Follow up of patients with severe coronavirus disease 2019 (COVID-19): Pulmonary and extrapulmonary disease sequelae

Daher, Ayham; Balfanz, Paul; Cornelissen, Christian; Müller, Annegret; Bergs, Ingmar; Marx, Nikolaus; Müller-Wieland, Dirk; Hartmann, Bojan; Dreher, Michael; Müller, Tobias

BACKGROUND: Since December 2019 the novel coronavirus disease 2019 (COVID-19) has been burdening all health systems worldwide. However, pulmonary and extrapulmonary sequelae of COVID-19 after recovery from the acute disease are unknown. MATERIAL AND METHODS: Hospitalized COVID-19 patients not requiring mechanical ventilation were included and followed 6 weeks after discharge. Body plethysmography, lung diffusion capacity (DLco), blood gas analysis (ABG), 6-min walk test (6MWT), echocardiography, and laboratory tests were performed. Quality of life (QoL), depression, and anxiety were assessed using validated questionnaires. RESULTS: 33 patients with severe disease were included. Patients were discharged without prophylactic anticoagulation. At follow-up there were no thromboembolic complications in any patient. 11 patients (33%) had dyspnea, 11 (33%) had cough, and 15 (45%) suffered from symptoms of fatigue. Pulmonary function tests including ABG did not reveal any limitations (TLC: median = 94% of predicted [IQR:85–105]; VC: 93% [78–101]; FEV1: 95% [72–103]; FEV1/FVC 79% [76–85]; PaO2: 72 mmHg [67–79]; PaCO2: 38 mmHg (Xu et al., 2020; Tian et al., 2020; Huang et al., 2020; Ware, 2013) [35-38], except for slightly reduced DLco (77% [69–95]). There were no echocardiographic impairments. 6MWT distance was reduced in most patients without oxygen desaturation. According to standardized questionnaires, patients suffered from reduced QoL, mainly due to decreased mobility (SGRQ activity score: 54 [19–78]). There were no indicators for depression or anxiety (PHQ-9: 7 [4], [5], [6], [7], [8], [9], [10], [11]( Mizumoto et al., 2020; Kimball et al., 2020; Sakurai et al., 2020; Tabata et al., 2020; Wu and McGoogan, 2020; Richardson et al., 2020; Lewnard et al., 2020; Wang et al., 2020) [4], [5], [6], [7], [8], [9], [10], [11]4-11, GAD-7: 4 [1], [2], [3], [4], [5], [6], [7], [8], [9]( Lu et al., 2020; Zhou et al., 2020; Zhu et al., 2020; Mizumoto et al., 2020; Kimball et al., 2020; Sakurai et al., 2020; Tabata et al., 2020; Wu and McGoogan, 2020; Richardson et al., 2020) [1], [2], [3], [4], [5], [6], [7], [8], [9]1-9, respectively). CONCLUSIONS: Hospitalized patients with severe COVID-19, who did not require mechanical ventilation, are unlikely to develop pulmonary long-term impairments, thromboembolic complications or cardiac impairments after discharge but frequently suffer from symptoms of fatigue.