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Pulmonary function and radiological features four months after COVID-19: first results from the national prospective observational Swiss COVID-19 lung study

Sabina A. Guler, Lukas Ebner, Catherine Beigelman, Pierre-Olivier Bridevaux, Martin Brutsche, Christian Clarenbach, Christian Garzoni, Thomas K. Geiser, Alexandra Lenoir, Marco Mancinetti, Bruno Naccini, Sebastian R. Ott, Lise Piquilloud, Maura Prella, Yok-Ai Que, Paula M. Soccal, Christophe von Garnier, Manuela Funke-Chambour
European Respiratory Journal 2021; DOI: 10.1183/13993003.03690-2020
Sabina A. Guler
1Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Lukas Ebner
2Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Catherine Beigelman
3Radiodiagnostic and Interventional Radiology, CHUV-University Hospital, Lausanne, Switzerland
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Pierre-Olivier Bridevaux
4Service de Pneumologie, Hôpital du Valais, Sion, Switzerland
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Martin Brutsche
5Lung Center, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Christian Clarenbach
6Pneumology, University Children Hospital Zurich, Zurich, Switzerland
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Christian Garzoni
7Clinic of Internal Medicine and Infectious Diseases, Clinica Luganese Moncucco, Lugano, Switzerland
8Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
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Thomas K. Geiser
1Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
9Department for BioMedical Research, University of Bern, Bern, Switzerland
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Alexandra Lenoir
10Division of Pulmonary Medicine, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
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Marco Mancinetti
11Department of Internal Medicine, University and Hospital of Fribourg, Fribourg, Switzerland
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Bruno Naccini
12Department of Pulmonary medicine, Clinica Luganese Moncucco, Lugano, Switzerland
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Sebastian R. Ott
13Department of Pulmonary Medicine, St. Claraspital AG, Basel, Switzerland
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Lise Piquilloud
14Adult Intensive care unit, University Hospital and University of Lausanne, Lausanne, Switzerland
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Maura Prella
10Division of Pulmonary Medicine, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
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Yok-Ai Que
15Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Paula M. Soccal
16Division of Pulmonary Medicine, Geneva University Hospitals, Geneva
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Christophe von Garnier
10Division of Pulmonary Medicine, Lausanne University Hospital (CHUV), University of Lausanne, Lausanne, Switzerland
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Manuela Funke-Chambour
1Department of Pulmonary Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
9Department for BioMedical Research, University of Bern, Bern, Switzerland
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Abstract

Background The coronavirus infectious disease (COVID-19) pandemic is an ongoing global health care challenge. Up to one third of hospitalised patients develop severe pulmonary complications and ARDS. Pulmonary outcomes following COVID-19 are unknown.

Methods The Swiss COVID-19 lung study is a multicentre prospective cohort investigating pulmonary sequela of COVID-19. We report on initial follow-up 4 months after mild/moderate or severe/critical COVID-19 according to the WHO severity classification.

Results 113 COVID-19 survivors were included (mild/moderate 47, severe/critical 66). We confirmed several comorbidities as risk factors for severe/critical disease. Severe/critical disease was associated with impaired pulmonary function, i.e. diffusing capacity (DLCO) %-predicted, reduced 6-MWD, and exercise-induced oxygen desaturation. After adjustment for potential confounding by age, sex, and BMI, patients after severe/critical COVID-19 had a 20.9 (95% CI 12.4–29.4, p=0.01) lower DLCO %-predicted at follow up. DLCO %-predicted was the strongest independent factor associated with previous severe/critical disease when age, sex, BMI, 6MWD, and minimal SpO2 at exercise, were included in the multivariable model (adjusted odds ratio [OR] per 10%-predicted 0.59 [95% CI 0. 37–0.87], p=0.01). Mosaic hypoattenuation on chest computed tomography at follow-up was significantly associated with previous severe/critical COVID-19 including adjustment for age and sex (adjusted OR 11.7 [95%CI 1.7–239), p=0.03).

Conclusions Four months after SARS CoV-2 infection, severe/critical COVID-19 was associated with significant functional and radiological abnormalities, potentially due to small airway and lung parenchymal disease. A systematic follow-up for survivors needs to be evaluated to optimise care for patients recovering from COVID-19.

Abstract

COVID-19 pulmonary sequelae are unknown. The Swiss COVID-19 lung study reports on initial follow-up findings. Severe or critical COVID-19 was associated with significant functional impairment and radiological abnormalities after 4 months.

Footnotes

  • This article has supplementary material available from erj.ersjournals.com

  • Data availability: Data are available upon request and after approval of teh steering committee of the Swiss COVID-19 lung study group.

  • Support statement: Lungenliga Bern, Johanna Dürmüller Foundation, Bern Center for Precision Medicine (BCPM) and the Department für Lehre und Forschung (DLF) of the Inselspital Bern funded parts of this study but had no role in the conduct of the conduct of the investigation. Department for Research and Education, Inselspital (DLF); Bern Center for Precision Medicine; Johanna Dürmüller Foundation; Lungenliga Bern.

  • Conflict of interest: Dr. Guler has nothing to disclose.

  • Conflict of interest: Dr. Ebner has nothing to disclose.

  • Conflict of interest: Dr. Beigelman-Aubry reports personal fees from Astra Zeneca, personal fees from Boehringer, outside the submitted work;.

  • Conflict of interest: Dr. Bridevaux has nothing to disclose.

  • Conflict of interest: Dr. BRUTSCHE has nothing to disclose.

  • Conflict of interest: Dr. Clarenbach reports personal fees from Roche, personal fees from Novartis, personal fees from Boehringer, personal fees from GSK, personal fees from Astra Zeneca, personal fees from Sanofi, personal fees from Vifor, personal fees from Mundipharma, outside the submitted work;.

  • Conflict of interest: Dr. Garzoni has nothing to disclose.

  • Conflict of interest: TG has nothing to disclose.

  • Conflict of interest: Dr. Lenoir has nothing to disclose.

  • Conflict of interest: Dr. Mancinetti has nothing to disclose.

  • Conflict of interest: Dr.B.Naccini has nothing to disclose.

  • Conflict of interest: Dr. Ott has nothing to disclose.

  • Conflict of interest: Dr. Piquilloud has nothing to disclose.

  • Conflict of interest: Dr Prella has nothing to disclose.

  • Conflict of interest: Dr. QUE has nothing to disclose.

  • Conflict of interest: Dr. Soccal has nothing to disclose.

  • Conflict of interest: Dr. von Garnier has nothing to disclose.

  • Conflict of interest: Dr. Funke-Chambour has nothing to disclose.

  • Received September 30, 2020.
  • Accepted December 13, 2020.
  • Copyright ©ERS 2021
http://creativecommons.org/licenses/by-nc/4.0/

This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

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Pulmonary function and radiological features four months after COVID-19: first results from the national prospective observational Swiss COVID-19 lung study
Sabina A. Guler, Lukas Ebner, Catherine Beigelman, Pierre-Olivier Bridevaux, Martin Brutsche, Christian Clarenbach, Christian Garzoni, Thomas K. Geiser, Alexandra Lenoir, Marco Mancinetti, Bruno Naccini, Sebastian R. Ott, Lise Piquilloud, Maura Prella, Yok-Ai Que, Paula M. Soccal, Christophe von Garnier, Manuela Funke-Chambour
European Respiratory Journal Jan 2021, 2003690; DOI: 10.1183/13993003.03690-2020

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Pulmonary function and radiological features four months after COVID-19: first results from the national prospective observational Swiss COVID-19 lung study
Sabina A. Guler, Lukas Ebner, Catherine Beigelman, Pierre-Olivier Bridevaux, Martin Brutsche, Christian Clarenbach, Christian Garzoni, Thomas K. Geiser, Alexandra Lenoir, Marco Mancinetti, Bruno Naccini, Sebastian R. Ott, Lise Piquilloud, Maura Prella, Yok-Ai Que, Paula M. Soccal, Christophe von Garnier, Manuela Funke-Chambour
European Respiratory Journal Jan 2021, 2003690; DOI: 10.1183/13993003.03690-2020
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