami, KasraAuthorCastella Pericas, ManelAuthorFernández Barat, LaiaAuthorFerrando Ortolá, CarlosAuthorBueno Freire, LeticiaAuthorCanseco, JoanAuthorMoreno Guarnido, CristinaAuthorCeccato, AdrianAuthorMotos, AnnaAuthor

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Key factors associated with pulmonary sequelae in the follow-up of critically ill COVID-19 patients

Publicated to:Archivos De Bronconeumologia. 59 (4): 205-215 - 2023-04-01 59(4), DOI: 10.1016/j.arbres.2022.12.017

Authors: Gonzalez, Jessica; de Batlle, Jordi; Benitez, Ivan D; Torres, Gerard; Santisteve, Sally; Targa, Adriano D S; Gort-Paniello, Clara; Moncusi-Moix, Anna; Aguila, Maria; Seck, Fatty; Ceccato, Adrian; Ferrer, Ricard; Motos, Anna; Riera, Jordi; Fernandez, Laia; Menendez, Rosario; Lorente, Jose Angel; Penuelas, Oscar; Garcia-Gasulla, Dario; Penasco, Yhivian; Ricart, Pilar; Palomares, Elena Abril; Aguilera, Luciano; Rodriguez, Alejandro; Varela, Maria Victoria Boado; Betere, Belen; Pozo-Laderas, Juan Carlos; Sole-Violan, Jordi; Salvador-Adell, Inmaculada; Novo, Mariana Andrea; Villar, Rosario Amaya; Garnacho-Montero, Jose; Gomez, Jose M; Ortiz, Aaron Blandino; Lomas, Luis Tamayo; Ubeda, Alejandro; Catalan-Gonzalez, Mercedes; Sanchez-Miralles, Angel; Varela, Ignacio Martinez; Garcia, Ruth Noemi Jorge; Franco, Nieves; Gumucio-Sanguino, Victor D; Bustamante-Munguira, Elena; Valdivia, Luis Jorge; Caballero, Jesus; Gallego, Elena; Rodriguez, Covadonga; Castellanos-Ortega, Alvaro; Trenado, Josep; Marin-Corral, Judith; Albaiceta, Guillermo M; de la Torre, Maria del Carmen; Loza-Vazquez, Ana; Vidal, Pablo; Anon, Jose M; Perez, Cristina Carbajales; Sagredo, Victor; Carbonell, Nieves; Socias, Lorenzo; Barbera, Carme; Estella, Angel; Diaz, Emili; de Gonzalo-Calvo, David; Torres, Antoni; Barbe, Ferran

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Abstract

Critical COVID-19 survivors have a high risk of respiratory sequelae. Therefore, we aimed to identify key factors associated with altered lung function and CT scan abnormalities at a follow-up visit in a cohort of critical COVID-19 survivors.Multicenter ambispective observational study in 52 Spanish intensive care units. Up to 1327 PCR-confirmed critical COVID-19 patients had sociodemographic, anthropometric, comorbidity and lifestyle characteristics collected at hospital admission; clinical and biological parameters throughout hospital stay; and, lung function and CT scan at a follow-up visit.The median [p25-p75] time from discharge to follow-up was 3.57 [2.77-4.92] months. Median age was 60 [53-67] years, 27.8% women. The mean (SD) percentage of predicted diffusing lung capacity for carbon monoxide (DLCO) at follow-up was 72.02 (18.33)% predicted, with 66% of patients having DLCO<80% and 24% having DLCO<60%. CT scan showed persistent pulmonary infiltrates, fibrotic lesions, and emphysema in 33%, 25% and 6% of patients, respectively. Key variables associated with DLCO<60% were chronic lung disease (CLD) (OR: 1.86 (1.18-2.92)), duration of invasive mechanical ventilation (IMV) (OR: 1.56 (1.37-1.77)), age (OR [per-1-SD] (95%CI): 1.39 (1.18-1.63)), urea (OR: 1.16 (0.97-1.39)) and estimated glomerular filtration rate at ICU admission (OR: 0.88 (0.73-1.06)). Bacterial pneumonia (1.62 (1.11-2.35)) and duration of ventilation (NIMV (1.23 (1.06-1.42), IMV (1.21 (1.01-1.45)) and prone positioning (1.17 (0.98-1.39)) were associated with fibrotic lesions.Age and CLD, reflecting patients' baseline vulnerability, and markers of COVID-19 severity, such as duration of IMV and renal failure, were key factors associated with impaired DLCO and CT abnormalities.Published by Elsevier España, S.L.U.

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