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

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

Autores: 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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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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