Irrespective Of Severity, 40 Percent Of Post-COVID Pneumonia Patients Still Have Impaired Lung Diffusion And 22 Percent Developed Lung Fibrosis A Year Later!

It is becoming more apparent with mounting study findings that hundreds of thousands of individuals globally are literally walking around without even being aware that their lungs are deteriorating as a result of having been exposed to the SARS-CoV-2 virus!


 
A new study by researchers from the COVID-FIBROTIC study team in Spain has found that irrespective of severity, about 40% of Post-COVID pneumonia patients still have Impaired lung diffusion a year later after so-called ‘recovery’ while more than 22% of them also developed lung fibrosis! Most exhibited dyspnea. (A condition often described as an intense tightening in the chest, air hunger, difficulty breathing, breathlessness or a feeling of suffocation.)
 
Some of the conditions and symptoms seen in individuals with Long COVID can actually be attributed to lung deterioration.
 
The COVID-FIBROTIC study team in Spain comprise pulmonary physicians and researchers from the following hospitals and institutions:
 
-Hospital Clinico, INCLIVA, Valencia
-Hospital General, Valencia
-Hospital San Juan, Alicante
-Hospital La Ribera, Alzira, Valencia
-Hospital Vinalopo de Elche, Alicante
-Hospital Dr Peset, Valencia
-Hospital Virgen de la Arrixaca, Murcia
-Hospital Arnau de Vilanova, Valencia
-Hospital Virgen del Rocio, Seville
-Hospital los Arcos, Murcia
-Hospital General, Castellon
-Hospital Clínico San Carlos, Universidad Complutense, Madrid
-Hospital Clinico, INCLIVA, Valencia
-Hospital La Princesa, Universidad Autónoma, Madrid
-Hospital Clinico, INCLIVA, Valencia
 
The ongoing COVID-19) pandemic has already affected more than 617 million individuals globally and caused more than 6.5 million deaths according to official reports. In reality it is predicted that the actual figures could be as high as 5 to 6-fold and worse, excess deaths associated with COVID-19 could actually be phenomenal!
 
The aim of the study was to evaluate pulmonary sequelae in patients with bilateral COVID-19 pneumonia according to severity 1 year after hospital discharge.
 
The COVID-FIBROTIC study is a multicenter prospective observational cohort study for admitted patients with bilateral COVID-19 pneumonia. Pulmonary functional outcomes and chest computed tomography sequelae were analyzed 12 months after hospital discharge and the study team classified patients into three groups according to severity. A post hoc analysis model was designed to establish how functional test changed between groups and over time. A multivariable logistic regression model was created to study prognostic factors for lung diffusion impairment and radiological fibrotic-like changes at 12 months.
 
In the ongoing study, among 488 hospitalized patients with COVID-19 pneumonia, 284 patients had completed the entire evaluation at 12 months. Median age was 60.5 ± 11.9 and 55.3% were men. The study team found between-group differences in male sex, length of hospital stays, radiological involvement and inflammatory laboratory parameters.
 
The study findings showed severe patient s had statistically worse levels of lung diffusion at 2 months but no between group differences were found in subsequent controls.
 
The study findings however alarmingly found that at a 12-month follow up, impaired lung diffusion was identified in 39.8% of the all the patients irrespective of severity.
 
Furthermore, radiological fibrotic-like changes at 12 months were reported in 22.7% of patients (102/448), only associated with radiological involvement at admission (OR: 1.55, 95% CI 1.06–2.38; p = 0.02) and LDH (OR: 0.99, 95% CI 0.98–0.99; p = 0.046).
 
The study findings suggest that a significant percentage of individuals would develop pulmonary sequelae after COVID 19 pneumonia, regardless of severity of the acute process.
 
Th study findings were published in the peer reviewed journal: Respiratory Research (Springer).
https://respiratory-research.biomedcentral.com/articles/10.1186/s12931-022-02166-8
 
Typical symptoms of long COVID range from lingering headaches and myalgia to permanent disabilities, affecting the survivors' quality of life. Nearly one-third of the infected patients develop acute respiratory distress syndrome (ARDS), while fibrotic pulmonary lesions develop in many.
 
Already study data show that patients on mechanical ventilation during the acute phase of COVID-19 sustain more alterations in their pneumocytes, pulmonary endothelial and alveolar cells, as well as interstitial and pulmonary fibrotic changes compared to those on conventional oxygen. One-fourth of the patients who developed pneumonia suffered from sub-pleural cystic/reticular lesions, and one-third of the patients had fibrotic changes following one year and six months post-discharge, respectively.
 
This new ongoing multicenter, prospective, observational cohort study evaluated patients with bilateral pneumonia as a pulmonary sequela of SARS-CoV-2 infection….for lung function alterations and persistent fibrous lesions one year after hospital discharge.
https://clinicaltrials.gov/ct2/show/NCT04409275
 
The Spanish study enrolled all adult patients discharged from respiratory services with a life expectancy of more than one year. Functional changes, the evolution of dyspnea, and exercise capacity were evaluated after discharge––at two months (V1), six months (V2), and twelve months (V3).
 
In the study, the mean age of the participants was 60.5 years, and the majority were males. Notably, males showed a greater preponderance of more severe disease. In addition, the duration of hospital stay, the laboratory parameters (C-reactive protein, lymphocyte count, lactate dehydrogenase levels, D-dimer, and ferritin), and RALE scores varied between the study groups (vis, V1, V2, and V3). Whereas there were no significant differences amongst the study groups concerning patients' demographics, such as body mass index (BMI), age, smoking, and comorbidities.
 
Detailed pulmonary function tests revealed that 53.8% of patients had impaired diffusion after two months, which gradually improved after six months and one year.
 
Surprisingly, the mean diffusing capacity of the lungs for carbon monoxide (DLCO) abnormalities was 78.5 in V1, 81.6 in V2, and 84 in V3. Significant alterations in diffusion were found at 60 days - relative to time and severity - between mild, moderate, and severe patients.
 
Corresponding author, Dr Jaime Signes-Costa from the Pulmonary Department, Hospital Clinico, Valencia told Thailand Medical News, “The study findings showed that throughout the cohort, a restricted abnormality was seen in 14.3% of patients at two months, 9.3% at six months, and 6.7% at 12 months. The mean forced vital capacity (FVC) was 99 at V1, 100.8 at V2, and 104.2 at V3. Meanwhile, no significant differences were found in FVC relative to time and severity.”
 
The cohort was subsequently analyzed for dyspnea.
 
The mMRC scale depicted dyspnea ≥ 2 in 21.5% of the patients at V1, 11.3% at V2, and 9.8% at V3. A significant association was found between dyspnea and the time of follow-up.
 
Time-dependent significant differences among the severity groups were however absent.
 
Lung static volumes remained comparable between the groups, while the six-minute walk test (6MWT) showed differences in the distance walked ie with severity as the confounding factor. Altered DLCO (of <80% at 12 months) is associated with age, female gender, ferritin levels, and BMI.
 
CT scans or computed tomography was advised two months post-discharge in patients with abnormal chest X-rays, abnormal pulmonary function test results, and persistent dyspnea.
 
High resolution computed tomography or HRCT was performed after two months on 325 patients. Among these, 38.4% revealed complete resolution, while the remaining exhibited ground glass opacities (GGO). Notably, GGO was the most common (in 73.5%) and showed differences based on age groups.
 
Computed tomography (CT) was repeated in patients with prior abnormal CT findings one-year post-discharge.
 
Overall, 156 out of 200 patients had CT at V3 – 78.8 % of whom showed persistent radiological alterations. Of the 200 patients, 45.5% had GGO; the reticular pattern was found in 34% of patients; parenchymal bands were found in 33.4%, and traction bronchiectasis was seen in 30.8%. 
 
Worryingly, out of 156 patients, 102 revealed fibrotic-like sequelae…depicted by CT conducted at 12 months. Significant changes between age groups were more frequently detected in severe cases.
 
LDH or lactate dehydrogenase and the involvement of the lungs, as seen in radiology during admission, were associated with the fibrotic pattern at V3.
 
The study team concluded, “Many patients with pneumonia associated with SARS-CoV-2 infection developed fibrous sequelae and showed dyspnea and impairments in lung function one year after hospital discharge. Therefore, further follow-ups of the patients who suffered from severe COVID-19-associated pneumonia are warranted to study the progression of the fibrotic lesions over time.”
 
More on POST-COVID Pulmonary Sequelae, keep on logging to Thailand Medical News.