TY - JOUR
T1 - Chest radiography is a poor predictor of respiratory symptoms and functional impairment in survivors of severe COVID-19 pneumonia
AU - D'Cruz, Rebecca
AU - Waller, Michael
AU - Perrin, Felicity
AU - Periselneris, Jimstan
AU - Norton, Sam
AU - Smith, Laura-Jane
AU - Patrick, Tanya
AU - Walder, David
AU - Heitmann, Amadea
AU - Lee, Kai Kong
AU - Madula, Rajiv
AU - McNulty, William
AU - Macedo, Patricia
AU - Lyall, Rebecca
AU - Warwick, Geoffrey
AU - Galloway, James
AU - Birring, Surinder
AU - Patel, Amit
AU - Patel, Irem
AU - Jolley, Caroline
PY - 2021/2/8
Y1 - 2021/2/8
N2 - BACKGROUND A standardised approach to assessing COVID-19 survivors has not been established, largely due to the paucity of data on medium- and long-term sequelae. Interval chest radiograph is recommended following community-acquired pneumonia, however its utility in monitoring recovery from COVID-19 pneumonia remains unclear.
METHODS Prospective single-centre observational cohort study. Patients hospitalised with severe COVID-19 pneumonia (admission duration ≥48hours and oxygen requirement ≥40% or critical care admission) underwent face-to-face assessment 4-6 weeks post-discharge. Primary outcome: radiological resolution of COVID-19 pneumonitis (Radiographic Assessment of Lung Oedema score <5). Secondary outcomes: clinical outcomes, symptom questionnaires, mental health screening (Trauma Screening Questionnaire, GAD-7, PHQ-9), physiological testing (4-metre gait speed (4MGS), 1-minute sit-to-stand test (STS)).
RESULTS 119 patients assessed between 3rd June and 2nd July 2020 at median (IQR) 61 (51-67) days post-discharge. Mean±SD age 58.7±14.4 years, body mass index 30.0 (25.9-35.2) kg/m2, 62% male, 68% ethnic minority. Despite radiographic resolution of pulmonary infiltrates in 87%, mMRC breathlessness scores were above pre-COVID baseline in 46% and patients reported persistent
fatigue (68%), sleep disturbance (57%) and breathlessness (32%). Screening thresholds were breached for post-traumatic stress disorder (25%), anxiety (22%) and depression (18%). 4MGS was slow (<0.8m/s) in 38%, 35% desaturated by ≥4% during STS. Of 56 thoracic computed tomography scans performed, 75% demonstrated COVID-related interstitial and/or airways disease.
CONCLUSIONS Persistent symptoms, adverse mental health outcomes and physiological impairment are common 2 months after severe COVID-19 pneumonia. Follow-up chest radiograph is a poor marker of recovery, therefore holistic face-to-face assessment is recommended to facilitate early recognition and management of post-COVID sequelae.
AB - BACKGROUND A standardised approach to assessing COVID-19 survivors has not been established, largely due to the paucity of data on medium- and long-term sequelae. Interval chest radiograph is recommended following community-acquired pneumonia, however its utility in monitoring recovery from COVID-19 pneumonia remains unclear.
METHODS Prospective single-centre observational cohort study. Patients hospitalised with severe COVID-19 pneumonia (admission duration ≥48hours and oxygen requirement ≥40% or critical care admission) underwent face-to-face assessment 4-6 weeks post-discharge. Primary outcome: radiological resolution of COVID-19 pneumonitis (Radiographic Assessment of Lung Oedema score <5). Secondary outcomes: clinical outcomes, symptom questionnaires, mental health screening (Trauma Screening Questionnaire, GAD-7, PHQ-9), physiological testing (4-metre gait speed (4MGS), 1-minute sit-to-stand test (STS)).
RESULTS 119 patients assessed between 3rd June and 2nd July 2020 at median (IQR) 61 (51-67) days post-discharge. Mean±SD age 58.7±14.4 years, body mass index 30.0 (25.9-35.2) kg/m2, 62% male, 68% ethnic minority. Despite radiographic resolution of pulmonary infiltrates in 87%, mMRC breathlessness scores were above pre-COVID baseline in 46% and patients reported persistent
fatigue (68%), sleep disturbance (57%) and breathlessness (32%). Screening thresholds were breached for post-traumatic stress disorder (25%), anxiety (22%) and depression (18%). 4MGS was slow (<0.8m/s) in 38%, 35% desaturated by ≥4% during STS. Of 56 thoracic computed tomography scans performed, 75% demonstrated COVID-related interstitial and/or airways disease.
CONCLUSIONS Persistent symptoms, adverse mental health outcomes and physiological impairment are common 2 months after severe COVID-19 pneumonia. Follow-up chest radiograph is a poor marker of recovery, therefore holistic face-to-face assessment is recommended to facilitate early recognition and management of post-COVID sequelae.
UR - https://openres.ersjournals.com/content/early/2020/10/15/23120541.00655-2020
UR - https://openres.ersjournals.com/content/7/1/00655-2020.article-info
U2 - 10.1183/23120541.00655-2020
DO - 10.1183/23120541.00655-2020
M3 - Article
SN - 2312-0541
VL - 7
JO - ERJ Open Research
JF - ERJ Open Research
IS - 1
ER -
