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RESPIRATORY SEQUELAE AND ASSOCIATED RISK FACTORS AMONG PATIENTS WITH COVID-19 SIX MONTHS AFTER HOSPITAL DISCHARGE

      TOPIC: Chest Infections
      TYPE: Late Breaking
      PURPOSE: Patients hospitalized with coronavirus disease 2019 (COVID-19) have demonstrated impairments in lung function after discharge. The most commonly documented abnormalities include reductions in diffusion capacity for carbon monoxide (DLCO), total lung capacity (TLC), and impairments in six-minute walk testing (6MWT). It is important to identify risk factors for prolonged pulmonary dysfunction following COVID-19 so that physicians may more equitably direct follow-up resources in their communities.
      METHODS: Patients hospitalized at the University of Virginia Medical Center with COVID-19 received a phone call after discharge in which they underwent a 10-point symptom-based questionnaire. Those who had persistent respiratory symptoms were invited to follow up for pulmonary function testing; including spirometry, lung volumes, diffusion capacity, and exercise tolerance. Of the 234 patients who received a screening phone call, 123 completed pulmonary function testing at 6 months. A multivariate analysis was performed to assess risk factors for prolonged lung function impairment. A total of 12 covariates, including the severity of COVID-19 infection, smoking history, history of pulmonary disease, sex, ethnicity, body mass index (BMI), age, highest recorded d-dimer, highest recorded ferritin, highest recorded c-reactive protein, clinically relevant venothromboembolism and need for oxygen at discharge were included in the analysis.
      RESULTS: At a mean follow-up time of 174 days, 31% of patients demonstrated newly developed impairments in diffusion capacity, 27% had new impairments in lung volumes and 36% had new abnormalities in spirometry. Impairments in lung function correlated significantly with smoking status (never smoker OR = 0.39; CI 0.17-0.88), sex (male sex OR = 2.67; CI 1.09-7.1) and age (OR 1.04; CI 1.01-1.08). Of note, COVID-19 severity, as measured by the National Institute of Health (NIH) COVID-19 illness severity scale and the World Health Organization (WHO) ordinal scale, was not significantly associated with long-term lung function outcomes.
      CONCLUSIONS: Long-term impairments in lung function following COVID-19 are common, occurring in roughly 30% of patients, and include abnormalities in diffusion capacity, lung volumes and spirometry. Long-term impairments in lung function are directly associated with smoking status, male sex, and older age. Surprisingly, long-term lung function does not appear to correlate with COVID-19 severity as measured by the NIH COVID-19 illness severity scale and the WHO ordinal scale.
      CLINICAL IMPLICATIONS: Patients who are at higher risk for impairments in lung function following COVID-19 include those with a history of smoking, male sex, and older age. Particular attention should be paid to these populations when determining how to best allocate community follow-up resources.
      DISCLOSURES: No relevant relationships by Carissa Harnish-Cruz, source=Web Response
      No relevant relationships by Alex Kadl, source=Web Response
      No relevant relationships by Samuel Konkol, source=Web Response
      no disclosure on file for David Martin;
      No relevant relationships by Kelsie Mietla, source=Web Response
      No relevant relationships by CHINTAN RAMANI, source=Web Response
      No relevant relationships by Ryan Sessums, source=Web Response
      No relevant relationships by John Widere, source=Web Response