ABSTRACT
SESSION TITLE: Post-COVID-19 Outcomes SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: The World Health Organization defines post-acute sequelae of SARS-COV-2 infection (Long-COVID) as persistent symptoms after COVID-19 for more than two months. Although many studies show associations of comorbidities with prolonged COVID-19 symptoms, to our knowledge, there is no study with a comparison group for Long-COVID. We performed a retrospective study looking at risk factors for the development of Long-COVID. METHODS: We retrospectively reviewed 2,234 records of patients with a history of COVID-19 diagnosed by RT-PCR who followed up as outpatients at multiple pulmonary clinics in Hartford, Connecticut, USA, from March 2020 to December 2021. Data included the patient's age, sex, comorbidities, oxygen device including FiO2 level, and duration of symptoms. We evaluated patient characteristics, duration of symptoms, comorbidities, and disease severity. Analyses comprised the Mann-Whitney U test, χ2 test, or Fisher's exact test Using SPSS v. 26 at an alpha of 0.05. RESULTS: Of the 2,234 patients evaluated, 471 patients were included. The mean age was 56 ± 15 years (± SD), and 62.6% were female. 212 (45%) required hospital admission, and 23 (4.9%) required mechanical ventilation. Of those patients, 351 had symptoms for more than two months (Long-COVID) and 121 for two months or less (no Long-COVID). Both groups had similar characteristics. Hospitalization was more common in the Long-COVID group (51.6% vs. 21.8%, p<0.001). Increased FiO2 requirement was associated with prolonged symptoms (p<0.001), and patients requiring high-flow, non-invasive and invasive ventilation were more likely to develop Long-COVID (p=0.002). The mean duration of symptoms in patients with long-COVID was 7.9 ± 3.9 months versus 0.5 ± 0.8 months in the comparison group (p<0.001). Obesity, asthma, COPD, heart failure, interstitial lung disease, pulmonary hypertension, and immunosuppression were not found to be associated with Long-COVID. Regarding vaccination status, our analysis was limited since only 15 patients were vaccinated prior to developing COVID-19. CONCLUSIONS: Current data on Long-COVID suggests that prolonged symptoms are associated with older age, comorbidities, duration of hospitalization, and ICU stay. Our results, however, suggest that infection severity is the most important factor related to prolonged COVID-19 symptoms rather than comorbidities and age. Our study did contain limitations due to its retrospective nature, subjective duration of symptoms rather than objective 6-minute walk test, and lastly, patients may have been affected by different SARS-COV2 variants and received different treatments. CLINICAL IMPLICATIONS: Our results suggest that patients with severe COVID-19 are more predisposed to develop prolonged symptoms. Based on disease severity, this knowledge can inform providers and patients about prognosis and anticipated duration of symptoms post COVID-19 infection. DISCLOSURES: No relevant relationships by Brian Bustos No relevant relationships by Christopher Dipollina No relevant relationships by David O'Sullivan No relevant relationships by Eduardo Padrao No relevant relationships by Ravneet Randhawa No relevant relationships by Tejal Shah No relevant relationships by Pooja Shekar
ABSTRACT
SESSION TITLE: Long COVID: It Can Take Your Breath Away SESSION TYPE: Original Investigations PRESENTED ON: 10/16/2022 10:30 am - 11:30 am PURPOSE: The World Health Organization has defined post-acute sequelae of SARS-CoV-2 infection, or Long-COVID, as prolonged symptomatology after initial recovery lasting more than 2 months. Changes in respiratory function associated with this syndrome are not fully understood. Therefore, we performed a retrospective analysis of patients with pulmonary function tests (PFT) after COVID-19. METHODS: We retrospectively reviewed records of 2,234 patients with a history of COVID-19 diagnosed by RT-PCR who followed up in pulmonary clinics in Hartford, Connecticut from March 2020 to December 2021. Data included the patients’ age, sex, comorbidities, PFT results, and the maximum oxygen requirement during acute illness: room air (RA), low-flow oxygen (LF), high-flow nasal cannula (HFNC), non-invasive ventilation (NIV) or mechanical ventilation (MV). We performed an adjusted logistic regression analysis to evaluate if the disease severity (defined by oxygen requirement) was associated with the presence of obstructive and restrictive disease during follow-up. SPSS 26.0 was used with an alpha level of 0.05. RESULTS: Of the 2,234 records, 471 (21.1%) had available PFTs. Only PFTs done between 2 and 12 months post COVID-19 were included. The mean age (± SD) of the sample was 56 ± 15 years;62.6% were female. Twenty three (4.9%) patients required MV, 17 (3.6%) NIV, 45 (9.5%) HFNC, 111 (23.6%) LF and 275 (58.4%) remained on RA. Obstructive disease was seen in 106 (22.5%), and bronchodilator response was seen in 34 (9.1%). Restrictive disease was seen in 129 (27.4%) and was associated with use of HFNC, NIV and MV (OR: 2.44, 3.67, 3.26;p<0.01). The presence of obstruction did not correlate with disease severity, however use of HFNC did correlate with the absence of obstruction (OR: 0.24;p=0.019). CONCLUSIONS: Our results show a significant association between disease severity and restrictive disease during follow up. This is compatible with smaller studies and is likely related to the fibrotic stage of Acute Respiratory Distress Syndrome. There was an association of HFNC use with the absence of obstruction. Perhaps, patients with the pre-existing obstruction and severe COVID were less likely to tolerate HFNC and required higher support for recovery. Bronchodilator responsiveness was only present in a small portion of patients. Severe disease did not appear to predispose patients to the development of obstructive disease during the follow up period. Studies including pre- and post-COVID PFTs would further strengthen this assertion. CLINICAL IMPLICATIONS: We did find an association between severity of COVID-19 and restrictive disease during follow up. Conversely, disease severity did not correlate with obstruction. These data will help to define the typical course of progression in patients suffering from Long-COVID and may imply that management should mirror strategies employed in other pulmonary conditions that cause restriction. DISCLOSURES: No relevant relationships by Brian Bustos No relevant relationships by Christopher Dipollina No relevant relationships by David O'Sullivan No relevant relationships by Eduardo Padrao No relevant relationships by Ravneet Randhawa No relevant relationships by Tejal Shah No relevant relationships by Pooja Shekar