Endurance, respiratory symptom burden improve 1 year after COVID-19 hospitalization
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Key takeaways:
- Six-minute walk test distance and St. George’s Respiratory Questionnaire scores improved 1 year after severe COVID-19.
- After COVID-19 hospitalization, two chest CT abnormalities appeared frequently.
WASHINGTON — One year after COVID-19 hospitalization, measures of endurance and respiratory symptom burden improved, according to an abstract presented at the American Thoracic Society International Conference.
“The findings support what we have seen regarding post-COVID recovery,” Sarah E. Jolley, MD, MSc, assistant professor in the division of pulmonary sciences and critical care medicine at University of Colorado’s Anschutz Medical Center, told Healio. “Namely, patients recovering from COVID experience a variety of long-term impairments including decreases in physical function, increased pulmonary symptomatology and fatigue.”
In a prospective, multicenter cohort study, Jolley and colleagues evaluated 55 individuals (mean age, 53 years; 53% men; 42% with comorbidities before hospital admittance) who survived COVID-19 hospitalization to understand 1-year pulmonary recovery in this patient population.
During the entry visit after hospital discharge, chest CT scans were taken, and abnormalities on scans were identified/measured by a radiologist using a standardized scoring system for COVID-19, according to the abstract.
Researchers also had patients complete pulmonary function testing (PFT) and four respiratory symptom and function assessments during this initial visit and 12 months after hospitalization to evaluate their pulmonary recovery. Assessments given to patients included the St. George’s Respiratory Questionnaire, the Functional Assessment of Chronic Illness Therapy-Fatigue scale, the 6-minute walk test and the Short Performance Physical Battery assessment.
Notably, before being admitted to the hospital, 96% of patients lived at home, and 86% were independent, not needing assistance in daily living, according to the abstract.
ICU admission was observed in 33% of patients (median stay, 11 days), of which 18% needed mechanical ventilation for a median of 10 days and 27% needed high flow nasal cannula or noninvasive mechanical ventilation, according to the abstract.
At a median of 12.5 months after hospitalization, 36 patients (66%) out of the total cohort took part in a follow-up visit, with a median time of first follow-up of 6.3 months.
Looking at entry visit data, researchers found that the total cohort of patients had normal range median PFT values, signaling no significant impairment. However, two frequent abnormalities were found on chest CT scans: residual ground glass opacities (58%) and fibrotic abnormalities (32%).
“We found that radiographic changes were common after a hospitalization for COVID, which is similar to what is observed in other cohorts and that lung function largely returns to normal over the year after COVID,” Jolley told Healio.
When assessing the change in median 6-minute walk test distance from the entry visit to the 12-month visit, researchers observed a median increase of 102 m (P = .002), implying improvement in endurance.
Researchers also saw improvement in respiratory symptom burden 1 year after hospitalization when looking at St. George’s Respiratory Questionnaire scores. Patients who completed a 12-month visit showed a median decrease of 7 points (P = .001) to their total score compared with their initial visit.
Slightly worse overall fatigue was found one year after COVID-19 hospitalization with 3 fewer points on the Functional Assessment of Chronic Illness Therapy-Fatigue compared with the initial visit.
For the Short Performance Physical Battery assessment, the total score at the initial visit did not significantly differ from the score at the 12-month visit, according to the abstract.
“It is important for practicing clinicians to understand the natural history of recovery after a COVID hospitalization so that they can be ready to support patients over their recovery journey,” Jolley told Healio. “Understanding the spectrum of impairments that patients can experience will allow providers to better target therapies towards ongoing symptoms and allow providers to better educate patients and families on longer-term effects of their COVID infection.”
More long-term data on patients recovering from COVID-19 hospitalization is needed, Jolley told Healio.
“Our data support the growing body of evidence indicating that the effects of COVID do not stop after the initial infection and COVID-related changes can persist for long periods after initial infection,” Jolley told Healio. “Future studies should plan for long-term, longitudinal follow-up in order to completely understand the trajectory of recovery after COVID-19.
“Further, future studies should aim to enroll larger numbers of recovering patients across the spectrum of COVID illness to fully understand the long-term pulmonary effects of the virus,” Jolley added. “Studies should enroll cohorts of uninfected controls to allow for comparison to evaluate age-related effects or new impacts of recent viral infection.”
For more information:
Sarah E. Jolley, MD, MSc, can be reached at sarah.jolley@cuanschutz.edu.