Resumen de Key Factors Associated With Pulmonary Sequelae in the Follow-Up of Critically Ill COVID-19 Patients
Jéssica González Gutiérrez, Jordi de Batlle, Iván D. Benítez Iglesias, Gerard Torres Cortada, Sally Santiesteve, Adriano D.S. Targa, Clara Gort Paniello, Anna Moncusí Moix, Maria Aguilà, Fatty Seck, Adrian Arturo Ceccato, Ricard Ferrer Roca, Anna Motos, J. Riera, Laia Fernández Barat, Rosario Menéndez Villanueva, José Ángel Lorente Balanza, Oscar Peñuelas Rodríguez, Dario Garcia Gasulla, Yhivian Peñasco Martín, Pilar Ricart Martí, Elena Abril Palomares, Luciano Aguilera Celorrio, Alejandro Rodríguez Oviedo, María Victoria Boado, Belén Beteré, Juan Carlos Pozo Laderas, J. Solé Violán, I. Salvador Adell, Mariana Andrea Novo, José Barberán López, Rosario Amaya-Villar, José Garnacho Montero, José M. Gómez, Aaron Blandino Ortiz, Luis Mariano Tamayo Lomas, A. Ubeda-Iglesias, Miguel Catalán, Ángel Luis Sánchez Miralles, Ignacio Yago Martínez Varela, Ruth Noemí, Nieves Franco, Víctor D. Gumucio Sanguino, Elena Bustamante Munguira, Jorge Valdivia Ruiz, J. Caballero, Elena Gallego Domínguez, Covadonga Rodríguez, Álvaro Castellanos Ortega, Josep Trenado, J. Marín, Guillermo Muñiz Albaiceta, M. Carmen de la Torre, Ana Loza Vázquez, Pablo Vidal Cortés, José Manuel Añón Elizalde, Cristina Carbajales Pérez, Victor Sagredo, Nieves Carbonell Monleón, Lorenzo Socías Crespí, Carme Barberà, Angel Estella García, Emili Díaz, David de Gonzalo Calvo, Antoni Torres Martí, Ferrán Barbé Illa, Jorge García
Introduction 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.
Methods 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.
Results 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.
Conclusion 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.
