Cluster analysis unveils a severe persistent respiratory impairment phenotype 3-months after severe COVID-19

• Published in: Respiratory research Vol. 23; no. 1; pp. 1 - 199
• Main Authors: Perotin, Jeanne-Marie, Gierski, Fabien, Bolko, Lois, Dury, Sandra, Barrière, Sarah, Launois, Claire, Dewolf, Maxime, Chouabe, Stéphane, Bongrain, Eric, Picard, Davy, Tran, Eric, N'Guyen, Yoann, Mourvillier, Bruno, Servettaz, Amélie, Rapin, Amandine, Marcus, Claude, Lebargy, François, Kaladjian, Arthur, Salmon, Jean-Hugues, Deslee, Gaetan
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 02.08.2022; BioMed Central; BMC
• Subjects: Abnormalities; Anxiety; Body composition; Cluster analysis; Clustering; Complications; Computed tomography; Coronaviruses; COVID-19; DLCO; Dyspnea; Epidemics; Evaluation; Hospitalization; Impairment; Life Sciences; Lungs; Medical imaging; Mental disorders; Oxygen therapy; Patients; Phenotype; Phenotypes; Pneumonia; Post traumatic stress disorder; Psychological stress; Pulmonary manifestations of general diseases; Quality of life; Questionnaires; Respiration; Respiratory function; Respiratory tract diseases; Risk factors; Sarcopenia; Severe acute respiratory syndrome; Severe acute respiratory syndrome coronavirus 2; Statistical analysis; Statistics; Stress; Subgroups; Ventilators; France; COVID-19; Sarcopenia; DLCO; Clustering; Post-traumatic stress disorder
• ISSN: 1465-993X; 1465-9921; 1465-993X; 1465-9921
• DOI: 10.1186/s12931-022-02111-9

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: D LCO , total lung capacity and 6-min walking distance (6MWD). Results Sixty-two patients were analysed, 39% had dyspnea on exercise (mMRC ≥ 2), 72% had D LCO < 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 (D LCO 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