Evaluation of pulmonary sequelae, quality of life, exercise capacity in patients post-COVID-19 moderate to severe in Sao Paulo State: prospective and multicenter study

Abstract

The SARS-COV-2 coronavirus has resulted in the infection of millions of people worldwide and thousands of deaths. Brazil is the second country with the highest number of cases and the State of São Paulo the most affected. In addition to the number of deaths, many patients had a more severe condition requiring continuous oxygen supplementation and even the use of mechanical ventilation. In these cases, SARS-VOC-2 infection is characterized by having a systemic involvement and prolonged hospitalization. In previous pandemics due to other respiratory viruses (such as Influenza H1N1, SARS-COV-1 and MERS), the main involvement was respiratory failure and systemic involvement. In these cases, the surviving patients had important and long-term sequelae, lasting up to 1 year. In the respiratory part, many had impaired lung function and a fibrotic process, with significant impairment in gas exchange. Exercise capacity has also been reduced in many cases. Finally, the reported quality of life was clearly reduced. Therefore, it is clear that the risk of life and the impairment of the patient's health status are not restricted only to the moment of hospitalization, but can for several months after hospital discharge.SARS-COV-2 is also presenting with longer hospitalizations, a severe impairment of respiratory failure and more complications of other organs (mainly cardiovascular and hematological). As a consequence, it is logical to expect that these patients will be at greater risk of presenting these sequelae impairments. To date, there are no data in the scientific literature describing the types of involvement and their consequences.The present study aims to follow prospectively patients who were hospitalized for SARS-COV-2 with moderate to severe involvement, defined by oxygen dependence and extent of involvement on pulmonary tomography. Two hundred patients will be followed in 4 important medical and scientific centers in the state of São Paulo, for a period of 12 months after hospital discharge. The tests include respiratory function, exercise capacity with gas exchange on effort, questionnaires of quality of life, peripheral muscle strength and body composition.We believe that many patients might have impairment in several of these assessments. With this, we will be able to identify the intensity of these damages and characterize the individuals most at risk for sequelae of SARS-VOC-2 infection. In this way, we will be able to design protocols to identify these patients at greatest risk and, eventually, discuss possible therapeutic interventions, such as earlier cardiopulmonary rehabilitation. (AU)