Lingering Lung, Psychological Issues Plague Patients Who Had Severe COVID-19

Pharmacists are getting a lot of questions from patients who recovered from COVID-19 but still face lingering effects. A new study from northern Italy quantifies what patients who had been hospitalized for COVID-19 now are facing. Here is more information that can be shared.

NOVARA, ITALY – With COVID-19, the effects don’t always end when patients test negative for infection.

An Italian study published in JAMA Network Open reports on respiratory, functional, and psychological sequalae associated with recovery from coronavirus disease 2019.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2775643

Università del Piemonte Orientale researchers and colleagues conducted a cohort study of 238 patients with COVID-19 hospitalized in an academic hospital in Northern Italy. They found that more than half of participants had a significant reduction of diffusing lung capacity for carbon monoxide or measurable functional impairment. Furthermore, about 20% of patients had symptoms of posttraumatic stress 4 months after discharge.

“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,” study authors write. To remedy that, they sought to evaluate the prevalence of lung function anomalies, exercise function impairment, and psychological sequelae among patients who had been hospitalized for COVID-19.

Included were a consecutive series of adult patients (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. In all cases, SARS-CoV-2 infection was confirmed via reverse transcription–polymerase chain reaction testing, bronchial swab, serological testing, or suggestive computed tomography results.

Researchers defined the primary outcome as the proportion of patients with a diffusing lung capacity for carbon monoxide (D_lco) less than 80% of expected value. Secondary outcomes included proportion of patients with:

• severe lung function impairment (defined as D_lco<60% expected value);
• posttraumatic stress symptoms (measured using the Impact of Event Scale–Revised total score); and
• functional impairment (assessed using the Short Physical Performance Battery [SPPB] score and 2-minute walking test).

Researchers also identified factors associated with D_lco reduction and psychological or functional sequelae.

Among 767 patients hospitalized for severe COVID-19, 494 (64.4%) refused to participate, and 35 (4.6%) died during follow-up, according to the report. The 238 patients consenting to participate had a median age of 61 and most, 59.7%, were men and median of two comorbidities; most, 59.7%, were men.Of these, 219 patients were able to complete both pulmonary function tests and D_lco measurement.

Results indicate that D_lco 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 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%); that led the authors to conclude that 53.8% of patients had functional impairment. Posttraumatic stress symptoms were reported in 17.2% of patients, they add.

“While COVID-19 is a systemic disease, the lungs are most commonly affected, with histopathological findings that may include diffuse alveolar epithelium destruction, capillary damage or bleeding, hyaline membrane formation, alveolar septal fibrous proliferation, and pulmonary consolidation,” researchers note. “As a consequence, the diffusion capacity of the lung for carbon monoxide (D_lco) is commonly altered in patients who recover from COVID-19,⁸ similarly to SARS and Middle East respiratory syndrome (MERS), illnesses that are associated with an impairment of lung function lasting months to years.”

The authors also point out that adverse psychological outcomes might occur, adding, “A multidisciplinary approach investigating the functional and psychological aspects associated with COVID-19 may be more effective in disclosing potential sequelae associated with COVID-19.”