Öz
Amaç: COVID-19 hastalığının yaygınlığı ve ağırlığına bağlı olarak post-COVID dönemde pulmoner sekeller ve fibrotik akciğer hastalığı hastalar için önemli problemler oluşturmaya devam etmektedir. Biz de çalışmamızda post-COVID hasta yönetimi ile pulmoner sekel ve fibrozis için risk faktörlerini belirlemeyi amaçladık.
Gereç ve Yöntem: COVID-19 nedeni ile hastaneden düşük doz kortikosteroid (0,5 mg/kg/gün metilprednisolon) ile taburcu edilen 67 post-COVID hasta çalışmaya dahil edildi. Hastaların sosyo-demografik verileri, radyolojik ve laboratuvar bulguları kayıt altına alındı. Taburculuk sonrası tüm hastalar 3,6 ve 12. ayda takipleri yapılarak ayrıntılı biyokimyasal kan tetkikleri ve yüksek rezolüsyonlu bilgisayarlı tomografi (HRCT) ile değerlendirilerek pulmoner fibrozis tanısı HRCT bulgularına göre konuldu.
Bulgular: Altmış yedi hastanın 34 (50,7%)’ü erkek ve yaş ortalaması 57±16,33 yıl (min.19–max.90) idi. Üçüncü ayda 59 (%88,1), 6. ayda 28 (%41,8) ve 12. ayda 21 (%31,3) hastada anormal toraks bilgisayarlı tomografi (BT) bulguları vardı. On ikinci ay takibinde toraks BT bulgularına göre toplam 9 (%13,4) hastada pulmoner fibrozis saptandı.
Sonuç: Araştırmamızda post-COVID pulmoner fibrosis gelişimi için en önemli risk faktörleri yoğun bakım ünitesi (YBÜ) takibi, lenfosit sayısının <500, ferritinin ≥300 olması şeklinde tespit edildi. Bu nedenle özellikle hastanede YBÜ’de tedavi gören hastaların taburculuk sonrası düzenli ve sık aralıklarla takibi gerekmektedir.
Anahtar Kelimeler
Kortikosteroid COVID-19 post-COVID pulmoner fibrosis radiolojik bulgular risk faktörleri.
Kaynakça
- 1) Shah W, Hillman T, Playford ED, Hishmeh L. Managing the long term effects of COVID-19: summary of NICE, SIGN, and RCGP rapid guideline. BMJ. 2021;372:n136.
- 2) Korompoki E, Gavriatopoulou M, Hicklen RS, Ntanasis-Stathopoulos I, Kastritis E, Fotiou D et al. Epidemiology and organ specific sequelae of post-acute COVID19: A narrative review. J Infect. 2021;83:1-16.
- 3) Aul DR, Gates DJ, Draper DA, Dunleavy DA, Ruickbie DS, Meredith DH et al. Complications after discharge with COVID-19 infection and risk factors associated with development of post-COVID pulmonary fibrosis. Respir Med. 2021;188:106602.
- 4) Chen J, Wu J, Hao S, Yang M, Lu X, Chen X et al. Long term outcomes in survivors of epidemic Influenza A (H7N9) virus infection. Sci Rep. 2017;7:17275.
- 5) Xie L, Liu Y, Xiao Y, Tian Q, Fan B, Zhao H et al. Follow-up study on pulmonary function and lung radiographic changes in rehabilitating severe acute respiratory syndrome patients after discharge. Chest. 2005;127:2119-24.
- 6) Liu J, Zheng X, Tong Q, Li W, Wang B, Sutter K et al. Overlapping and discrete aspects of the pathology and pathogenesis of the emerging human pathogenic coronaviruses SARS-CoV, MERS-CoV, and 2019-nCoV. J Med Virol. 2020;92:491-494.
- 7) Silva Andrade B, Siqueira S, de Assis Soares WR, de Souza Rangel F, Santos NO, Dos Santos et al. Long-COVID and post-COVID health complications: an Up-to-Date review on clinical conditions and their possible molecular mechanisms. Viruses. 2021;13:700.
- 8) Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180:934-943.
- 9) Osuchowski MF, Winkler MS, Skirecki T, Cajander S, Shankar-Hari M, Lachmann G et al. The COVID-19 puzzle: deciphering pathophysiology and phenotypes of a new disease entity. Lancet Respiratory Medicine 2021;9:622-642.
- 10) Myall KJ, Mukherjee B, Castanheira AM, Lam JL, Benedetti G, Mak SM et al. Persistent post-COVID-19 interstitial lung disease. An observational study of corticosteroid treatment. Ann Am Thorac Soc. 2021;18:799-806.
- 11) Lopez-Leon S, Wegman-Ostrosky T, Perelman C, Sepulveda R, Rebolledo P, Cuapio A et al. More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. Res Sq [Preprint]. 2021:rs.3.rs-266574
- 12) Huang C, Huang L, Wang Y, Li X, Ren L, Gu X et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397:220-232.
- 13) Fernández-de-Las-Peñas C, Palacios-Ceña D, Gómez-Mayordomo V, Rodríuez-Jiménez J, Palacios-Ceña M, Velasco-Arribas M et al. Long-term post-COVID symptoms and associated risk factors in previously hospitalized patients: a multicenter study. J Infect. 2021;83:237-279.
- 14) Fernández-de-Las-Peñas C, Guijarro C, Plaza-Canteli S, Hernández-Barrera V, Torres-Macho J. Prevalence of post-COVID-19 cough one year after SARS-CoV-2 infection: a multicenter study. Lung. 2021;199:249-253.
- 15) Das KM, Lee EY, Singh R, Enani MA, Al Dossari K, Van Gorkom K et al. Follow-up chest radiographic findings in patients with MERS-CoV after recovery. Indian J Radiol Imaging. 2017;27:342-349.
- 16) Liu C, Ye L, Xia R, Zheng X, Yuan C, Wang Z et al. Chest computed tomography and clinical follow-up of discharged patients with COVID-19 in Wenzhou City, Zhejiang, China. Ann Am Thorac Soc. 2020;17:1231-1237.
- 17) Mandal S, Barnett J, Brill SE, Brown JS, Denneny EK, Hare SS et al. 'Long-COVID': a cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalisation for COVID-19. Thorax. 2021;76:396-398.
- 18) Zhao YM, Shang YM, Song WB, Li QQ, Xie H, Xu QF et al. Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery. EClinicalMedicine. 2020;25:100463.
- 19) McGroder CF, Zhang D, Choudhury MA, Salvatore MM, D'Souza BM, Hoffman EA et al. Pulmonary fibrosis 4 months after COVID-19 is associated with severity of illness and blood leucocyte telomere length. Thorax. 2021;76:1242-1245.
- 20) Huang C, Huang L, Wang Y, Li X, Ren L, Gu X et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397:220-232.
- 21) Esendağli D, Yilmaz A, Akçay Ş, Özlü T. Post-COVID syndrome: pulmonary complications. Turk J Med Sci. 2021;51:3359-3371.
- 22) Sheard S, Rao P, Devaraj A. Imaging of acute respiratory distress syndrome. Respir Care. 2012;57:607-12.
- 23) Li X, Shen C, Wang L, Majumder S, Zhang D, Deen MJ et al. Pulmonary fibrosis and its related factors in discharged patients with new corona virus pneumonia: a cohort study. Respir Res 2021;22:203.
Öz
Purpose: Depending on the prevalence and severity of COVID-19 disease, pulmonary sequelae and fibrotic lung disease continue to pose significant problems for patients in the post-COVID period. In our study, we aimed to determine the risk factors for pulmonary sequelae and fibrosis with post-COVID patient management.
Materials and Methods: The study comprised 67 post-COVID patients who were released from the hospital after receiving low-dose corticosteroids (0.5 mg/kg daily methylprednisolone) as a result of COVID-19. Socio-demographic data, radiological and laboratory findings of the patients were recorded. All patients were followed up at 3, 6, and 12 months after discharge, and the diagnosis of pulmonary fibrosis was made according to high resolution computed tomography (HRCT) findings, by evaluating with detailed biochemical blood tests and HRCT.
Results: Thirtyfour (50.7%) of the 67 patients were male and the mean age was 57±16.33 (min.19–max.90). At 3 months, there were 59 patients (88.1%) with aberrant thoracic computed tomography (CT) findings, 28 (41.8%) at 6 months, and 21 (31.3%) at 12 months. In the 12th month follow-up, pulmonary fibrosis was detected in a total of 9 (13.4%) patients according to thorax CT findings.
Conclusion: In our study, the most important risk factors for the development of post-COVID pulmonary fibrosis were intensive care unit (ICU) follow-up, lymphocyte count <500 and ferritin ≥300. For this reason, patients who are treated in the ICU, especially in the hospital, should be followed up regularly and frequently after discharge.
Anahtar Kelimeler
Corticosteroid COVID-19 post-COVID pulmonary fibrosis radiological findings risk factors
Kaynakça
- 1) Shah W, Hillman T, Playford ED, Hishmeh L. Managing the long term effects of COVID-19: summary of NICE, SIGN, and RCGP rapid guideline. BMJ. 2021;372:n136.
- 2) Korompoki E, Gavriatopoulou M, Hicklen RS, Ntanasis-Stathopoulos I, Kastritis E, Fotiou D et al. Epidemiology and organ specific sequelae of post-acute COVID19: A narrative review. J Infect. 2021;83:1-16.
- 3) Aul DR, Gates DJ, Draper DA, Dunleavy DA, Ruickbie DS, Meredith DH et al. Complications after discharge with COVID-19 infection and risk factors associated with development of post-COVID pulmonary fibrosis. Respir Med. 2021;188:106602.
- 4) Chen J, Wu J, Hao S, Yang M, Lu X, Chen X et al. Long term outcomes in survivors of epidemic Influenza A (H7N9) virus infection. Sci Rep. 2017;7:17275.
- 5) Xie L, Liu Y, Xiao Y, Tian Q, Fan B, Zhao H et al. Follow-up study on pulmonary function and lung radiographic changes in rehabilitating severe acute respiratory syndrome patients after discharge. Chest. 2005;127:2119-24.
- 6) Liu J, Zheng X, Tong Q, Li W, Wang B, Sutter K et al. Overlapping and discrete aspects of the pathology and pathogenesis of the emerging human pathogenic coronaviruses SARS-CoV, MERS-CoV, and 2019-nCoV. J Med Virol. 2020;92:491-494.
- 7) Silva Andrade B, Siqueira S, de Assis Soares WR, de Souza Rangel F, Santos NO, Dos Santos et al. Long-COVID and post-COVID health complications: an Up-to-Date review on clinical conditions and their possible molecular mechanisms. Viruses. 2021;13:700.
- 8) Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180:934-943.
- 9) Osuchowski MF, Winkler MS, Skirecki T, Cajander S, Shankar-Hari M, Lachmann G et al. The COVID-19 puzzle: deciphering pathophysiology and phenotypes of a new disease entity. Lancet Respiratory Medicine 2021;9:622-642.
- 10) Myall KJ, Mukherjee B, Castanheira AM, Lam JL, Benedetti G, Mak SM et al. Persistent post-COVID-19 interstitial lung disease. An observational study of corticosteroid treatment. Ann Am Thorac Soc. 2021;18:799-806.
- 11) Lopez-Leon S, Wegman-Ostrosky T, Perelman C, Sepulveda R, Rebolledo P, Cuapio A et al. More than 50 long-term effects of COVID-19: a systematic review and meta-analysis. Res Sq [Preprint]. 2021:rs.3.rs-266574
- 12) Huang C, Huang L, Wang Y, Li X, Ren L, Gu X et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397:220-232.
- 13) Fernández-de-Las-Peñas C, Palacios-Ceña D, Gómez-Mayordomo V, Rodríuez-Jiménez J, Palacios-Ceña M, Velasco-Arribas M et al. Long-term post-COVID symptoms and associated risk factors in previously hospitalized patients: a multicenter study. J Infect. 2021;83:237-279.
- 14) Fernández-de-Las-Peñas C, Guijarro C, Plaza-Canteli S, Hernández-Barrera V, Torres-Macho J. Prevalence of post-COVID-19 cough one year after SARS-CoV-2 infection: a multicenter study. Lung. 2021;199:249-253.
- 15) Das KM, Lee EY, Singh R, Enani MA, Al Dossari K, Van Gorkom K et al. Follow-up chest radiographic findings in patients with MERS-CoV after recovery. Indian J Radiol Imaging. 2017;27:342-349.
- 16) Liu C, Ye L, Xia R, Zheng X, Yuan C, Wang Z et al. Chest computed tomography and clinical follow-up of discharged patients with COVID-19 in Wenzhou City, Zhejiang, China. Ann Am Thorac Soc. 2020;17:1231-1237.
- 17) Mandal S, Barnett J, Brill SE, Brown JS, Denneny EK, Hare SS et al. 'Long-COVID': a cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalisation for COVID-19. Thorax. 2021;76:396-398.
- 18) Zhao YM, Shang YM, Song WB, Li QQ, Xie H, Xu QF et al. Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery. EClinicalMedicine. 2020;25:100463.
- 19) McGroder CF, Zhang D, Choudhury MA, Salvatore MM, D'Souza BM, Hoffman EA et al. Pulmonary fibrosis 4 months after COVID-19 is associated with severity of illness and blood leucocyte telomere length. Thorax. 2021;76:1242-1245.
- 20) Huang C, Huang L, Wang Y, Li X, Ren L, Gu X et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397:220-232.
- 21) Esendağli D, Yilmaz A, Akçay Ş, Özlü T. Post-COVID syndrome: pulmonary complications. Turk J Med Sci. 2021;51:3359-3371.
- 22) Sheard S, Rao P, Devaraj A. Imaging of acute respiratory distress syndrome. Respir Care. 2012;57:607-12.
- 23) Li X, Shen C, Wang L, Majumder S, Zhang D, Deen MJ et al. Pulmonary fibrosis and its related factors in discharged patients with new corona virus pneumonia: a cohort study. Respir Res 2021;22:203.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Klinik Tıp Bilimleri |
| Bölüm | Araştırma |
| Yazarlar | |
| Yayımlanma Tarihi | 30 Eylül 2022 |
| Kabul Tarihi | 5 Ağustos 2022 |
| Yayımlandığı Sayı | Yıl 2022 Cilt: 47 Sayı: 3 |
