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Respiratory Function at 3 Months after Hospital Discharge in Critically Ill Patients with COVID-19

Joaquim Henrique de Carvalho Lobato Filho, Guilherme Bruzarca Tavares, Francisco de Souza Trindade Neto, Suellen Christine de Carvalho Souza, Hugo Leonardo Freitas, Adlyene Muniz da Silva Cruz, Ana Chaves Silva, Jose Raimundo Araujo de Azevedo*

Aim: Up to 20% of patients with COVID-19 get critically ill and require Intensive Care Unit (ICU) admission. At hospital discharge, most patients still have physical and mental limitations, which affect their quality of life. Pulmonary functional alterations in patients with COVID-19 vary from the absence of functional abnormalities to restrictive and diffusion impairments. We aimed to describe pulmonary function abnormalities as well as their impact on the 6-Minute Walk Test (6 MWT) and SF-36 Physical Component Summary (PCS) score in patients with COVID-19 at ≥ 3 months after hospital discharge.

Methods: We included 65 patients aged ≥ 18 years with severe COVID-19 confirmed through real-time reverse transcriptase-polymerase chain reaction and admitted to the ICU between April 2020 and October 2021. Patients were evaluated at ≥ 3 months after hospital discharge using the 6 MWT, Pulmonary Function Tests (PFTs), and the PCS score.

Results: Among the included patients, 27 patients had abnormal PFT findings, 21 (32.3%) had forced vital capacity<80%, 17 (26.1%) had forced expiratory volume in 1 s<80%, and 4 (6.1%) had a maximal mid-expiratory flow<65%. Compared with patients without abnormal PFT findings, patients with abnormal PFT findings were older and had significantly higher ferritin levels. There were no significant between-group differences in invasive and noninvasive respiratory support, mechanical ventilation duration, vasopressor use, and renal replacement therapy. However, compared with patients with normal PFT findings, patients with abnormal PFT findings showed a significantly lower 6-MWT score [78% (0.0–92) vs. 95% (75–100), p=0.01] and worse PCS scores [39.4 (32.1–51.3) vs. 52.0 (47.4–57.3), p=0.007]. There was an independent association between the PCS scores and PFT findings.

Conclusion: We found that a significant proportion of patients present pulmonary functional alterations ≥ 3 months after discharge from the hospital after treatment for severe COVID-19; further, these alterations affect physical functional capacity and quality of life.