In patients 12 weeks post discharge after COVID-19-related acute respiratory distress syndrome (ARDS) requiring intubation, risk factors for developing residual pulmonary functional and radiological abnormalities include obesity, kidney failure, older age, diabetes, and the use of dexamethasone. Patients who did not use dexamethasone were at risk of developing traction bronchiectasis, pneumonia, and cystic changes. These were among research results being presented at the American College of Chest Physicians (CHEST) 2022 Annual Meeting, held October 16 to 19, in Nashville, Tennessee.
The investigator sought to determine risk factors for residual pulmonary radiological and functional abnormalities in patients with post-ARDS related to COVID-19 and to assess treatments for reducing these complications.
The investigator conducted an observational study of 97 patients who were 12 weeks post discharge for COVID-19-related severe ARDS from a university hospital from the end of August 2021 through November 2021. All patients had been intubated; 58 had lung abnormalities with greater than 75% lung involvement; and 39 had lung abnormalities with between 50% and 75% lung involvement. At 12 weeks post discharge, patients reported persistent dyspnea (100%), chest pain (51.1%), cough (42.3%), fever (29.0%), and hemoptysis (18.5%).
All patients had abnormal pulmonary function tests. Patients with more than 75% lung involvement vs those with 50% to 75% lung involvement had more severe abnormalities, worse median forced vital capacity (46.3[11.9] vs 64.7[10.6]; P <.001), and poorer diffusing capacity of the lungs for carbon monoxide (54.6[9.3] vs 70.4[8.4]; P <.01).
The investigator found that patients with more than 75% lung involvement commonly had comorbidities (obesity odds ratio [OR] 2.44; 95% CI, 0.79-6.98, P =.003; kidney failure OR 2.01; 95% CI, 0.70-5.22, P =.005; older age OR 2.12; 95% CI, 0.72-5.88, P <.004; DM OR 2.87; 95% CI, 0.86-7.34, P <.002).
Additionally, the investigation found interesting results with respect to dexamethasone use. There was a significant association between nonuse of dexamethasone prior to ICU admission and traction bronchiectasis (OR 2.38; 95% CI, 0.74-6.12; P <.001), usual interstitial pneumonia (OR 3.22; 95% CI, 0.85-9.23; P <.0004), organizing pneumonia (OR 4.82; 95% CI, 0.99-12.32; P <.0001), and cystic changes (P <.001). Conversely, the use of dexamethasone was associated with ground glass opacity (OR 2.95; 95% CI, 0.79-7.54; P <.001). Ventilator-associated pneumonia at the time of intubation caused by multi-drug resistant pathogen was significantly associated with residual organizing pneumonia (OR 4.76; 95% CI, 0.91-11.66; P <.0001).
Study limitations include the observational design.
In summary, “There were several risk factors found for development of more severe residual pulmonary functional and radiological abnormalities: older age, and comorbidities such as [diabetes mellitus], obesity, and kidney failure,” the investigator noted. “Lack of use of dexamethasone was associated with development of [organizing pneumonia], [usual interstitial pneumonia], traction bronchiectasis, and cystic changes,” and “The use of dexamethasone was associated with nonsevere residual pulmonary functional and radiological abnormalities.”
Sadigov AS. Radiographic and clinical correlations in survivors with post-ARDS-related COVID-19: What are risk factors for residual pulmonary abnormalities? Presented at: CHEST 2022 Annual Meeting; October 16-19, 2022; Nashville, TN.