Chest radiography is a poor predictor of respiratory symptoms and functional impairment in survivors of severe COVID-19 pneumonia
- Rebecca F. D'Cruz1,
- Michael D. Waller1,2,
- Felicity Perrin2,
- Jimstan Periselneris2,
- Sam Norton3,
- Laura-Jane Smith2,
- Tanya Patrick2,
- David Walder2,
- Amadea Heitmann2,
- Kai Lee2,
- Rajiv Madula2,
- William McNulty2,
- Patricia Macedo2,
- Rebecca Lyall2,
- Geoffrey Warwick2,
- James B. Galloway3,
- Surinder S. Birring1,2,
- Amit Patel2,
- Irem Patel1,2 and
- Caroline J. Jolley1,2
- 1Centre for Human and Applied Physiological Sciences, King's College London, London, UK
- 2Department of Respiratory Medicine, King's College Hospital NHS Foundation Trust, London, UK
- 3Centre for Rheumatic Disease, King's College London, London, United Kingdom
- Dr Caroline Jolley. E-mail: caroline.jolley{at}kcl.ac.uk
Abstract
Background A standardised approach to assessing COVID-19 survivors has not been established, largely due to the paucity of data on medium- and long-term sequelae. Interval chest radiograph is recommended following community-acquired pneumonia, however its utility in monitoring recovery from COVID-19 pneumonia remains unclear.
Methods Prospective single-centre observational cohort study. Patients hospitalised with severe COVID-19 pneumonia (admission duration ≥48 h and oxygen requirement ≥40% or critical care admission) underwent face-to-face assessment 4–6 weeks post-discharge. Primary outcome: radiological resolution of COVID-19 pneumonitis (Radiographic Assessment of Lung Oedema score <5). Secondary outcomes: clinical outcomes, symptom questionnaires, mental health screening (Trauma Screening Questionnaire, GAD-7, PHQ-9), physiological testing (4-metre gait speed (4MGS), 1-minute sit-to-stand test (STS)).
Results 119 patients assessed between 3rd June and 2nd July 2020 at median (IQR) 61 (51–67) days post-discharge. Mean±sd age 58.7±14.4 years, body mass index 30.0 (25.9–35.2) kg·m−2, 62% male, 68% ethnic minority. Despite radiographic resolution of pulmonary infiltrates in 87%, mMRC breathlessness scores were above pre-COVID baseline in 46% and patients reported persistent fatigue (68%), sleep disturbance (57%) and breathlessness (32%). Screening thresholds were breached for post-traumatic stress disorder (25%), anxiety (22%) and depression (18%). 4MGS was slow (<0.8 m·s−1) in 38%, 35% desaturated by ≥4% during STS. Of 56 thoracic computed tomography scans performed, 75% demonstrated COVID-related interstitial and/or airways disease.
Conclusions Persistent symptoms, adverse mental health outcomes and physiological impairment are common 2 months after severe COVID-19 pneumonia. Follow-up chest radiograph is a poor marker of recovery, therefore holistic face-to-face assessment is recommended to facilitate early recognition and management of post-COVID sequelae.
Footnotes
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Conflict of interest: Dr. D'Cruz has nothing to disclose.
Conflict of interest: Dr. Waller has nothing to disclose.
Conflict of interest: Dr. Perrin has nothing to disclose.
Conflict of interest: J. Periselneris reports lecture fees from Gilead outside the submitted work.
Conflict of interest: Dr. Norton has nothing to disclose.
Conflict of interest: Dr. LJ Smith has nothing to disclose.
Conflict of interest: Dr. Patrick has nothing to disclose.
Conflict of interest: Dr. Walder has nothing to disclose.
Conflict of interest: Dr. Heitmann has nothing to disclose.
Conflict of interest: Dr. Lee has nothing to disclose.
Conflict of interest: Dr. Madula has nothing to disclose.
Conflict of interest: Dr. McNulty has nothing to disclose.
Conflict of interest: Dr. Macedo has nothing to disclose.
Conflict of interest: Dr. lyall has nothing to disclose.
Conflict of interest: Dr. Warwick has nothing to disclose.
Conflict of interest: Dr. Galloway has nothing to disclose.
Conflict of interest: Dr. Birring has nothing to disclose.
Conflict of interest: Dr. Patel has nothing to disclose.
Conflict of interest: Dr. Patel has nothing to disclose.
Conflict of interest: Dr. Jolley has nothing to disclose.
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- Received September 9, 2020.
- Accepted October 7, 2020.
- Copyright ©ERS 2020
This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.