Comprehensive evaluation of the respiratory system, cardiovascular system, and psychoemotional disorders in post-COVID-19 adult patients

The aim was to study changes in the respiratory system, cardiovascular system, functional and psychoemotional status of adult patients after inpatient treatment for COVID-19 (COronaVIrus Disease 2019). Methods. This cohort prospective observational study recruited patients with COVID-19 and lung damage. Transthoracic echocardiography, lung ultrasound, ECG, dyspnea assessment using mMRC and Borg scales, 6-minute walk test, and pulmonary function tests were performed 3 months after discharge from hospital. Psychoemotional status was assessed using MFI-20 international asthenia test, Spielberger–Hanin situational anxiety scale, Beck depression scale, MMSE cognitive function assessment scale. A standard set of statistical tools was used to describe and compare the data. The differences were considered statistically significant at p < 0.05. Results. A total of 51 patients were enrolled, including 29 (55.8%) women, the median age 64.5 (60.0 – 70.0) years. The most frequent complaints at 3 months after the hospital discharge were weakness (88.2%) and mild (62.7%) to moderate (29.4%) dyspnea. There was a decrease in the lung tissue lesions compared to inpatient treatment (14.5 vs 23.0 points), but the lung ultrasound found consolidates in 78.4% of the patients. The degree of lung tissue lesions correlated with the functional status of the patients. Decreased diffusion lung capacity (DL_CO) was the most frequent functional disorder. It was detected in 23.1% of the patients and accompanied by decreased 6-minute walk test distance and increased volume of lung lesions according to the ultrasound. The threshold value of ultrasound score indicative of the abnormal lung diffusion capacity was 24.5 at the stage of inpatient treatment and 15.5 points at 3 months after discharge from hospital. A mental status assessment at 3 months after discharge from hospital showed that asthenia persisted in all patients. Their anxiety and depression statistically significantly decreased, and the cognitive status improved. Conclusion. The majority of adult patients who had COVID-19 with lung damage still have complaints, lung tissue changes of varying severity at 3 months after discharge from hospital. A significant proportion of the patients also had psychoemotional disorders, abnormalities in the performance of functional tests, and impaired DL_CO. Lung ultrasound can be considered an informative non-invasive method of assessing severity of the lung tissue damage, allowing to predict impaired gas transport function of the lungs.

1. Wiersinga W.J., Rhodes A., Cheng A.C. et al. Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19): a review. JAMA. 2020; 324 (8): 782–793. DOI: 10.1001/jama.2020.12839.

2. Cevik M., Kuppalli K., Kindrachuk J., Peiris M. Virology, transmission, and pathogenesis of SARS-CoV-2. BMJ. 2020; 371: m3862. DOI: 10.1136/bmj.m3862.

3. Tsamakis K., Tsiptsios D., Ouranidis A. et al. COVID-19 and its consequences on mental health (review). Exp. Ther Med. 2021; 21 (3): 244. DOI: 10.3892/etm.2021.9675.

4. Liu D., Baumeister R.F., Zhou Y. Mental health outcomes of coronavirus infection survivors: a rapid meta-analysis. J. Psychiatr. Res. 2021; 137: 542–553. DOI: 10.1016/j.jpsychires.2020.10.015.

5. Komarova I.S., Mukhina N.V., Rachina S.A. et al. [Structural-functional status of cardiovascular and respiratory systems, psychoemotional disorders in patients with COVID-19 at the time of hospital discharge]. Profilakticheskaya meditsina. 2024; 27 (5): 60–68. DOI: 10.17116/profmed20242705160 (in Russian).

6. Bakalidou D., Krommydas G., Abdimioti T. et al. The dimensionality of the multidimensional fatigue inventory (MFI-20) derived from healthy adults and patient subpopulations: a challenge for clinicians. Cureus. 2022; 14 (6): e26344. DOI: 10.7759/cureus.26344.

7. Alekhin M.N., Bartosh-Zelenaya S.Yu., Beresten N.F. et al. [Standardization of transthoracic echocardiography in adults: an expert consensus statement from the Russian Association of Specialists in Ultrasound Diagnostics in Medicine (RASUDM) and the Russian Association of Specialists in Functional Diagnostics (RASFD)]. Ul'trazvukovaya i funktsional'naya diagnostika. 2021; (2): 63–79. DOI: 10.24835/1607-0771-2021-2-63-79 (in Russian).

8. Visseren F.L.J., Mach F., Smulders Y. M. et al. 2021 ESC guidelines on cardiovascular disease prevention in clinical practice. Eur. Heart J. 2021; 42 (34): 3227–3337. DOI: 10.1093/eurheartj/ehab484.

9. Peixoto A.O., Costa R.M., Uzun R. et al. Applicability of lung ultrasound in COVID-19 diagnosis and evaluation of the disease progression: a systematic review. Pulmonology. 2021; 27 (6): 529–562. DOI: 10.1016/j.pulmoe.2021.02.004.

10. Demi L., Mento F., Di Sabatino A. et al. Lung ultrasound in COVID-19 and post-COVID-19 patients, an evidence-based approach. J. Ultrasound Med. 2022; 41 (9): 2203–2215. DOI: 10.1002/jum.15902.

11. Stanojevic S., Graham B.L., Cooper B.G. et al. Official ERS technical standards: Global Lung Function Initiative reference values for the carbon monoxide transfer factor for Caucasians. Eur. Respir. J. 2017; 50 (3): 1700010. DOI: 10.1183/13993003.00010-2017.

12. Singh S.J., Puhan M.A., Andrianopoulos V. et al. An official systematic review of the European Respiratory Society/American Thoracic Society: measurement properties of field walking tests in chronic respiratory disease. Eur. Respir. J. 2014; 44 (6): 1447–1478. DOI: 10.1183/09031936.00150414.

13. Oronsky B., Larson C., Hammond T.C. et al. A review of persistent post-COVID syndrome (PPCS). Clin. Rev. Allergy Immunol. 2023; 64 (1): 66–74. DOI: 10.1007/s12016-021-08848-3.

14. Salamanna F., Veronesi F., Martini L. et al. Post-COVID-19 syndrome: the persistent symptoms at the post-viral stage of the disease. A systematic review of the current data. Front. Med. (Lausanne). 2021; 8: 653516. DOI: 10.3389/fmed.2021.653516.

15. Mandal S., Barnett J., Brill S.E. et al. ‘Long-COVID’: a cross-sectional study of persisting symptoms, biomarker and imaging abnormalities following hospitalisation for COVID-19. Thorax. 2021; 76 (4): 396–398. DOI: 10.1136/thoraxjnl-2020-215818.

16. World Health Organization. A clinical case definition of post COVID-19 condition by a Delphi consensus, 6 October 2021. Available at: https://apps.who.int/iris/handle/10665/345824

17. Zhang P., Li J., Liu H. et al. Long-term bone and lung consequences associated with hospital-acquired severe acute respiratory syndrome: a 15-year follow-up from a prospective cohort study. Bone Res. 2020; 8: 8. DOI: 10.1038/s41413-020-0084-5.

18. Dong E., Du H., Gardner L. An interactive web-based dashboard to track COVID-19 in real time. Lancet Infect. Dis. 2020; 20 (5): 533–534. DOI: 10.1016/ S1473-3099(20)30120-1.

19. Stewart I., Jacob J., George P.M. et al. Residual lung abnormalities following COVID-19 hospitalization: interim analysis of the UKILD Post-COVID study. Am. J. Respir. Crit. Care Med. 2023; 207 (6): 693–703. DOI: 10.1164/rccm.202203-0564OC.

20. Zhao Y.M., Shang Y.M., Song W.B. 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. DOI: 10.1016/j.eclinm.2020.100463.

21. Abdullaeva G.B., Avdeev S.N., Fominykh E.V. et al. [Assessment of long-term clinical and functional changes in patients recovering from severe COVID-19-associated lung damage]. Pul'monologiya. 2023; 33 (4): 461–471. DOI: 10.18093/0869-0189-2023-33-4-461-471 (in Russian).

22. Wang M., Luo X., Wang L. et al. A comparison of lung ultrasound and computed tomography in the diagnosis of patients with COVID-19: a systematic review and meta-analysis. Diagnostics (Basel). 2021; 11 (8): 1351. DOI: 10.3390/diagnostics11081351.

23. Barbieri G., Gargani L., Lepri V. et al. Long-term lung ultrasound follow-up in patients after COVID-19 pneumonia hospitalization: a prospective comparative study with chest computed tomography. Eur. J. Intern. Med. 2023; 110: 29–34. DOI: 10.1016/j.ejim.2022.12.002.

24. Rachina S.A., Strelkova D.A., Cabello Montoya F.E. et al. [Lung ultrasound in COVID-19: practical experience in a multidisciplinary hospital]. Vestnik vosstanovitel’noy meditsiny. 2022; 21 (5): 9–19. DOI: 10.38025/2078-1962-2022-21-5-9-19 (in Russian).

25. Chavez M.A., Shams N., Ellington L.E. et al. Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis. Respir. Res. 2014; 15 (1): 50. DOI: 10.1186/1465-9921-15-50.

26. Lopez-Leon S., Wegman-Ostrosky T., Perelman C. et al. More than 50 Long-term effects of COVID-19: a systematic review and meta-analysis. Sci. Rep. 2021; 11 (1): 16144. DOI: 10.1038/s41598-021-95565-8.

27. Lerum T.V., Aaløkken T.M., Brønstad E. et al. Dyspnoea, lung function and CT findings 3 months after hospital admission for COVID-19. Eur. Respir. J. 2021; 57 (4): 2003448. DOI: 10.1183/13993003.03448-2020.

28. van den Borst B., Peters J.B., Brink M. et al. Comprehensive health assessment 3 months after recovery from acute coronavirus disease 2019 (COVID-19). Clin. Infect. Dis. 2021; 73 (5): e1089–1098. DOI: 10.1093/cid/ciaa1750.

29. Sonnweber T., Sahanic S., Pizzini A. et al. Cardiopulmonary recovery after COVID-19: an observational prospective multicentre trial. Eur. Respir. J. 2021; 57 (4): 2003481. DOI: 10.1183/13993003.03481-2020.

30. Fortini A., Torrigiani A., Sbaragli S. et al. COVID-19: persistence of symptoms and lung alterations after 3–6 months from hospital discharge. Infection. 2021; 49 (5): 1007–1015. DOI: 10.1007/s15010-021-01638-1.

31. Chernyak A.V., Karchevskaya N.A., Savushkina O.I. et al. [Functional changes in the respiratory system after COVID-19-associated lung injury]. Pul'monologiya. 2022; 32 (4): 558–567. DOI: 10.18093/0869-0189-2022-32-4-558-567 (in Russian).

32. Leshchenko I.V., Glushkova T.V. [Clinical and functional characteristics of the post-COVID period (6-month follow-up)]. Pul'monologiya. 2022; 32 (6): 795–805. DOI: 10.18093/0869-0189-2022-32-6-795-805 (in Russian).

33. Glushkova T.V., Leschenko I.V., Skornyakov N., Savelyev A.V. [Functional and radiological assessment of the respiratory system in patients with impaired lung diffusion capacity in the post-COVID period. Tuberkulez i bolezni legkikh. 2023; 101 (3): 44–51. DOI: 10.58838/2075-1230-2023-101-3-44-51 (in Russian).

34. Ivonina N.A., Petrov K.B. [The use of neurotropic therapy in young patients with postcovid syndrome]. Zhurnal nevrologii i psikhiatrii imeni S.S.Korsakova. 2022; 122 (3): 126–130. DOI: 10.17116/jnevro2022122031126 (in Russian).

35. Mazza M.G., Palladini M., De Lorenzo R. et al. Persistent psychopathology and neurocognitive impairment in COVID-19 survivors: Effect of inflammatory biomarkers at three-month follow-up. Brain Behav. Immun. 2021; 94: 138–147. DOI: 10.1016/j.bbi.2021.02.021.

36. Premraj L., Kannapadi N.V., Briggs J. et al. Mid and long-term neurological and neuropsychiatric manifestations of post-COVID-19 syndrome: a meta-analysis. J. Neurol. Sci. 2022; 434: 120162. DOI: 10.1016/j.jns.2022.120162.