Cluster analysis unveils a severe persistent respiratory impairment phenotype 3-months after severe COVID-19

Jeanne-Marie Perotin (1, 2, 3) , Fabien Gierski (4, 5, 3) , Lois Bolko (5, 6) , Sandra Dury (7, 5) , Sarah Barrière (5) , Claire Launois (5, 3, 2) , Maxime Dewolf (5) , Stéphane Chouabe (8) , Eric Bongrain (9) , Davy Picard (5, 10) , Eric Tran (5) , Yoann N’guyen (5) , Bruno Mourvillier (5) , Amélie Servettaz (5) , Amandine Rapin (5, 6) , Claude Marcus (5) , François Lebargy (7, 5) , Arthur Kaladjian (4, 5, 3) , Jean-Hugues Salmon (5, 6) , Gaetan Deslee (1, 2)

1 Service des maladies respiratoires et allergiques [CHU Reims]
2 P3CELL - Pathologies Pulmonaires et Plasticité Cellulaire - UMR-S 1250
3 SFR CAP Santé (Champagne-Ardenne Picardie Santé)
4 C2S - Cognition, Santé, Société
5 CHU Reims - Hôpital universitaire Robert Debré [Reims]
6 URCA - Université de Reims Champagne-Ardenne
7 IRMAIC - Immuno-Régulation dans les Maladies Auto-Immunes Inflammatoires et le Cancer - EA 7509
8 Centre Hospitalier de Charleville-Mezières
9 Centre Hospitalier Auban - Moët (Epernay, France)
10 Hôpital de Châlons-en-Champagne

Abstract Background The mid-term respiratory sequelae in survivors of severe COVID-19 appear highly heterogeneous. In addition, factors associated with respiratory sequelae are not known. In this monocentric prospective study, we performed a multidisciplinary assessment for respiratory and muscular impairment and psychological distress 3 months after severe COVID-19. We analysed factors associated with severe persistent respiratory impairment, amongst demographic, COVID-19 severity, and 3-month assessment. Methods Patients with severe SARS-CoV-2 pneumonia requiring ≥ 4L/min were included for a systematic 3-month visit, including respiratory assessment (symptoms, lung function, CT scan), muscular evaluation (body composition, physical function and activity, disability), psychopathological evaluation (anxiety, depression, post-traumatic stress disorder-PTSD) and quality of life. A cluster analysis was performed to identify subgroups of patients based on objective functional measurements: D LCO , total lung capacity and 6-min walking distance (6MWD). Results Sixty-two patients were analysed, 39% had dyspnea on exercise (mMRC ≥ 2), 72% had D LCO < 80%, 90% had CT-scan abnormalities; 40% had sarcopenia/pre-sarcopenia and 31% had symptoms of PTSD. Cluster analysis identified a group of patients (n = 18, 30.5%) with a severe persistent (SP) respiratory impairment (D LCO 48 ± 12%, 6MWD 299 ± 141 m). This SP cluster was characterized by older age, severe respiratory symptoms, but also sarcopenia/pre-sarcopenia, symptoms of PTSD and markedly impaired quality of life. It was not associated with initial COVID-19 severity or management. Conclusions and clinical implication We identified a phenotype of patients with severe persistent respiratory and muscular impairment and psychological distress 3 months after severe COVID-19. Our results highlight the need for multidisciplinary assessment and management after severe SARS-CoV-2 pneumonia. Trial registration The study was registered on ClinicalTrials.gov (May 6, 2020): NCT04376840

Mots clés: COVID-19; Clustering; DLCO; Post-traumatic stress disorder; Sarcopenia

Domaines: Sciences du Vivant [q-bio]

Jeanne-Marie Perotin, Fabien Gierski, Lois Bolko, Sandra Dury, Sarah Barrière, et al.. Cluster analysis unveils a severe persistent respiratory impairment phenotype 3-months after severe COVID-19. Respiratory Research, 2022, 23 (1), pp.199. ⟨10.1186/s12931-022-02111-9⟩. ⟨hal-03800323⟩