Respiratory and Psychophysical Sequelae Among Patients With COVID-19 Four Months After Hospital Discharge

Bellan, Mattia; Soddu, Daniele; Balbo, Piero Emilio; Baricich, Alessio; Zeppegno, Patrizia; Avanzi, Gian Carlo; Baldon, Giulia; Bartolomei, Giuseppe; Battaglia, Marco; Battistini, Sofia; Binda, Valeria; Borg, Margherita; Cantaluppi, Vincenzo; Castello, Luigi Mario; Clivati, Elisa; Cisari, Carlo; Costanzo, Martina; Croce, Alessandro; Cuneo, Daria; De Benedittis, Carla; De Vecchi, Simona; Feggi, Alessandro; Gai, Martina; Gambaro, Eleonora; Gattoni, Eleonora; Gramaglia, Carla; Grisafi, Leonardo; Guerriero, Chiara; Hayden, Eyal; Jona, Amalia; Invernizzi, Marco; Lorenzini, Luca; Loreti, Lucia; Martelli, Maria; Marzullo, Paolo; Matino, Erica; Panero, Antonio; Parachini, Elena; Patrucco, Filippo; Patti, Giuseppe; Pirovano, Alice; Prosperini, Pierluigi; Quaglino, Riccardo; Rigamonti, Cristina; Sainaghi, Pier Paolo; Vecchi, Camilla; Zecca, Erika; Pirisi, Mario

IMPORTANCE: Although plenty of data exist regarding clinical manifestations, course, case fatality rate, and risk factors associated with mortality in severe coronavirus disease 2019 (COVID-19), long-term respiratory and functional sequelae in survivors of COVID-19 are unknown. OBJECTIVE: To evaluate the prevalence of lung function anomalies, exercise function impairment, and psychological sequelae among patients hospitalized for COVID-19, 4 months after discharge. DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study at an academic hospital in Northern Italy was conducted among a consecutive series of patients aged 18 years and older (or their caregivers) who had received a confirmed diagnosis of severe acute respiratory coronavirus 2 (SARS-CoV-2) infection severe enough to require hospital admission from March 1 to June 29, 2020. SARS-CoV-2 infection was confirmed via reverse transcription–polymerase chain reaction testing, bronchial swab, serological testing, or suggestive computed tomography results. EXPOSURE: Severe COVID-19 requiring hospitalization. MAIN OUTCOMES AND MEASURES: The primary outcome of the study was to describe the proportion of patients with a diffusing lung capacity for carbon monoxide (D(lco)) less than 80% of expected value. Secondary outcomes included proportion of patients with severe lung function impairment (defined as D(lco) <60% expected value); proportion of patients with posttraumatic stress symptoms (measured using the Impact of Event Scale–Revised total score); proportion of patients with functional impairment (assessed using the Short Physical Performance Battery [SPPB] score and 2-minute walking test); and identification of factors associated with D(lco) reduction and psychological or functional sequelae. RESULTS: Among 767 patients hospitalized for severe COVID-19, 494 (64.4%) refused to participate, and 35 (4.6%) died during follow-up. A total of 238 patients (31.0%) (median [interquartile range] age, 61 [50-71] years; 142 [59.7%] men; median [interquartile range] comorbidities, 2 [1-3]) consented to participate to the study. Of these, 219 patients were able to complete both pulmonary function tests and D(lco) measurement. D(lco) was reduced to less than 80% of the estimated value in 113 patients (51.6%) and less than 60% in 34 patients (15.5%). The SPPB score was suggested limited mobility (score <11) in 53 patients (22.3%). Patients with SPPB scores within reference range underwent a 2-minute walk test, which was outside reference ranges of expected performance for age and sex in 75 patients (40.5%); thus, a total of 128 patients (53.8%) had functional impairment. Posttraumatic stress symptoms were reported in a total of 41 patients (17.2%). CONCLUSIONS AND RELEVANCE: These findings suggest that at 4 months after discharge, respiratory, physical, and psychological sequelae were common among patients who had been hospitalized for COVID-19.