Comparative Study of Early Impacts of Post-COVID-19 Pneumonia on Clinical Manifestations, Pulmonary Function, and Chest Radiographs
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Data Collection
2.3. Study Size Estimation
2.4. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Severe (n = 37) | Non-Severe (n = 68) | Healthy Control (n = 25) | p-Value |
---|---|---|---|---|
Demographic data | ||||
Age (year) | 44.5 ± 14.5 # | 30.8 ± 14.3 * | 43.0 ± 9.6 | <0.001 |
Male gender | 21 (56.8) | 33 (48.5) | 12 (48.0) | 0.689 |
Body mass index (kg/m2) | 31.5 ± 5.9 *,# | 26.1 ± 6.1 | 26.1 ± 5.6 | <0.001 |
Co-morbidities | 0.099 | |||
No | 15 (40.5) | 42 (61.8) | 15 (60.0) | |
At least 1 disease | 22 (59.5) # | 26 (38.2) | 10 (40.0) | |
Lists of co-morbidities | ||||
Cardiovascular | 16 (43.2) # | 4 (5.9) * | 6 (24.0) | <0.001 |
Metabolic | 2 (5.4) | 1 (1.5) | 0 (0.0) | 0.283 |
Respiratory | 2 (5.4) # | 17 (25.0) | 4 (16.0) | 0.041 |
Hematology | 1 (2.7) | 3 (4.4) | 0 (0.0) | 0.544 |
Gastrointestinal | 1 (2.7) | 0 (0.0) | 0 (0.0) | 0.282 |
Neuromuscular | 0 (0.0) | 1 (1.5) | 0 (0.0) | 0.632 |
Smoking status | 0.049 | |||
Current | 0 (0.0) | 7 (10.3) | 4 (16.0) | |
Ex-smoker | 9 (24.3) | 9 (13.2) | 1 (4.0) | |
Non-smoker | 28 (75.7) | 52 (76.5) | 20 (80.0) |
Variables | Severe (n = 37) | Non-Severe (n = 68) | p-Value |
---|---|---|---|
Data during hospitalization | |||
Duration of symptoms before hospitalization (days) Median (IQR) | 5 (3.5, 7.5) | 4 (2, 6) | 0.073 |
Vital signs | |||
Body temperature (°C) | 37.6 ± 1.2 | 36.7 ± 0.8 | <0.001 |
Pulse rate (beats/min) | 92.0 ± 16.7 | 101.0 ± 17.7 | 0.012 |
Respiratory rate (breaths/min) | 23.3 ± 4.4 | 20.4 ± 1.3 | <0.001 |
Mean arterial pressure (mmHg) | 93.3 ± 12.4 | 91.8 ±12.5 | 0.578 |
SpO2 %)) | 92.1 ± 5.0 | 96.0 ± 2.5 | <0.001 |
Chest X-ray score, Median (IQR) | 13 (5, 21) | 2 (2, 4) | <0.001 |
Chest X-ray pattern | <0.001 | ||
Ground glass opacities | 11 (29.7) | 60 (88.2) | |
Consolidation | 3 (8.1) | 0 | |
Mixed | 23 (62.2) | 8 (11.8) | |
Chest X-ray distribution | |||
Lower lobe involvement | 36 (97.3) | 66 (97.1) | 1 |
Multi-lobar | 35 (94.6) | 54 (79.4) | 0.047 |
Bilateral | 35 (94.6) | 52 (76.5) | 0.028 |
Complete blood count on admission | |||
Hemoglobin (g/dL) | 13.8 ± 1.8 | 13.6 ± 1.9 | 0.673 |
Hematocrit (%) | 40.8 ± 4.7 | 40.7 ± 5.3 | 0.972 |
White blood count (×103 cells/mm3) | 6.9 ± 3.1 | 5.9 ± 2.1 | 0.105 |
Neutrophil count (×103 cells/mm3) | 5.3 ± 3.1 | 3.6 ± 1.7 | 0.004 |
Lymphocyte count (×103 cells/mm3) | 1.2 ± 0.6 | 1.9 ± 0.7 | <0.001 |
Platelet count (×103/mm3) | 221.9 ± 82.8 | 248.5 ± 84.3 | 0.123 |
Neutrophil–lymphocyte ratio, Median (IQR) | 4.1 (2.0, 7.6) | 1.7 (1.2, 2.6) | <0.001 |
Platelet–lymphocyte ratio, Median (IQR) | 201.2 (114.4, 289.4) | 130.0 (97.9, 167.0) | 0.002 |
Biomarker | |||
CRP (mg/L), Median (IQR) | 67.8 (28.8, 122.6) | 16.3 (4.3, 61.7) | 0.01 |
D-dimer (ng/mL), Median (IQR) | 463 (339, 826) | 391 (272, 556) | 0.154 |
Management at admission | |||
Antiviral therapy | <0.001 | ||
Favipiravir | 18 (48.6) | 62 (91.2) | |
Remdesivir | 7 (18.9) | 2 (2.9) | |
Favipiravir + Remdesivir | 11 (29.7) | 2 (2.9) | |
None | 1 (2.7) | 2 (2.9) | |
Antibiotic | 30 (81.1) | 19 (27.9) | <0.001 |
Systemic corticosteroid | 37 (100) | 41 (60.3) | <0.001 |
Tocilizumab | 8 (21.6) | 0 (0.0) | <0.001 |
Hemoperfusion | 6 (16.2) | 1 (1.5) | 0.007 |
Variables | Severe (n = 37) | Non-Severe (n = 68) | Healthy Control (n = 25) | p-Value |
---|---|---|---|---|
Symptoms | <0.001 | |||
No symptoms | 13 (35.1) | 42 (61.8) | 23 (92.0) | |
At least 1 symptom | 24 (64.9) *,# | 26 (38.2) * | 2 (8.0) | |
List of symptoms | ||||
Fever | 3 (8.1) # | 0 (0.0) | 0 (0.0) | 0.021 |
Cough | 12 (32.4) *,# | 9 (13.2) | 0 (0.0) | 0.002 |
Dyspnea | 5 (13.5) | 5 (7.4) | 0 (0.0) | 0.145 |
Wheeze | 1 (2.7) | 1 (1.5) | 0 (0.0) | 0.696 |
Purulent sputum | 1 (2.7) | 1 (1.5) | 0 (0.0) | 0.696 |
Chest pain | 4 (10.8) | 5 (7.4) | 0 (0.0) | 0.253 |
Sore throat | 3 (8.1) | 3 (4.4) | 0 (0.0) | 0.326 |
Rhinorrhea | 3 (8.1) | 7 (10.3) | 1 (4.0) | 0.624 |
Headache | 3 (8.1) | 4 (5.9) | 1 (4.0) | 0.797 |
Muscle pain | 5 (13.5) | 4 (5.9) | 1 (4.0) | 0.278 |
Fatigue | 8 (21.6) *,# | 5 (7.4) | 0 (0.0) | 0.012 |
Nausea/vomiting | 2 (5.4) | 0 (0.0) | 0 (0.0) | 0.078 |
Diarrhea | 3 (8.1) | 2 (2.9) | 0 (0.0) | 0.227 |
Anosmia | 0 (0.0) | 2 (2.9) | 0 (0.0) | 0.396 |
Ageusia | 2 (5.4) | 1 (1.5) | 0 (0.0) | 0.305 |
Skin rash | 8 (21.6) *,# | 5 (7.4) | 0 (0.0) | 0.012 |
Vital signs | ||||
Temperature (°C) | 36.6 ± 0.2 | 36.6 ± 0.3 | 36.5 ± 0.3 | 0.073 |
Pulse rate (beats/min) | 94.3 ± 12.1 * | 93.2 ± 11.5 * | 83.8 ± 13.7 | 0.002 |
Respiratory rate (breaths/min) | 19.2 ± 1.1 | 18.8 ± 1.1 | 18.3 ± 2.2 | 0.084 |
Mean arterial pressure (mmHg) | 104.4 ± 9.4 *,# | 97.1 ± 10.6 | 96.6 ± 14.2 | 0.003 |
SpO2 (%) | 97.0 ±1.6 *,# | 97.8 ± 1.3 | 98.2 ± 0.9 | 0.001 |
Parameters | Severe (n = 37) | Non-Severe (n = 68) | Healthy Control (n = 25) | p-Value |
---|---|---|---|---|
MMRC dyspnea scale, Median (IQR) a | 1 (0, 1) *,# | 0 (0, 0) | 0 (0, 0) | <0.001 |
Classification b | 0.007 | |||
0 | 18 (48.6) *,# | 56 (82.4) | 22 (88.0) | |
1 | 16 (43.2) | 10 (14.7) | 3 (12.0) | |
2 | 2 (5.4) | 1 (1.5) | 0 (0.0) | |
3 | 1 (2.7) | 1 (1.5) | 0 (0.0) | |
4 | 0 (0.0) | 0 (0.0) | 0 (0.0) | |
QoL: EQ-5D-5L | ||||
Score (0–1) | 0.77 ± 0.17 *,# | 0.88 ± 0.16 | 0.89 ± 0.12 | 0.001 |
VAS (0–100) | 83.5 ± 11.9 | 83.5 ± 11.3 | 87.4 ± 9.5 | 0.289 |
QoL: SF-36 (0–100) | ||||
Physical functioning | 66.2 ± 21.4 *,# | 82.4 ± 19.9 * | 93.6 ± 10.9 | <0.001 |
Role limitations, physical problems | 43.9 ± 44.2 *,# | 77.2 ± 35.2 | 92.0 ± 20.1 | <0.001 |
Bodily pain | 81.8 ± 22.8 # | 91.9 ± 12.7 | 84.8 ± 18.3 | 0.013 |
General health perceptions | 60.9 ± 23.2 * | 64.9 ± 19.8 * | 76.8 ± 12.1 | 0.008 |
Vitality | 63.5 ± 18.9 * | 62.1 ± 21.3 * | 77.8 ± 9.8 | 0.002 |
Social functioning | 71.6 ± 26.5 * | 79.6 ± 21.8 | 92.0 ± 13.9 | 0.002 |
Role limitations, emotional problems | 54.0 ± 43.3 *,# | 76.4 ± 38.2 | 96.0 ± 14.6 | <0.001 |
Mental health | 73.3 ± 13.9 *,# | 76.8 ± 15.4 * | 84.9 ± 11.1 | 0.007 |
Mood disorder: HADS | ||||
Anxiety score, Median (IQR) a | 3.0 (1.5, 5.0) | 2.5 (1.0, 5.0) | 2.5 (1.0, 5.5) | 0.887 |
Score ≥ 11 b | 1 (2.7) | 2 (2.9) | 0 (0.0) | 0.692 |
Depression score, Median (IQR) a | 2.0 (1.0, 5.0) | 2.0 (1.0, 4.0) | 2.0 (0.5, 3.5) | 0.68 |
Score ≥ 11 b | 4 (10.8) * | 1 (1.5) | 0 (0.0) | 0.032 |
Anxiety and/or depression b | 4 (10.8) | 3 (4.4) | 0 (0.0) | 0.158 |
Both anxiety and depression b | 1 (2.7) | 0 (0.0) | 0 (0.0) | 0.282 |
Parameters | Severe (n = 37) | Non-Severe (n = 68) | Healthy Control (n = 25) | p-Value |
---|---|---|---|---|
Complete blood count | ||||
Hemoglobin (g/dL) | 13.4 ± 1.5 | 13.4 ± 1.7 | 13.2 ± 1.7 | 0.845 |
Hematocrit (%) | 40.5 ± 4.0 | 40.3 ± 4.5 | 38.5 ± 8.2 | 0.266 |
White blood cells (×103 cells/mm3) | 9.2 ± 6.1 *,# | 7.2 ± 1.9 | 6.9 ± 1.9 | 0.01 |
Neutrophil (×103 cells/mm3) | 5.5 ± 3.8 *,# | 4.0 ± 1.6 | 3.9 ± 1.4 | 0.011 |
Lymphocyte (×103 cells/mm3) | 2.9 ± 2.1 | 2.4 ± 0.7 | 2.3 ± 0.5 | 0.079 |
Eosinophil (×103 cells/mm3), Median (IQR) | 127.3 (57.3, 198.2) | 146.5 (81.7, 234.6) | 141.4 (105.3, 257.5) | 0.355 |
Platelet (×103/mm3) | 339.4 ± 110.6 * | 307.8 ± 85.2 | 280.6 ± 54.9 | 0.036 |
Neutrophil–lymphocyte ratio | 2.0 ± 0.8 | 1.8 ± 0.7 | 1.8 ± 0.7 | 0.274 |
Platelet–lymphocyte ratio | 139.7 ± 55.7 | 135.5 ± 43.7 | 128.8 ± 36.9 | 0.66 |
Chest X-ray score, Median (IQR) a | 2 (0, 2.5) *,# | 0 (0, 0) | 0 (0, 0) | <0.001 |
Chest X-ray interpretation | <0.001 | |||
Improved with complete resolution | 12 (32.4) | 58 (85.3) | ||
Improved with residual lesion | 22 (59.5) | 7 (10.3%) | ||
Not improved without progression | 1 (2.7) | 1 (1.5%) | ||
Not improved with progression | 2 (5.4) | 2 (2.9%) |
Parameters | Severe (n = 31) | Non-Severe (n = 29) | Healthy Control (n = 25) | p-Value |
---|---|---|---|---|
Spirometry | ||||
FVC (L) | 3.05 ± 0.82 | 3.38 ± 0.79 | 3.44 ± 0.90 | 0.168 |
FVC (% predicted) a | 88.3 ± 12.8 * | 94.6 ± 13.9 | 102.4 ± 11.9 | 0.001 |
z-score of FVC | −0.864 (−1.523, −0.015) * | −0.310 (−1.260, 0.113) * | 0.235 (−0.277, 0.789) | 0.002 |
FEV1 (L) | 2.59 ± 0.68 | 2.95 ± 0.68 | 2.91 ± 0.78 | 0.118 |
FEV1 (% predicted) a | 89.7 ± 12.8 * | 96.0 ± 14.7 | 102.9 ± 11.9 | 0.002 |
z-score of FEV1 | −0.450 (−1.451, −0.014) * | −0.294 (−1.235, 0.384) | 0.160 (−0.475, 0.923) | 0.005 |
FEV1/FVC (%) a | 85.2 ± 5.7 | 87.4 ± 6.1 | 84.5 ± 3.5 | 0.107 |
z-score of FEV1/FVC | 0.287 (−0.469, 1.197) | −0.101 (−0.465, 0.913) | −0.280 (−0.486, 0.393) | 0.481 |
FEV1/FVC < LLN b | 1 (3.2) | 0 (0) | 0 (0.0) | 0.414 |
FEF25-75% (L/s) | 3.30 ± 1.13 | 3.67 ± 1.07 | 3.44 ± 1.28 | 0.463 |
FEF25-75% (% predicted) a | 106.3 ± 34.0 | 105.5 ± 36.4 | 108.9 ± 25.6 | 0.923 |
z-score of FEF25-75% | 0.250 (−0.828, 1.103) | 0.150 (−0.771, 0.596) | 0.210 (−0.318, 0.707) | 0.695 |
FeNO | ||||
FeNO (ppb) a | 15.6 ± 6.8 | 15.5 ± 8.8 | 13.0 ± 7.9 | 0.411 |
FeNO > 25 ppb b | 3 (9.7) | 5 (17.2) | 2 (8.0) | 0.520 |
Parameters | Mean ± SD | Adjusted Mean Difference (95%CI) | p-Value |
---|---|---|---|
R5 (kPa/L/s) | |||
Healthy control (n = 25) | 0.41 ± 0.15 | Ref. | |
Non-severe (n = 29) | 0.35 ± 0.12 | −0.06 (−0.14, 0.00) | 0.068 |
Severe (n = 31) | 0.39 ± 0.11 | −0.04 (−0.11, 0.03) | 0.245 |
R20 (kPa/L/s) | |||
Healthy control (n = 25) | 0.33 ± 0.12 | Ref. | |
Non-severe (n = 29) | 0.26 ± 0.10 | −0.06 (−0.12, 0.00) | 0.045 |
Severe (n = 31) | 0.32 ± 0.10 | −0.02 (−0.08, 0.04) | 0.471 |
R5-R20 (kPa/L/s) | |||
Healthy control (n = 25) | 0.08 ± 0.05 | Ref. | |
Non-severe (n = 29) | 0.08 ± 0.04 | −0.00 (−0.03, 0.02) | 0.591 |
Severe (n = 31) | 0.08 ± 0.03 | −0.02 (−0.04, 0.00) | 0.079 |
Fres (Hz) | |||
Healthy control (n = 25) | 10.2 ± 3.9 | Ref. | |
Non-severe (n = 29) | 10.8 ± 2.9 | 0.73 (−0.97, 2.43) | 0.394 |
Severe (n = 31) | 12.0 ± 3.1 | 0.54 (−1.19, 2.27) | 0.536 |
AX (kPa/L) | |||
Healthy control (n = 25) | 0.39 ± 0.45 | Ref. | |
Non-severe (n = 29) | 0.40 ± 0.45 | 0.04 (−0.22, 0.29) | 0.772 |
Severe (n = 31) | 0.57 ± 0.49 | 0.06 (−0.20, 0.32) | 0.651 |
X5 (kPa/L/s) | |||
Healthy control (n = 25) | −0.07 ± 0.06 | Ref. | |
Non-severe (n = 29) | −0.08 ± 0.06 | −0.01 (−0.05, 0.02) | 0.436 |
Severe (n = 31) | −0.10 ± 0.07 | −0.02 (−0.05, 0.02) | 0.31 |
Small airway disorder(R5-R20 > 0.1 kPa/L/s) | 0.801 | ||
Healthy control (n = 25) | 9 (36.0) | ||
Non-severe (n = 29) | 8 (27.6) | ||
Severe (n = 31) | 10 (32.3) |
6-MWD (m) | Mean ± SD | Adjusted Mean Difference (95%CI) | p-Value |
---|---|---|---|
Healthy control (n = 25) | 525.5 ± 36.4 | Ref. | |
Non-severe (n = 29) | 451.7 ± 78.9 | −79.2 (−116.5, −41.8) | <0.001 |
Severe (n = 31) | 419.9 ± 74.4 | −103.8 (−141.8, −65.7) | <0.001 |
Exercise desaturation (SpO2 decrease ≥ 3%) | n (%) | Adjusted risk ratio (95%CI) | p-value |
Healthy control (n = 25) | 0 (0.0) | ||
Non-severe (n = 29) | 1 (3.2) | Ref. | |
Severe (n = 31) | 6 (19.4) | 3.31 (0.38, 28.96) | 0.279 |
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Niyatiwatchanchai, N.; Deesomchok, A.; Chaiwong, W.; Duangjit, P.; Pothirat, C.; Liwsrisakun, C.; Bumroongkit, C.; Theerakittikul, T.; Limsukon, A.; Tajarernmuang, P.; et al. Comparative Study of Early Impacts of Post-COVID-19 Pneumonia on Clinical Manifestations, Pulmonary Function, and Chest Radiographs. Medicina 2022, 58, 216. https://doi.org/10.3390/medicina58020216
Niyatiwatchanchai N, Deesomchok A, Chaiwong W, Duangjit P, Pothirat C, Liwsrisakun C, Bumroongkit C, Theerakittikul T, Limsukon A, Tajarernmuang P, et al. Comparative Study of Early Impacts of Post-COVID-19 Pneumonia on Clinical Manifestations, Pulmonary Function, and Chest Radiographs. Medicina. 2022; 58(2):216. https://doi.org/10.3390/medicina58020216
Chicago/Turabian StyleNiyatiwatchanchai, Nutchanok, Athavudh Deesomchok, Warawut Chaiwong, Pilaiporn Duangjit, Chaicharn Pothirat, Chalerm Liwsrisakun, Chaiwat Bumroongkit, Theerakorn Theerakittikul, Atikun Limsukon, Pattraporn Tajarernmuang, and et al. 2022. "Comparative Study of Early Impacts of Post-COVID-19 Pneumonia on Clinical Manifestations, Pulmonary Function, and Chest Radiographs" Medicina 58, no. 2: 216. https://doi.org/10.3390/medicina58020216