ABSTRACT
Rationale: Over 60 million people have had coronavirus disease 2019 (COVID-19), but consequences of severe infection are unknown. We sought to characterize interstitial lung abnormalities (ILA) after COVID-19, and to identify risk factors for the development of lung fibrosis.Methods: We performed a prospective single-center cohort study with 4-month follow-up after COVID-19 hospitalization. We sequentially enrolled 76 community-dwelling adults who were hospitalized with laboratory-confirmed severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and required supplemental oxygen between March and May 2020. Participants had no prior history of interstitial lung disease and were discharged to acute rehabilitation or home, with sampling weighted to include half who were mechanically ventilated. We used a radiologic scoring system to quantify non-fibrotic ILA (ground glass opacities alone) and fibrotic ILA (defined as presence of reticulations, traction bronchiectasis, or honeycombing) on chest high-resolution computed tomography scans four months after hospital admission. We assessed measures of severity of illness during hospitalization, as well as pulmonary function and leukocyte telomere length at followup. Results: Participants had a mean age of 54 (SD14) years;most were male (61%) and Hispanic (57%). Thirty-two (43%) required mechanical ventilation. After a median (IQR) of 4.4 (4.0-4.8) months following hospital admission, the most common ILAs were ground glass opacities, reticulations, and traction bronchiectasis, which correlated with lower diffusion capacity (ρ -0.34, - 0.64, and -0.49, respectively, all p<0.01). A total of 31 participants (41%) had no ILA, 13 (17%) had only non-fibrotic ILA, and 32 (42%) had fibrotic ILA. Fibrotic ILA was more common in mechanically ventilated patients (72%) than non-mechanically ventilated patients (20%), (p=0.001). In adjusted analyses, each 1 point increase in admission SOFA score, additional day of ventilator support, and 10% decrease in blood leukocyte telomere length were associated with fibrotic ILA [OR 1.49 (95%CI 1.17 - 1.89), 1.07 (95%CI 1.03-1.12), and 1.35 (95%CI 1.06 - 1.72), respectively].Conclusions: Radiographic evidence of lung fibrosis four months after severe COVID-19 infection is associated with initial severity of illness, duration of mechanical ventilation, and telomere length.
ABSTRACT
Introduction: Before the COVID-19 pandemic, 20-30% of family members had symptoms of Post-Traumatic Stress Disorder (PTSD) or anxiety, while 15-30% had symptoms of depression. Interventions supporting family members have reduced burden of these symptoms. COVID-19 has resulted in prolonged ICU stays, high morbidity/mortality, and hospital policies severely limiting family presence at the bedside. We hypothesized the combination of prolonged critical illness and the necessary reduction of family presence would lead to high rates of PTSD, anxiety, and depression;likely higher than observed in previous studies. Methods: This was a multicenter study including 12 US hospitals, 8 academic and 4 community-based hospitals. A consecutive sample of family members of all patients with COVID-19 receiving ICU admission during the spring US peak in 2020 were called 3-4 months after the patients' ICU admission, except for New York City hospitals where a random sample was generated given the large number of hospitalizations. Consented participants completed the Impact-of- Events Scale-6 (IES-6;scored 0-30, higher scores indicate more symptoms of PTSD), Hospital-Anxiety- Depression Score (HADS, scored 0-20 for anxiety and 0-20 for depression, higher scores indicate more symptoms), and a subset of questions from Family-Satisfaction in the ICU-27 (FS-ICU27;scored on a Likert scale 1 to 5, with higher scores indicating more positive responses) selected as most likely impacted by restrictive family presence.Results: There were 945 eligible family members during the study period. Of those, 594 were contacted and 269 (45.3%) consented and completed surveys. The mean IES-6 score was 12.6 (95% CI 11.8- 13.4) with 65.4% having a score of 10 or greater, consistent with high levels of symptoms of PTSD. The mean score on the HADS-anxiety was 9.4 (95% CI 8.8-10.1) with 59.5% having a score of 8 or greater, consistent with high levels of symptoms of anxiety. Finally, the mean score for the HADS-depression was 8.0 (95% CI 7.3-8.7) with 47.6% having scores of 8 or greater, consistent with high level of symptoms of depression. The mean response for the FSICU27 questions of “I felt I had control” was 3.5 (95% CI 3.3-3.6), “I felt supported” was 3.8 (95% CI 3.6-4.0), and “I felt included” was 4.3 (95% CI 4.2-4.4).Conclusion: The consequences of a family member admitted to the ICU with COVID-19 infection are significant. We identify rates of PTSD, anxiety, and depression higher than recorded in non-COVID population. Further analysis is warranted to understand modifiable risk factors for developing these symptoms.