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Available online 23 January 2023
Key Factors Associated With Pulmonary Sequelae in the Follow-Up of Critically Ill COVID-19 Patients
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Jessica Gonzáleza,b,1, Jordi de Batllea,b,1, Iván D. Beníteza,b, Gerard Torresa,b, Sally Santistevea, Adriano D.S. Targaa,b, Clara Gort-Panielloa,b, Anna Moncusí-Moixa,b, Maria Aguilàa, Fatty Secka,b, Adrián Ceccatob,c, Ricard Ferrerd, Anna Motosb,e, Jordi Rierad, Laia Fernándezb,e, Rosario Menéndezb,f, José Ángel Lorenteb,g, Oscar Peñuelasb,g, Dario Garcia-Gasullah, Yhivian Peñascoi, Pilar Ricartj, Elena Abril Palomaresk, Luciano Aguileral, Alejandro Rodríguezm, Maria Victoria Boado Varelan, Belén Beteréo, Juan Carlos Pozo-Laderasp, Jordi Solé-Violanq, Inmaculada Salvador-Adellr, Mariana Andrea Novos, José Barberánt, Rosario Amaya Villaru, José Garnacho-Monterov, José M. Gómezw, Aaron Blandino Ortizx, Luis Tamayo Lomasy, Alejandro Úbedaz, Mercedes Catalán-Gonzálezaa, Angel Sánchez-Mirallesbb, Ignacio Martínez Varelacc, Ruth Noemí Jorge Garcíadd, Nieves Francoee, Víctor D. Gumucio-Sanguinoff, Elena Bustamante-Munguiragg, Luis Jorge Valdiviahh, Jesús Caballeroii, Elena Gallegojj, Covadonga Rodríguezkk, Álvaro Castellanos-Ortegall, Josep Trenadomm, Judith Marin-Corralnn, Guillermo M. Albaicetab,oo, Maria del Carmen de la Torrepp, Ana Loza-Vázquezqq, Pablo Vidalrr, Jose M. Añónb,ss, Cristina Carbajales Péreztt, Victor Sagredouu, Nieves Carbonellvv, Lorenzo Sociasww, Carme Barberàxx, Angel Estellayy, Emili Diazzz, David de Gonzalo-Calvoa,b, Antoni Torresb,e, Ferran Barbéa,b,
Corresponding author
febarbe.lleida.ics@gencat.cat

Corresponding author.
, on behalf of the CIBERESUCICOVID Project
a Translational Research in Respiratory Medicine, University Hospital Arnau de Vilanova and Santa Maria, IRBLleida, Lleida, Spain
b CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III, Madrid, Spain
c Critical Care Center, ParcTaulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí I3PT, Sabadell, Spain
d Intensive Care Department, Vall d’Hebron Hospital Universitari, SODIR Research Group, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
e Department of Pneumology, Hospital Clinic of Barcelona, August Pi i Sunyer Biomedical Research Institute – IDIBAPS, University of Barcelona, Barcelona, Spain
f Pulmonology Service, University and Polytechnic Hospital La Fe, Valencia, Spain
g Hospital Universitario de Getafe, Madrid, Spain
h Barcelona Supercomputing Center (BSC), Barcelona, Spain
i Servicio de Medicina Intensiva, Hospital Universitario Marqués de Valdecilla, Santander, Spain
j Servei de Medicina Intensiva, Hospital Universitari Germans Trias, Badalona, Spain
k Hospital Universitario Torrejón, Madrid, Spain
l Servicio de Anestesiología y Reanimación, Hospital Universitario Basurto, Bilbao, Spain
m Critical Care Department, Hospital Joan XXIII, Tarragona, Spain
n Servicio de Medicina Intensiva, Hospital de Cruces, Baracaldo, Vizcaya, Spain
o Servicio de Análisis Clínicos, Hospital Universitario Príncipe de Asturias, Alcalá de Henares, Spain
p UGC-Medicina Intensiva, Hospital Universitario Reina Sofia, Instituto Maimonides IMIBIC, Córdoba, Spain
q Critical Care Department, Hospital Dr. Negrín Gran Canaria, Universidad Fernando Pessoa, Las Palmas, Gran Canaria, Canarias, Spain
r Hospital Verge de la Cinta, Tortosa, Tarragona, Spain
s Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, Illes Balears, Spain
t Hospital Universitario HM Montepríncipe, Universidad San Pablo-CEU, Madrid, Spain
u Intensive Care Clinical Unit, Hospital Universitario Virgen de Rocío, Sevilla, Spain
v Intensive Care Clinical Unit, Hospital Universitario Virgen Macarena, Sevilla, Spain
w Hospital General Universitario Gregorio Marañón, Madrid, Spain
x Servicio de Medicina Intensiva, Hospital Universitario Ramón y Cajal, Madrid, Spain
y Critical Care Department, Hospital Universitario Río Hortega de Valladolid, Valladolid, Spain
z Servicio de Medicina Intensiva, Hospital Punta de Europa, Algeciras, Spain
aa Department of Intensive Care Medicine, Hospital Universitario 12 de Octubre, Madrid, Spain
bb Hospital de Sant Joan d’Alacant, Alacant, Spain
cc Critical Care Department, Hospital Universitario Lucus Augusti, Lugo, Spain
dd Intensive Care Department, Hospital Nuestra Señora de Gracia, Zaragoza, Spain
ee Hospital Universitario de Móstoles, Madrid, Spain
ff Department of Intensive Care, Hospital Universitari de Bellvitge, Bellvitge Biomedical Research Institute (IDIBELL), L’Hospitalet de Llobregat, Barcelona, Spain
gg Department of Intensive Care Medicine, Hospital Clínico Universitario Valladolid, Valladolid, Spain
hh Hospital Universitario de León, León, Spain
ii Critical Care Department, Hospital Universitari Arnau de Vilanova, IRBLleida, Lleida, Spain
jj Unidad de Cuidados Intensivos, Hospital Universitario San Pedro de Alcántara, Cáceres, Spain
kk Hospital Universitario Infanta Leonor, Madrid, Spain
ll Servicio de Medicina Intensiva, Hospital Universitario y Politécnico La Fe, Valencia, Spain
mm Servicio de Medicina Intensiva, Hospital Universitario Mútua de Terrassa, Terrassa, Barcelona, Spain
nn Critical Care Department, Hospital del Mar-IMIM, Barcelona, Spain
oo Departamento de Biología Funcional, Instituto Universitario de Oncología del Principado de Asturias, Universidad de Oviedo, Instituto de Investigación Sanitaria del Principado de Asturias, Hospital Central de Asturias, Oviedo, Spain
pp Hospital de Mataró de Barcelona, Spain
qq Unidad de Medicina Intensiva, Hospital Universitario Virgen de Valme, Sevilla, Spain
rr Complexo Hospitalario Universitario de Ourense, Ourense, Spain
ss Servicio de Medicina Intensiva, Hospital Universitario La Paz, IdiPAZ, Madrid, Spain
tt Intensive Care Unit, Hospital Álvaro Cunqueiro, Vigo, Spain
uu Hospital Universitario de Salamanca, Salamanca, Spain
vv Intensive Care Unit, Hospital Clínico y Universitario de Valencia, Valencia, Spain
ww Intensive Care Unit, Hospital Son Llàtzer, Palma de Mallorca, Illes Balears, Spain
xx Hospital Santa Maria, IRBLleida, Lleida, Spain
yy Intensive Care Unit, University Hospital of Jerez, Medicine Department University of Cadiz, INiBICA, Spain
zz Department of Medicine, Universitat Autònoma de Barcelona (UAB), Critical Care Department, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, Spain
Received 28 November 2022. Accepted 29 December 2022
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Abstract
Introduction

Critical COVID-19 survivors have a high risk of respiratory sequelae. Therefore, we aimed to identify key factors associated with altered lung function and CT scan abnormalities at a follow-up visit in a cohort of critical COVID-19 survivors.

Methods

Multicenter ambispective observational study in 52 Spanish intensive care units. Up to 1327 PCR-confirmed critical COVID-19 patients had sociodemographic, anthropometric, comorbidity and lifestyle characteristics collected at hospital admission; clinical and biological parameters throughout hospital stay; and, lung function and CT scan at a follow-up visit.

Results

The median [p25p75] time from discharge to follow-up was 3.57 [2.77–4.92] months. Median age was 60 [53–67] years, 27.8% women. The mean (SD) percentage of predicted diffusing lung capacity for carbon monoxide (DLCO) at follow-up was 72.02 (18.33)% predicted, with 66% of patients having DLCO<80% and 24% having DLCO<60%. CT scan showed persistent pulmonary infiltrates, fibrotic lesions, and emphysema in 33%, 25% and 6% of patients, respectively. Key variables associated with DLCO<60% were chronic lung disease (CLD) (OR: 1.86 (1.18–2.92)), duration of invasive mechanical ventilation (IMV) (OR: 1.56 (1.37–1.77)), age (OR [per-1-SD] (95%CI): 1.39 (1.18–1.63)), urea (OR: 1.16 (0.97–1.39)) and estimated glomerular filtration rate at ICU admission (OR: 0.88 (0.73–1.06)). Bacterial pneumonia (1.62 (1.11–2.35)) and duration of ventilation (NIMV (1.23 (1.06–1.42), IMV (1.21 (1.01–1.45)) and prone positioning (1.17 (0.98–1.39)) were associated with fibrotic lesions.

Conclusion

Age and CLD, reflecting patients’ baseline vulnerability, and markers of COVID-19 severity, such as duration of IMV and renal failure, were key factors associated with impaired DLCO and CT abnormalities.

Keywords:
COVID-19
CT abnormalities
ICU
Lung function
Sequelae
Abbreviations:
ARDS
CT
CLD
DLCO
EGFR
FEV1
FVC
ICU
IMV
MAR
MICE
LASSO
NIMV
PCR

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