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

Daher A.,
Balfanz P.,
Cornelissen C.,
Müller A.,
Bergs I.,
Marx N.,
Müller-Wieland D.,
Hartmann B.,
Dreher M.,
Müller T.
Document Type
Source Title
Respiratory Medicine
W.B. Saunders Ltd


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 {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 {4-11}, GAD-7: 4 {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. © 2020 Elsevier Ltd

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anticoagulant agent; C reactive protein; D dimer; ferritin; interleukin 6; lactate dehydrogenase; adult; anticoagulant therapy; anxiety; anxiety assessment; arterial carbon dioxide tension; arterial oxygen tension; Article; asthma; atrial fibrillation; blood gas analysis; body plethysmography; brain ischemia; chronic obstructive lung disease; clinical article; controlled study; coronavirus disease 2019; coughing; depression; diffusing capacity for carbon monoxide; disease severity; dyspnea; echocardiography; European Quality of Life 5 Dimensions 5 Level questionnaire; fatigue; female; follow up; forced expiratory volume; forced vital capacity; Generalized Anxiety Disorder 7; heart failure; heart left ventricle ejection fraction; heart right ventricle ejection fraction; hospital admission; hospital discharge; hospital patient; human; hypoxemia; lactate dehydrogenase blood level; lung diffusion capacity; lung function test; male; middle aged; oxygen desaturation; oxygen saturation; oxygen therapy; Patient Health Questionnaire 9; physical activity; prevalence; priority journal; prospective study; respiratory failure; six minute walk test; St. George Respiratory Questionnaire; thromboembolism; total lung capacity; vital capacity; aged; complication; coughing; depression; dyspnea; fatigue; follow up; genetics; heart disease; lung disease; pathophysiology; procedures; quality of life; severity of illness index; thromboembolism; virology; walk test; Aged; Anxiety; Blood Gas Analysis; Cough; COVID-19; Depression; Dyspnea; Echocardiography; Fatigue; Female; Follow-Up Studies; Heart Diseases; Humans; Lung Diseases; Male; Middle Aged; Patient Discharge; Plethysmography, Whole Body; Prospective Studies; Pulmonary Diffusing Capacity; Quality of Life; Respiratory Function Tests; SARS-CoV-2; Severity of Illness Index; Thromboembolism; Walk Test