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      Dyspnoea, lung function and CT findings three months after hospital admission for COVID-19

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          Abstract

          The long-term pulmonary outcomes of coronavirus disease 2019 (COVID-19) are unknown. We aimed to describe self-reported dyspnoea, quality of life, pulmonary function, and chest CT findings three months following hospital admission for COVID-19. We hypothesised outcomes to be inferior for patients admitted to intensive care units (ICU), compared with non-ICU patients.

          Discharged COVID-19-patients from six Norwegian hospitals were consecutively enrolled in a prospective cohort study. The current report describes the first 103 participants, including 15 ICU patients. Modified Medical Research Council dyspnoea scale (mMRC), EuroQol Group's Questionnaire, spirometry, diffusion capacity (DL CO), six-minute walk test, pulse oximetry, and low-dose CT scan were performed three months after discharge.

          mMRC was >0 in 54% and >1 in 19% of the participants. The median (25th–75th percentile) forced vital capacity and forced expiratory volume in one second were 94% (76, 121) and 92% (84, 106) of predicted, respectively. DL CO was below the lower limit of normal in 24%. Ground-glass opacities (GGO) with >10% distribution in ≥1 of 4 pulmonary zones were present in 25%, while 19% had parenchymal bands on chest CT. ICU survivors had similar dyspnoea scores and pulmonary function as non-ICU patients, but higher prevalence of GGO (adjusted odds ratio [95% confidence interval] 4.2 [1.1, 15.6]) and performance in lower usual activities.

          Three months after admission for COVID-19, one fourth of the participants had chest CT opacities and reduced diffusion capacity. Admission to ICU was associated with pathological CT findings. This was not reflected in increased dyspnoea or impaired lung function.

          Abstract

          Three months after discharge, one-fourth of COVID-19 survivors have reduced gas diffusion capacity and persistent parenchymal opacities. ICU treatment is associated with persistent parenchymal opacities, but not with dyspnoea or reduced diffusion capacity.

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          Most cited references25

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          Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

          Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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            Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area

            There is limited information describing the presenting characteristics and outcomes of US patients requiring hospitalization for coronavirus disease 2019 (COVID-19).
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              Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L)

              Purpose This article introduces the new 5-level EQ-5D (EQ-5D-5L) health status measure. Methods EQ-5D currently measures health using three levels of severity in five dimensions. A EuroQol Group task force was established to find ways of improving the instrument’s sensitivity and reducing ceiling effects by increasing the number of severity levels. The study was performed in the United Kingdom and Spain. Severity labels for 5 levels in each dimension were identified using response scaling. Focus groups were used to investigate the face and content validity of the new versions, including hypothetical health states generated from those versions. Results Selecting labels at approximately the 25th, 50th, and 75th centiles produced two alternative 5-level versions. Focus group work showed a slight preference for the wording ‘slight-moderate-severe’ problems, with anchors of ‘no problems’ and ‘unable to do’ in the EQ-5D functional dimensions. Similar wording was used in the Pain/Discomfort and Anxiety/Depression dimensions. Hypothetical health states were well understood though participants stressed the need for the internal coherence of health states. Conclusions A 5-level version of the EQ-5D has been developed by the EuroQol Group. Further testing is required to determine whether the new version improves sensitivity and reduces ceiling effects.
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                Author and article information

                Journal
                Eur Respir J
                Eur Respir J
                ERJ
                erj
                The European Respiratory Journal
                European Respiratory Society
                0903-1936
                1399-3003
                10 December 2020
                10 December 2020
                : 2003448
                Affiliations
                [1 ]Department of Pulmonary Medicine, Oslo University Hospital Ullevål, Oslo, Norway
                [2 ]Department of Radiology and Nuclear Medicine, Oslo University Hospital Ullevål, Oslo, Norway
                [3 ]Institute for Clinical Medicine, University of Oslo, Oslo, Norway
                [4 ]Thoracic Department, St. Olavs Hospital, Trondheim, Norway
                [5 ]Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences NTNU, Trondheim, Norway
                [6 ]Department of Thoracic Medicine, Haukeland University Hospital, Haukeland, Norway
                [7 ]Department of Clinical Science, University of Bergen, Bergen, Norway
                [8 ]Pulmonary Department, Akershus University Hospital, Lørenskog, Norway
                [9 ]Department of Infectious Diseases, Østfold Hospital Trust Kalnes, Grålum, Norway
                [10 ]Department of Respiratory Medicine, Oslo University Hospital Rikshospitalet, Oslo, Norway
                [11 ]Department of Infectious Diseases, Oslo University Hospital Ullevål, Oslo, Norway
                [12 ]Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
                [13 ]Department of Diagnostic Imaging, Akershus University Hospital, Lørenskog, Norway
                [14 ]shared last authors
                Author notes
                Gunnar Einvik, Pulmonary Department, Akershus University Hospital, 1470 Lørenskog, Norway. E-mail gunnar.einvik@ 123456medisin.uio.no
                Author information
                https://orcid.org/0000-0003-4512-8000
                Article
                ERJ-03448-2020
                10.1183/13993003.03448-2020
                7736755
                33303540
                0f0b38db-36fa-4a24-8a38-937d46c585f5
                Copyright ©ERS 2020

                This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial Licence 4.0.

                History
                : 9 September 2020
                : 18 November 2020
                Funding
                Funded by: Boehringer Ingelheim , open-funder-registry 10.13039/100001003;
                Categories
                Original Article

                Respiratory medicine
                Respiratory medicine

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