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EuropePMC; 2021.
Preprint in English | EuropePMC | ID: ppcovidwho-315777


Introduction: the Novel Coronavirus Disease (Covid-19) can infect the respiratory tract, causing mild to deadly respiratory impairment. It is still unknown whether patients recovering from Covid-19 will develop respiratory sequelae. This study aims to evaluate the respiratory and functional condition of Covid-19 recovered patients, stratified according to their worst p/F during hospitalization for Covid-19. Method: 86 Covid-19 recovered subjects performed, after 39 days on average, physical examination and arterial blood gas (ABG) examination, pulmonary function tests (PFTs) with diffusing capacity of the lung for carbon monoxide (DLco), and six-minute walk test (6MWT). Subjects also quantified their dyspnoea and cough using a visual analogic scale (VAS) at three-time points: previously than COVID infection, during COVID hospitalization, and currently. The 76 subjects with reliable ABG during the hospitalization were stratified in three groups according to their worst PaO2/FiO2 ratio (p/F): “mild”: p/F>300 (n = 38);“moderate”: 200<p/F<300 (n = 30), “severe” p/F < 200 (n = 20). Results: In this cohort, Covid-19 recovered subjects still reported significant residual dyspnoea at the visit time. The severe subjects group showed a lower Total Lung Capacity (TLC), a lower DLco, and a worse 6MWT performance. Conclusion: After Covid-19, respiratory and functional impairments may persist. These impairments seem to be more severe as much as minor was the patient worst p/F during hospitalization. These patients should receive a strict follow-up.

EClinicalMedicine ; 27: 100553, 2020 Oct.
Article in English | MEDLINE | ID: covidwho-1385448


BACKGROUND: Interleukin-6 signal blockade showed preliminary beneficial effects in treating inflammatory response against SARS-CoV-2 leading to severe respiratory distress. Herein we describe the outcomes of off-label intravenous use of Sarilumab in severe SARS-CoV-2-related pneumonia. METHODS: 53 patients with SARS-CoV-2 severe pneumonia received intravenous Sarilumab; pulmonary function improvement or Intensive Care Unit (ICU) admission rate in medical wards, live discharge rate in ICU treated patients and safety profile were recorded. Sarilumab 400 mg was administered intravenously on day 1, with eventual additional infusion based on clinical judgement, and patients were followed for at least 14 days, unless previously discharged or dead. FINDINGS: Of the 53 SARS-CoV-2pos patients receiving Sarilumab, 39(73·6%) were treated in medical wards [66·7% with a single infusion; median PaO2/FiO2:146(IQR:120-212)] while 14(26·4%) in ICU [92·6% with a second infusion; median PaO2/FiO2: 112(IQR:100-141.5)].Within the medical wards, 7(17·9%) required ICU admission, 4 of whom were re-admitted to the ward within 5-8 days. At 19 days median follow-up, 89·7% of medical inpatients significantly improved (46·1% after 24 h, 61·5% after 3 days), 70·6% were discharged from the hospital and 85·7% no longer needed oxygen therapy. Within patients receiving Sarilumab in ICU, 64·2% were discharged from ICU to the ward and 35·8% were still alive at the last follow-up. Overall mortality rate was 5·7%. INTERPRETATION: IL-6R inhibition appears to be a potential treatment strategy for severe SARS-CoV-2 pneumonia and intravenous Sarilumab seems a promising treatment approach showing, in the short term, an important clinical outcome and good safety.

BMC Pulm Med ; 21(1): 241, 2021 Jul 17.
Article in English | MEDLINE | ID: covidwho-1369491


INTRODUCTION: The novel coronavirus SARS-Cov-2 can infect the respiratory tract causing a spectrum of disease varying from mild to fatal pneumonia, and known as COVID-19. Ongoing clinical research is assessing the potential for long-term respiratory sequelae in these patients. We assessed the respiratory function in a cohort of patients after recovering from SARS-Cov-2 infection, stratified according to PaO2/FiO2 (p/F) values. METHOD: Approximately one month after hospital discharge, 86 COVID-19 patients underwent physical examination, arterial blood gas (ABG) analysis, pulmonary function tests (PFTs), and six-minute walk test (6MWT). Patients were also asked to quantify the severity of dyspnoea and cough before, during, and after hospitalization using a visual analogic scale (VAS). Seventy-six subjects with ABG during hospitalization were stratified in three groups according to their worst p/F values: above 300 (n = 38), between 200 and 300 (n = 30) and below 200 (n = 20). RESULTS: On PFTs, lung volumes were overall preserved yet, mean percent predicted residual volume was slightly reduced (74.8 ± 18.1%). Percent predicted diffusing capacity for carbon monoxide (DLCO) was also mildly reduced (77.2 ± 16.5%). Patients reported residual breathlessness at the time of the visit (VAS 19.8, p < 0.001). Patients with p/F below 200 during hospitalization had lower percent predicted forced vital capacity (p = 0.005), lower percent predicted total lung capacity (p = 0.012), lower DLCO (p < 0.001) and shorter 6MWT distance (p = 0.004) than patients with higher p/F. CONCLUSION: Approximately one month after hospital discharge, patients with COVID-19 can have residual respiratory impairment, including lower exercise tolerance. The extent of this impairment seems to correlate with the severity of respiratory failure during hospitalization.

COVID-19/physiopathology , Pneumonia, Viral/physiopathology , Aged , Blood Gas Analysis , COVID-19/complications , Carbon Monoxide , Dyspnea/virology , Exercise Tolerance , Female , Humans , Male , Middle Aged , Oxygen/blood , Partial Pressure , Pneumonia, Viral/complications , Pneumonia, Viral/virology , Pulmonary Diffusing Capacity , Residual Volume , SARS-CoV-2 , Severity of Illness Index , Walk Test