Cardiopulmonary exercise testing in patients with COVID19 at 3 months from hospital discharge

Introduction: The long-term COVID-19 effects are currently unknown. Whether and for how long symptoms extend beyond the acute phase of the disease is unresolved Aim: To determine the functional capacity of COVID-19 survivors by cardio- pulmonary exercise testing (CPET) and describe its association with dyspnoea and pulmonary function test (PFT). Methods and Results: All COVID-19 patients discharged from our tertiary care institution were enrolled in a prospective follow-up study which would assess clinical, instrumental and laboratory characteristics of COVID-19 survivors at 3months from hospital discharge (Careggi University Hospital, Florence). Clinical evaluation included: peripheral blood samples including inflammatory cytokines, pulmonary function test (functional respiratory and 6 minwalking test), lung ultrasound, ECG recording and echocardiographic exam. All patients with peripheral oxygen desaturation at 6 min-walking test (SpO2 < 92%), dyspnoea and with a history of hospitalization in critical care settings were referred for CPET. Dyspnoea was classified with the Medical Research Council (MRC) scale. From June 2020 to May 2021, 198 patients were enrolled;overall, 42% of patients presented with dyspnoea at 3 months from hospital discharge with no difference according to disease severity on hospital admission (P 1/4 0.233) Conclusion(s): At 3-months, almost 1 in 2 patients discharged for COVID-19 pneumonia presented with dyspnoea, irrespective of disease severity. We want to compare CPET and spirometry data (already performed in 110 patients), highlighting differences between ventilated patients (invasive or noninvasive) and patients admitted to the ward. The data are still being analyzed.

Phenotypes of post covid interstitial lung disease, clinical, radiological, and pathological correlations

Introduction: The clinical-radiologic-pathologic features of post-COVID interstitial lung disease (ILD) remain to be explored. Method(s): In a prospective multicenter Italian study (PCOILS), subsequent patients seen at 4-18 months after the acute infection underwent transbronchial lung cryobiopsy and BAL if they showed a significant ILD (progressive and/or symptomatic and/or with pulmonary function impairment). Result(s): 19 patients enrolled;characteristics are summarized in Fig.2. We identified 3 post-COVID phenotypes: 1) prominent vascular changes;2) post-COVID fibrosis;3) persistent COVID. Fig. 1. Phenotype 1 was detected only in 2 cases with similar characteristics as showed in Fig. 1 Phenotype 2 was detected in 7 patients all with HRCT NSIP/OP features. Histology showed fibrotic or mixed NSIP, fibrotic OP, fibrotic DAD and bronchiolar damage. Phenotype 3 was detected only in the case reported in Fig.1.The remaining 9 patients were reclassified as known ILDs and treated according to current guidelines. Conclusion(s): We identified 3 phenotypes of postcovid damage with heterogeneous pictures and leading to differenttreatment choices.

Role of BAL in COVID-19 patients: a prospective multicentre study

The present study is part of DRAGON, a prospective multicentre European project aimed at improving the diagnosis of COVID-19. The primary aim of this study is to evaluate BAL role in detecting coexisting infections. Secondary aims are BAL impact on the management of COVID patients, characteristics of BAL cellularity in COVID patients, and safety of BAL in COVID patients and for healthcare providers. The study was carried out in 2021. It involved hospitalized patients in non-ICU wards at Careggi University Hospital in Florence, at CHU of Liege and at Morgagni Hospital Bologna University/Forli. All patients underwent BAL for microbiological and cytological analysis. Coinfections were detected in 35 out of 115 patients. In 34% of cases we demonstrated the presence of lymphocytic alveolitis;in 49% of cases a neutrophilic alveolitis and in 7% of cases we observed the presence of a mixed lymphocytic/neutrophilic alveolitis. All patients tested positive for Sars-Cov-2 PCR nasal swabs on admission. BAL was positive for Sars-Cov-2 in all cases, 7 PCR nasal swab performed at the time of the BAL were negative. No major adverse events were demonstrated in the 24 hours after BAL in enrolled patients. There were no cases of infection among health care workers involved in bronchoscopic procedures. Coinfections in COVID-19 patients are common. BAL is a safe tool to identify the presence of coinfections and help clinicians manage these patients correctly. BAL cellularity in covid patients shows a predominance of neutrophils, particularly in cases of co-infection. Our data suggests an earlier negativisation of nasopharyngeal swab compared to BAL.

Relationship between hyponatremia at hospital admission and cardiopulmonary profile at follow-up in patients with SARS-CoV-2 (COVID-19) infection.

PURPOSE: Hyponatremia occurs in about 30% of patients with pneumonia, including those with SARS-CoV-2 (COVID-19) infection. Hyponatremia predicts a worse outcome in several pathologic conditions and in COVID-19 has been associated with a higher risk of non-invasive ventilation, ICU transfer and death. The main objective of this study was to determine whether early hyponatremia is also a predictor of long-term sequelae at follow-up. METHODS: In this observational study, we collected 6-month follow-up data from 189 laboratory-confirmed COVID-19 patients previously admitted to a University Hospital. About 25% of the patients (n = 47) had hyponatremia at the time of hospital admission. RESULTS: Serum [Na+] was significantly increased in the whole group of 189 patients at 6 months, compared to the value at hospital admission (141.4 ± 2.2 vs 137 ± 3.5 mEq/L, p < 0.001). In addition, IL-6 levels decreased and the PaO2/FiO2 increased. Accordingly, pulmonary involvement, evaluated at the chest X-ray by the RALE score, decreased. However, in patients with hyponatremia at hospital admission, higher levels of LDH, fibrinogen, troponin T and NT-ProBNP were detected at follow-up, compared to patients with normonatremia at admission. In addition, hyponatremia at admission was associated with worse echocardiography parameters related to right ventricular function, together with a higher RALE score. CONCLUSION: These results suggest that early hyponatremia in COVID-19 patients is associated with the presence of laboratory and imaging parameters indicating a greater pulmonary and right-sided heart involvement at follow-up.

Prevalence of nutritional risk and malnutrition during and after hospitalization for COVID-19 infection: Preliminary results of a single-centre experience.

BACKGROUND & AIMS: The effect of the COVID-19 infection on nutritional status is not well established. Worldwide epidemiological studies have begun to investigate the incidence of malnutrition during hospitalization for COVID-19. The prevalence of malnutrition during follow-up after COVID-19 infection has not been investigated yet. The primary objective of the present study was to estimate the prevalence of the risk of malnutrition in hospitalized adult patients with COVID-19, re-evaluating their nutritional status during follow-up after discharge. The secondary objective was to identify factors that may contribute to the onset of malnutrition during hospitalization and after discharge. METHODS: We enrolled 142 COVID-19 patients admitted to Careggi University Hospital. Nutritional parameters were measured at three different timepoints for each patient: upon admission to hospital, at discharge from hospital and 3 months after discharge during follow-up. The prevalence of both the nutritional risk and malnutrition was assessed. During the follow-up, the presence of nutritional impact symptoms (NIS) was also investigated. An analysis of the association between demographic and clinical features and nutritional status was conducted. RESULTS: The mean unintended weight loss during hospitalization was 7.6% (p < 0.001). A positive correlation between age and weight loss during hospitalization was observed (r = 0.146, p = 0.08). Moreover, for elderly patients (>61 years old), a statistically significant correlation between age and weight loss was found (r = 0.288 p = 0.05). Patients admitted to an Intensive Care Unit (ICU) or Intermediate Care Unit (IMCU) had a greater unintended weight loss than patients who stayed in a standard care ward (5.46% vs 1.19%; p < 0.001). At discharge 12 patients were malnourished (8.4%) according to the ESPEN definition. On average, patients gained 4.36 kg (p < 0.001) three months after discharge. Overall, we observed a weight reduction of 2.2% (p < 0.001) from the habitual weight measured upon admission. Patients admitted to an ICU/IMCU showed a higher MUST score three months after discharge (Cramer's V 0.218, p = 0.035). With regard to the NIS score, only 7 patients (4.9%) reported one or more nutritional problems during follow-up. CONCLUSIONS: The identification of groups of patients at a higher nutritional risk could be useful with a view to adopting measures to prevent worsening of nutritional status during hospitalization. Admission to an ICU/IMCU, age and length of the hospital stay seem to have a major impact on nutritional status. Nutritional follow-up should be guaranteed for patients who lose more than 10% of their habitual weight during their stay in hospital, especially after admission to an ICU/IMCU.

Aerosol therapies during the sars-cov-2 pandemic

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes COronaVirus Disease 2019 (COVID-19), has resulted in a worldwide pandemic and currently represents a major public health issue. It has caused outbreaks of illness due to person-to-person transmission of the virus mainly via close contacts and droplets produced by an infected person’s cough or sneeze. Although aerosol therapy is a mainstay procedure for treating obstructive airway diseases at home and healthcare settings, there is concern about the hypothesized enhanced risk for transmission of SARS-CoV-2 in the form of aerosolised respiratory droplets during the nebulised treatment of patients with COVID-19. Consequently, the use of hand-held inhalers, particularly pressurised metered dose inhalers, has risen considerably as an alternative to nebulisers, which has led to inadequate supplies in some countries. However, switching to hand-held inhalers may result in unintended consequences for some patients, who may be unable to adequately use their new device or benefit fully from treatment via hand-held inhalers. Furthermore, there is no evidence supporting an increased risk of viral transmission during nebulisation in COVID-19 patients. Thus, there is no compelling reason to alter aerosol modality for patients with established nebuliser-based regimens. The purpose of this paper is to discuss the current evidence and understanding of the use of aerosol therapies during the SARS-CoV-2 pandemic and to provide some guidance on the measures to be taken to minimise the hypothetical enhanced risk of infection, if any, during aerosol therapies.