Published in:
Open Access
01-12-2022 | Post-Traumatic Stress Disorder | Research
Cluster analysis unveils a severe persistent respiratory impairment phenotype 3-months after severe COVID-19
Authors:
Jeanne-Marie Perotin, Fabien Gierski, Lois Bolko, Sandra Dury, Sarah Barrière, Claire Launois, Maxime Dewolf, Stéphane Chouabe, Eric Bongrain, Davy Picard, Eric Tran, Yoann N’Guyen, Bruno Mourvillier, Amélie Servettaz, Amandine Rapin, Claude Marcus, François Lebargy, Arthur Kaladjian, Jean-Hugues Salmon, Gaetan Deslee
Published in:
Respiratory Research
|
Issue 1/2022
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Abstract
Background
The mid-term respiratory sequelae in survivors of severe COVID-19 appear highly heterogeneous. In addition, factors associated with respiratory sequelae are not known. In this monocentric prospective study, we performed a multidisciplinary assessment for respiratory and muscular impairment and psychological distress 3 months after severe COVID-19. We analysed factors associated with severe persistent respiratory impairment, amongst demographic, COVID-19 severity, and 3-month assessment.
Methods
Patients with severe SARS-CoV-2 pneumonia requiring ≥ 4L/min were included for a systematic 3-month visit, including respiratory assessment (symptoms, lung function, CT scan), muscular evaluation (body composition, physical function and activity, disability), psychopathological evaluation (anxiety, depression, post-traumatic stress disorder-PTSD) and quality of life. A cluster analysis was performed to identify subgroups of patients based on objective functional measurements: DLCO, total lung capacity and 6-min walking distance (6MWD).
Results
Sixty-two patients were analysed, 39% had dyspnea on exercise (mMRC ≥ 2), 72% had DLCO < 80%, 90% had CT-scan abnormalities; 40% had sarcopenia/pre-sarcopenia and 31% had symptoms of PTSD. Cluster analysis identified a group of patients (n = 18, 30.5%) with a severe persistent (SP) respiratory impairment (DLCO 48 ± 12%, 6MWD 299 ± 141 m). This SP cluster was characterized by older age, severe respiratory symptoms, but also sarcopenia/pre-sarcopenia, symptoms of PTSD and markedly impaired quality of life. It was not associated with initial COVID-19 severity or management.
Conclusions and clinical implication
We identified a phenotype of patients with severe persistent respiratory and muscular impairment and psychological distress 3 months after severe COVID-19. Our results highlight the need for multidisciplinary assessment and management after severe SARS-CoV-2 pneumonia.
Trial registration The study was registered on ClinicalTrials.gov (May 6, 2020): NCT04376840