Respiratory outcomes 3-month following COVID-19- related hospitalisation: a Tunisian prospective study

Background: Despite recovery from COVID-19,concern remains that some organs, including the lungs, might have long-term impairment following infection. Aim(s): Assess symptoms,pulmonary function,exercise capacity and chest HRCT changes in non-intubated patients hospitalised with severe COVID19 pneumonia at 3months. Method(s): In this prospective,longitudinal study,patients admitted to hospital for severe COVID19 who did not require mechanical ventilation were prospectively followed up at 3months after discharge from respiratory department Rabta Hospital of Tunis. During the follow-up,patients were interviewed and underwent pulmonary function tests(PFT),chest high-resolution CT(HRCT)and 6-min walk distance test(6MWT). PFT included:diffusing capacity of the lungs for carbon monoxide (DLCO);forced vital capacity(FVC);forced expiratory volume in 1 second (FEV1) and total lung capacity (TLC). Result(s): Between June 1st, and august 31, 2021;47 patients (mean age 56 +/- 12 years;sex ratio 0.74)were included. At 3 months, the most common persistent symptoms were dyspnea(78.7%),cough(46.8%),fatigue(36.2%) and anxiety(17%). Abnormal HRCT findings were pulmonary fibrosis (4%),ground glass opacities(42.5%) and consolidation(32%). Median FVC, FEV1 and TLC were respectively 97% (53-119%), 87.5% (30-120%) and 87% (72- 127%). DLCO was below the lower limit of normal in 12.7% of patients. During 6MWT, the average walked distance was 480 meters [120-680];22 patients (46.8%) showed reduced physical capacity. Conclusion(s): At 3 months after severe COVID pneumonia,a substantial number of patients still have respiratory symptoms with radiological and functional impairment. A long-term monitoring is mandatory.

Persistent dyspnea six months after SARS-CoV-2 pneumonia : what are the contributing factors ?

Introduction: Dyspnea is a common symptom in post Covid-19 Syndrome. The aim of this study was to evaluate the frequency of persistent dyspnea and assess the factors associated with persistent dyspnea in patients 6 months after discharge for covid-19 pneumonia. Method(s): A retrospective comparative study was performed between november 2020 and december 2021. Sixty - two patients were included from the post-COVID follow-up consultation 6 months after hospitalization for the acute episode. Patients were divided into 2 groups: G1 (n=19) with persistent dyspnea and G2 (n=43) patients without persistent dyspnea. Result(s): The frequency of persistent dyspnea was 30.64%. Compared to G2, the G1 have also more persistent dray cough (42.1% vs 9.3 % ;p=0.005) and memory loss (10.5% vs 0% ;p=0.03) at 6 months. G1 had more severe cases of COVID-19 pneumonia (47.4% vs 41.9%,p=0.01) and non-invasive ventilation (22.2% vs 2.4%,p=0.02) and less anosmia (0% vs 20.9%,p=0.04) in the acute phase of Covid-19 infection than G2. Asthma (21,1% vs 2,3% p=0,02) was more prevalent in G1. The age (p=0.6), female sex (p=0.53), cardiovascular (p=0.5) and metabolic (p=0.8) diseases and extensive radiological damage greater than 50% in the acute phase (p=0.4) were similar in both groups. The mean of FEV1(77.6% vs 104,2%,p=0.01) and DLCO (57% vs 78.72%,p=0.01) were lower in G1 than G2. Radiological cleaning (p=0.1), the mean of FVC (p=0.09), TLC(p=0.32) and 6MWT (p=0.8) were similar in both groups. Conclusion(s): The severity of COVID-19 pneumonia and impairment of DLCO and FEV1 are factors associated with persistent dyspnea in patients at 6 months post Covid -19 infection.

Predictive factors of mechanical ventilation among critically ill adults with COVID-19

Introduction: Acute respiratory failure is the main indication for ICU admission in COVID-19 patients. Most of these patients will require invasive mechanical ventilation (IMV). Aim(s): Identify predictive factors for IMV in Tunisian patients with COVID19 hospitalized in intensive care unit (ICU). Method(s): Cross sectional comparative study conducted in Rabta hospital in Tunis, Tunisia from January 2021 and December 2021. Patients with laboratory confirmed COVID-19 admitted in ICU department were enrolled. Clinical, biological and radiological features of all patients were assessed. Patients requiring MV (G1) and those no (G2) were compared. Result(s): A total of 95 patients were included (61 in G1;34 in G2). There was no significant difference between the 2 groups regarding to age or gender. However, comorbidities such as dyslipidemia, stroke and hypertension were more frequent in G1. Among symptoms, anosmia and confusion were predictive for IMV. Patients with anosmia and confusion had respectively 45% and 25% higher risk for IMV. C-reactive protein (CRP) level (95% in G1 VS 89% in G2;p=0.003), D-dimer rate (86.5% in G1 VS 60% in G2;p=0.008) and severe radiological extension (>50%) (64% in G1 VS 35% in G2;p=0.08) were significantly higher in G1. Conclusion(s): Among ICU admitted patients, comorbidities, neurological symptoms, elevated rate of D-dimer and CRP and important radiological damage are the main risk factors for requiring IMV.

Vaccination and hospitalization of COVID-19:what difference does it make?

Background: The world is currently facing the coronavirus disease(COVID-19)pandemic which places great pressure on health care systems. Global vaccine development efforts have been accelerated in response to the devastating COVID-19 pandemic. Aim(s): To evaluate the impact of COVID-19 vaccination on the length of hospital stay,admission to an intensive care unit (ICU)and deaths from covid-19 infection in patients hospitalized with severe Covid-19 pneumonia. Method(s): Retrospective comparative study between September 2021 and February 2022 including patients hospitalized with severe Covid-19 pneumonia. Patients were divided according to their covid-19 vaccination status into two groups:G1:Vaccinated patients(n=30);G2:Non vaccinated patients(n=100). Result(s): We enrolled 130 patients. Among vaccinated patients,19 were received a messenger RNA vaccine and 11 were received a viral vector vaccine. There was no difference between the two groups in the mean age(62.7 vs 62.2 years,p=0.1),sex ratio(1.75 vs 1.15,p=0.5)and smoking history(22.7% vs 32%,p=0.5). Hypertension, diabetes,obesity and chronic renal failure were the most frequent comorbidities observed in the two groups without significant difference. Non-vaccinated Patients showed significant increase in admission to intensive care unit(17.9% Vs 4.5% in G1,p=0.01)and mortality(11% Vs 4.8% in G1,p=0.02)compared to G1. The median length of hospital stay was shorter in the vaccinated patients(5 [3-12] days vs 8.5[1-15] days,p=0.01).the average oxygen requirements were higher in patients without vaccination (7.5 vs 11 Liter/minute,p=0.01). Conclusion(s): Vaccination can reduce the length of hospital stay and can ovoid the admission to intensive care unit and reduces covid-19 mortality.

Facteurs influencant la duree d'hospitalisation au cours du COVID-19

Declaration de liens d'interets: Les auteurs declarent ne pas avoir de liens d'interets. Copyright © 2022

Impact du tabagisme sur la presentation radioclinique et evolutive de l'infection COVID

Declaration de liens d'interets: Les auteurs declarent ne pas avoir de liens d'interets. Copyright © 2022

Facteurs prédictifs de la persistance des symptômes prolongés à 1 mois post-pneumonie COVID-19

Introduction Certains patients gardent des symptômes plus longtemps post-pneumonie COVID-19. L’objective de notre étude est de caractériser les symptômes en post-pneumonie COVID-19 et de déterminer les facteurs prédictifs de leurs persistances. Méthodes Étude rétrospective longitudinale incluant 121 patients ayant présenté une pneumonie COVID-19 et qui ont consulté à 1 mois après hospitalisation pour l’épisode aiguë. Ces patients ont été recrutés au sein de la consultation de suivi post-COVID, au service de pneumologie D de l’hôpital Abderrahmen Mami de l’Ariana, durant une période allant de janvier 2020 à août 2021. Résultats Quatre-vingt-sept patients (71,9 %) avaient des symptômes prolongés. Cette symptomatologie était dominée par la dyspnée (45,5 %), la toux sèche (19 %), l’asthénie (18,2 %), l’oppression thoracique (14 %) et les céphalées (12,4 %). Une anosmie persistante a été notée chez 5 % des patients. Comparativement aux patients asymptomatiques, les patients avec des symptômes prolongés étaient plus de sexe féminin (51,7 % versus 48,3 % ;p=0,02) et avaient une forme sévère plus fréquente de la pneumonie COVID-19 (48,3 % versus 20,6 % ;p=0,001) et une durée d’hospitalisation plus longue (12,45 jours versus 9,18 jours ;p=0,02) à la phase aiguë de l’infection. L’âge moyen (64,47 ans versus 60,45 ans, p=0,128), la fréquence des sujets âgés de plus que 65 ans (48,3 % versus 38,2 % ;p=0,31), les comorbidités cardiovasculaires (39,1 % versus 41,2 % ;p=0,6) et métaboliques (56,3 % vs 64,1 % ;p=0,9) et une étendue radiologique plus que 50 % à la phase aiguë de la pneumonie COVID-19 (42 % versus 40 % ;p=0,85) étaient comparables entre les deux groupes. Conclusion La dyspnée est le symptôme le plus fréquent après la phase aiguë de la pneumonie. Les facteurs prédictifs de la persistance des symptômes à un mois post-pneumonie COVID-19 étaient le sexe féminin et la sévérité de l’infection initiale.

Impact à long terme de la pneumonie à Sars-CoV-2 sur la fonction respiratoire

Introduction La pneumonie à Sars-CoV-2 est pourvoyeuse de séquelles respiratoires avec un retentissement fonctionnel respiratoire. L’objectif de notre étude est d’évaluer le retentissement fonctionnel respiratoire à 3 mois post pneumonie à Sars CoV-2. Méthodes Étude rétrospective longitudinale incluant 70 patients ayant présentaient une pneumonie à SARS CoV-2 confirmée par une RT-PCR et qui ont consulté à 3 mois (M3) post hospitalisation pour l’épisode aiguë. Ces patients ont été recrutés au sein de la consultation de suivi post Covid, au service de pneumologie D de l’hôpital Abderrahmen Mami de l’Ariana, durant une période allant de janvier 2020 à août 2021. Résultats L’âge moyen des patients était de 60,83 ans (28–85 ans) avec une prédominance masculine (58,6 %). Les comorbidités étaient dominées par l’hypertension artérielle (52,9 %) et le diabète (38,6 %). L’obésité a été notée chez 38,6 % des patients avec un IMC moyen à 30,43kg/m2 [20,99–63,4kg/m2]. La dyspnée d’effort à M3 était notée dans 34,28 % des patients. Les valeurs moyennes des paramètres fonctionnels aux explorations fonctionnelles respiratoires (EFR) à M3 étaient respectivement: CVF à 90,94 % (58 %–121,7 %), VEMS à 92,84 % (45 %–125 %), CPT à 88,4 % (64 %–118 %) et DLCO à 76,23 % (35 %–118 %) de la valeur prédite. L’EFR était normale dans 38,6 % des cas. Elle a montré un trouble ventilatoire restrictif chez (5,7 %), un ventilatoire obstructif (2,9 %) et un trouble de la diffusion (44,3 %). Le TM6 a montré une réduction du PM dans 27,1 % des cas. Les patients avec une atteinte sévère (au moins 50 %) au scanner initial avaient une valeur de VEMS moyen plus basses (87,4 versus 97,7 % de la valeur prédite;p=0,01). Cependant les valeurs de la CVF (p=0,2), CPT (p=0,2) et de la DLCO (p=0,16) étaient similaires quel que soit la sévérité de l’atteinte initiale. Conclusion La baisse de la DLCO constitue l’anomalie fonctionnelle la plus fréquente. Les anomalies fonctionnelles respiratoires persistantes à 3 mois d’une infection à SARS-CoV-2 justifient un suivi large et à long terme.