Severe SARS-CoV-2 pneumonia: Clinical, functional and imaging outcomes at 4 months

Introduction. - Given the pathophysiology of coronavirus disease 19 (COVID-19), persistent pulmonaryabnormalities are likely. Methods. - We conducted a prospective cohort study in severe COVID-19 patients who had oxygen saturation < 94% and were primarily admitted to hospital. We aimed to describe persistent gas exchangeabnormalities at 4 months, defined as decreased diffusing capacity of the lungs for carbon monoxide( DLco) and/or desaturation on the 6-minute walk test (6MWT), along with associated mechanisms andrisk factors. Results. - Of the 72 patients included, 76.1% required admission to an intensive care unit (ICU), while 68.5% required invasive mechanical ventilation (MV). A total of 39.1% developed venous thromboembolism( VTE). After 4 months, 61.4% were still symptomatic. Functionally, 39.1% had abnormal carbon monoxidetest results and/or desaturation on 6MWT; high-flow oxygen, MV, and VTE during the acute phase weresignificantly associated. Restrictive lung disease was observed in 23.6% of cases, obstructive lung diseasein 16.7%, and respiratory muscle dysfunction in 18.1%. A severe initial presentation with admission toICU (P = 0.0181), and VTE occurrence during the acute phase (P = 0.0089) were associated with theseabnormalities. 41% had interstitial lung disease in computed tomography (CT) of the chest. Four patients( 5.5%) displayed residual defects on lung scintigraphy, only one of whom had developed VTE during theacute phase (5.5%). The main functional respiratory abnormality (31.9%) was reduced capillary volume( Vc < 70%). Conclusion. - Among patients with severe COVID-19 pneumonia who were admitted to hospital, 61% werestill symptomatic, 39% of patients had persistent functional abnormalities and 41% radiological abnormalities after 4 months. Embolic sequelae were rare but the main functional respiratory abnormality wasreduced capillary volume. A respiratory check-up after severe COVID-19 pneumonia may be relevant toimprove future management of these patients.