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Chest radiography is a poor predictor of respiratory symptoms and functional impairment in survivors of severe COVID-19 pneumonia

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Rebecca D'Cruz, Michael Waller, Felicity Perrin, Jimstan Periselneris, Sam Norton, Laura-Jane Smith, Tanya Patrick, David Walder, Amadea Heitmann, Kai Kong Lee, Rajiv Madula, William McNulty, Patricia Macedo, Rebecca Lyall, Geoffrey Warwick, James Galloway, Surinder Birring, Amit Patel, Irem Patel, Caroline Jolley

Original languageEnglish
JournalERJ Open Research
Early online date22 Oct 2020
Accepted/In press7 Oct 2020
E-pub ahead of print22 Oct 2020


King's Authors


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 ≥48hours 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/m2, 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 (<0.8m/s) 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.

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