ABSTRACT
COVID-19 survivors commonly report persistent symptoms. In this observational study, we investigated the link between osteopontin (OPN) and post-acute COVID-19 symptoms and lung functional/imaging abnormalities. We recorded symptoms and lung imaging/functional data from previously hospitalized COVID-19 patients, who were followed for 4-84 weeks (122 patients/181 visits) post-symptom onset at our outpatient clinic. Circulating OPN was determined using ELISA. Plasma OPN levels were higher in symptomatic patients (compared with the asymptomatic ones); those with dyspnea (compared with those without dyspnea);those with a combination of serious symptoms, i.e., the presence of at least one of the following: dyspnea, fatigue and muscular weakness (compared with those with none of these symptoms); and those with dyspnea and m-MRC > 1 (compared with those with m-MRC = 0-1). Plasma OPN levels were inversely correlated with EQ-VAS (visual analog scale of the EQ-5D-5L health-related quality-of-life questionnaire) values. High-resolution CT or diffusion lung capacity (DLCO) findings were not related to circulating OPN. In the multiple logistic regression, the presence of symptoms, dyspnea, or the combination of serious symptoms were linked to female gender, increased BMI and pre-existing dyspnea (before the acute disease), while increased plasma OPN levels, female gender and pre-existing dyspnea with m-MRC > 1 were independently associated with severe post-COVID-19 dyspnea (m-MRC > 1). Using a correlation matrix to investigate multiple correlations between EQ-VAS, OPN and epidemiological data, we observed an inverse correlation between the OPN and EQ-VAS values. Increased circulating OPN was linked to the persistence of severe exertional dyspnea and impaired quality of life in previously hospitalized COVID-19 patients.
ABSTRACT
Introduction: During the current pandemic, there has been a paucity of Greek data in terms of recording the general long-term functional status of patients after coronavirus disease 2019 (COVID-19) hospitalizations, as well as very little information regarding rehabilitation services nationwide and their utilization. Objective-design: This is a prospective cohort study, including 92 adults discharged from the Infectious Disease Unit of a third-level hospital in Greece after hospitalization with COVID-19. Demographics and disease severity data was collected upon admission and symptoms at discharge, 4 months and 1 year. Following rating of 12 common symptoms on a Likert scale, quality-of-life data and accessibility to rehabilitation services were compared among the 3 time points. Results: At discharge, the most prevalent complaints were fatigue, exertional dyspnoea and difficulty walking. At 4 months, these 3 remained among the most prevalent symptoms, while pain and memory/loss concentration remained at high numbers as well. Finally, at the 1-year mark, the percentages of patients reporting fatigue, exertional dyspnoea and pain were the highest. At the 4-month follow-up, only 4.3% of the study participants had visited a rehabilitation facility of any kind, whereas at the 1-year mark the percentage rose to 10.9%. Conclusion: A clinically relevant number of participants experienced at least one post-COVID-19 hospitalization symptom. Quality of life was markedly affected by the longer-term effects of the disease. The percentage of people finally attending any kind of rehabilitation service was poor. With thousands more being infected and needing hospitalization nationwide daily, the need for the inclusion of relevant rehabilitation programmes in the Greek healthcare system appears imminent.
ABSTRACT
BACKGROUND: Noninvasive ventilation (NIV) is considered as the first-line treatment for acute exacerbation of COPD (AECOPD) complicated by respiratory acidosis. Recent studies demonstrate a role of nasal high-flow oxygen (NHF) in AECOPD as an alternative treatment in patients intolerant to NIV or with contraindications to it. AIM: The study aimed to evaluate whether NHF respiratory support is noninferior compared to NIV in respect to treatment failure, defined as need for intubation or change to alternative treatment group, in patients with AECOPD and mild-to-moderate acute or acute-on-chronic hypercapnic respiratory failure. METHODS: We designed a multicentre, prospective, randomised trial on patients with AECOPD, who have pH<7.35 but >7.25 and P aCO2 â >45â mmHg, in whom NIV is indicated as a first-line treatment. According to power analysis, 498 participants will be required for establishing noninferiority of NHF compared to NIV. Patients will be randomly assigned to receive NIV or NHF. Treatment will be adjusted to maintain S pO2 between 88%-92% for both groups. Arterial blood gases, respiratory variables, comfort, dyspnoea score and any pulmonary or extrapulmonary complications will be assessed at baseline, before treatment initiation, and at 1, 2, 4, 6, 12, 24, 48â h, then once daily from day 3 to patient discharge, intubation or death. CONCLUSION: Given the increasing number of studies demonstrating the physiological effects of NHF in COPD patients, we hypothesise that NHF respiratory support will be noninferior to NIV in patients with AECOPD and mild-to-moderate acute or acute on chronic hypercapnic respiratory failure.
