Post-COVID-19 Cardiopulmonary Symptoms: Predictors and Imaging Features in Patients after Hospital Discharge

Abstract Background Most of the evidence about the impact of the post-acute COVID-19 Syndrome (PACS) reports individual symptoms without correlations with related imaging. Objectives To evaluate cardiopulmonary symptoms, their predictors and related images in COVID-19 patients discharged from hospital. Methods Consecutive patients who survived COVID-19 were contacted 90 days after discharge. The Clinic Outcome Team structured a questionnaire evaluating symptoms and clinical status (blinded for hospitalization data). A multivariate analysis was performed to address the course of COVID-19, comorbidities, anxiety, depression, and post-traumatic stress during hospitalization, and cardiac rehabilitation after discharge. The significance level was set at 5%. Results A total of 480 discharged patients with COVID-19 (age: 59±14 years, 67.5% males) were included; 22.3% required mechanical ventilation. The prevalence of patients with PACS-related cardiopulmonary symptoms (dyspnea, tiredness/fatigue, cough, and chest discomfort) was 16.3%. Several parameters of chest computed tomography and echocardiogram were similar in patients with and without cardiopulmonary symptoms. The multivariate analysis showed that PACS-related cardiopulmonary-symptoms were independently related to female sex (OR 3.023; 95% CI 1.319-6.929), in-hospital deep venous thrombosis (OR 13.689; 95% CI 1.069-175.304), elevated troponin I (OR 1.355; 95% CI 1.048-1.751) and C-reactive protein during hospitalization (OR 1.060; 95% CI 1.023-1.097) and depression (OR 6.110; 95% CI 2.254-16.558). Conclusion PACS-related cardiopulmonary symptoms 90 days post-discharge are common and multifactorial. Beyond thrombotic and markers of inflammation/myocardial injury during hospitalization, female sex and depression were independently associated with cardiopulmonary-related PACS. These results highlighted the need for a multifaceted approach targeting susceptible patients.背景 现有关于新冠病毒感染后急性综合征（Post-acute COVID-19 Syndrome, PACS）影响的研究证据，大多仅报道了单一症状，未提及与相关影像学检查的关联。 研究目的 评估新冠病毒感染出院患者的心肺症状、其预测因素及相关影像学表现。 研究方法 对新冠病毒感染康复出院的连续入组患者，于出院后90天开展随访。临床结局研究团队设计结构化问卷，对患者症状及临床状态进行评估（对住院数据设盲）。采用多变量分析，探讨住院期间新冠感染病程、合并症、焦虑、抑郁及创伤后应激症状，以及出院后心脏康复情况的影响。检验水准设定为5%。 研究结果 共纳入480例新冠病毒感染出院患者（年龄：59±14岁，男性占比67.5%），其中22.3%的患者曾接受机械通气。合并PACS相关心肺症状（呼吸困难、疲劳乏力、咳嗽及胸部不适）的患者占比为16.3%。存在心肺症状与无心肺症状的患者，其胸部计算机断层扫描（Computed Tomography, CT）及超声心动图（echocardiogram）的多项参数无显著差异。多变量分析显示，PACS相关心肺症状与以下因素独立相关：女性性别（优势比（Odds Ratio, OR）=3.023，95%置信区间（Confidence Interval, CI）：1.319~6.929）、住院期间深静脉血栓形成（OR=13.689，95%CI：1.069~175.304）、肌钙蛋白I（troponin I）水平升高（OR=1.355，95%CI：1.048~1.751）、住院期间C反应蛋白（C-reactive protein）水平升高（OR=1.060，95%CI：1.023~1.097）以及抑郁状态（OR=6.110，95%CI：2.254~16.558）。 研究结论 出院后90天出现的PACS相关心肺症状较为常见，且受多因素影响。除住院期间的血栓形成、炎症/心肌损伤标志物外，女性性别及抑郁状态也与PACS相关心肺症状独立相关。本研究结果提示，需针对易感人群采取多维度干预策略。