Prognosis factors influencing three-month respiratory outcomes in intensive care unit survivors after COVID-19 pneumonia

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Introduction: Outcomes of the most severe patients who have survived COVID-19 are abundantly described but few data are currently available on the factors influencing these possible sequelae. Objectives: We aimed to evaluate prognosis factors influencing outcomes in patients who survived severe COVID-19 pneumonia. Methods: All patients admitted to intensive care unit (ICU) were screened. Eligible patients were assessed 3 months after onset of SARS-CoV-2 symptoms. Patients underwent a physical examination, pulmonary function testing, chest CT and six-minutes walk test (6MWT). The cohort was divided into patients with and without DLCO Impairment (DI) defining pulmonary sequalae, then we assessed risk factors for pulmonary sequalae. Results: 84 patients participated including 35 (41,7%) in DI group (median DLCO of 61.8%). There was no difference between groups regarding age, gender, comorbidities, intubation and severity. Groups differed in obesity, median IGS2 score and use of dialysis. At 3 months, patients with DI had higher prevalence of velcro crackles (34,3% vs 10,2%), irregular interface (62,9% vs 36,6%), traction bronchiectasis (85,7% vs 53,7%), a lower percentage of predicted walk distance in 6MWT and more oxygen desaturation. In multivariate analysis, length of stay (LOS) in ICU ≥ 27 days (OR=7,40) and serum creatinine level (SCL) ≥ 92,8 mmol/l (OR=4,23) were risk factors for DI while obesity (OR=0,069) was protective factor (p<0,01). Conclusions: Our findings suggest a residual pulmonary fibrosis at 3 months after onset disease. LOS in ICU and high SCL may be useful for prediction for DI while obesity can be protective factor.

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