Respiratory recovery trajectories after severe-to-critical COVID-19: a 1-year prospective multicentre study

Frédéric Schlemmer , Simon Valentin (1, 2) , Laurent Boyer (3, 4) , Anne Guillaumot (1) , François Chabot (1, 2) , Clairelyne Dupin (5) , Pierre Le Guen (6) , Gwenael Lorillon (7) , Anne Bergeron , Damien Basille (8, 9) , Julia Delomez (10) , Claire Andrejak (8, 9) , Valentine Bonnefoy , Hélène Goussault , Jean-Baptiste Assié (11, 12) , Pascaline Choinier (13) , Anne-Marie Ruppert (14) , Jacques Cadranel (15) , Maria Chiara Mennitti , Mehdi Roumila , Charlotte Colin , Sven Günther , Olivier Sanchez , Thomas Gille , Lucile Sésé , Yurdagul Uzunhan , Morgane Faure , Maxime Patout , Capucine Morelot-Panzini , Pierantonio Laveneziana , Maeva Zysman (16) , Elodie Blanchard (16) , Chantal Raherison-Semjen (17) , Violaine Giraud , Etienne Giroux-Leprieur , Stéfanie Habib , Nicolas Roche , Anh Tuan Dinh-Xuan , Islem Sifaoui , Pierre-Yves Brillet , Camille Jung , Emmanuelle Boutin , Richard Layese , Florence Canoui-Poitrine , Bernard Maitre

1 CHRU Nancy - Centre Hospitalier Régional Universitaire de Nancy
2 DCAC - Défaillance Cardiovasculaire Aiguë et Chronique
3 CEReSS - Centre d'études et de recherche sur les services de santé et la qualité de vie
4 Hôpitaux Sud - Département Universitaire de Psychiatrie - [Hôpital Sainte Marguerite - APHM]
5 AP-HP - Hopital Saint-Louis [AP-HP]
6 Service de Réanimation et USC Médico-Chirurgicale = Médecine intensive réanimation [CHU Tenon]
7 Service de pneumologie [Saint-Louis]
8 CHU Amiens-Picardie
9 AGIR - Agents infectieux, résistance et chimiothérapie - UR UPJV 4294
10 UPJV - Université de Picardie Jules Verne
11 CEpiA - Clinical Epidemiology and Ageing : Geriatrie Soins Primaires et Santé Publique
12 CRC (UMR_S_1138 / U1138) - Centre de Recherche des Cordeliers
13 IAME (UMR_S_1137 / U1137) - Infection, Anti-microbiens, Modélisation, Evolution
14 CHU Tenon [AP-HP]
15 Service de Pneumologie = Pneumologie - Oncologie Thoracique - Maladies Pulmonaires Rares [CHU Tenon]
16 CRCTB - Centre de recherche Cardio-Thoracique de Bordeaux [Bordeaux]
17 BPH - Bordeaux population health

Background Survivors of severe-to-critical COVID-19 may have functional impairment, radiological sequelae and persistent symptoms requiring prolonged follow-up. This pragmatic study aimed to describe their clinical follow-up and determine their respiratory recovery trajectories, and factors that could influence them and their health-related quality of life. Methods Adults hospitalised for severe-to-critical COVID-19 were evaluated at 3 months and up to 12 months post-hospital discharge in this prospective, multicentre, cohort study. Results Among 485 enrolled participants, 293 (60%) were reassessed at 6 months and 163 (35%) at 12 months; 89 (51%) and 47 (27%) of the 173 ones initially managed with standard oxygen were reassessed at 6 and 12 months, respectively. At 3 months, 34%, 70% and 56% of the participants had a restrictive lung defect, impaired DL CO and significant radiological sequelae, respectively. During extended follow-up, DL CO and FVC (% of predicted value) increased by means of +4 points at 6 months, and +6 points at 12 months. Sex, body mass index, chronic respiratory disease, immunosuppression, pneumonia extent or corticosteroid use during acute COVID-19 and prolonged invasive mechanical ventilation (IMV) were associated with DL CO at month 3, but not its trajectory thereafter. Among 475 (98%) patients with at least one chest computed-tomography scan during follow-up, 196 (41%) had significant sequelae on their last images. Conclusion Although pulmonary function and radiological abnormalities improved up to 1 year post-acute-COVID-19, high percentages of severe-to-critical disease survivors, including a notable proportion of those managed with standard oxygen, had significant lung sequelae and residual symptoms justifying prolonged follow-up.

Domaines: Sciences du Vivant [q-bio]; Médecine humaine et pathologie

Frédéric Schlemmer, Simon Valentin, Laurent Boyer, Anne Guillaumot, François Chabot, et al.. Respiratory recovery trajectories after severe-to-critical COVID-19: a 1-year prospective multicentre study. European Respiratory Journal, 2023, pp.2201532. ⟨10.1183/13993003.01532-2022⟩. ⟨hal-03958196⟩