Post-COVID impairment: objective multidimensional assessment of long term effects in hospitalized, non-ICU patients

There is mounting evidence of chronic symptoms following COVID-19. However, most studies are based solely on questionnaires or spirometry. We aimed to objectively evaluate the performance status in patients hospitalized for COVID-19 6 months after discharge. Ongoing single-center cohort. Patients hospitalized with confirmed COVID-19 without severe respiratory failure, i.e. not requiring high flow O2/MV, underwent clinical assessment, bodyplethysmography/DLCO, N2-Multiple Breath Washout, cardiopulmonary exercise testing (CPET) and polygraphy 6 months after discharge. An interim analysis revealed a patient population with a mean age of 64±3 years (70% males). After 6 months, 79% of the patients still reported symptoms. Bodyplethysmography showed an obstructive airflow limitation in 30% and combined obstructive-restrictive pattern in 5%. Impaired diffusion capacity was observed in 32%. The CPET detected reduced exercise tolerance in 50% of the study population, with cardio-vascular (50%) and ventilatory limitations (20%), deconditioning (20%) and pathologic gas exchange (10%) being commonly observed. Abnormal AHI (>5/h) was evidenced in 72% cases. There was a significant negative correlation between the extent of parenchymal alterations in CT at diagnosis and the VO2max% predicted in CPET (p=0.016) after 6 months, which persisted after adjustment for smoking status. Half of the patients requiring hospitalization for COVID-19 still present exercise capacity impairment 6 months after acute infection, mostly due to cardio-vascular limitation. Clinical features at infection might predict the extent of long term exercise capacity impairment.