Investigation of unfavorable cardiorrespiratory outputs in COVID-19 surviving patients accompanied for 6 months after hospital discharge

Abstract

Patients with elderly COVID-19 or with known cardiorespiratory diseases have worse disease progression when compared to healthy young individuals. Disorders of the heart rhythm and alteration of myocardial necrosis markers have also been prevalent in patients hospitalized for the disease, and the cardiovascular evolution of these patients over time is still unknown. Similarly, it is not well established the respiratory outputs of patients who present changes in lung function, functional capacity or pulmonary impairment on chest tomography at the time of hospitalization. There is doubt whether these changes may persist over the course of these patients and whether there is a correlation with unfavorable cardiorespiratory outcomes. Objectives: (i) To evaluate clinical, laboratory, electrocardiographic and tomographic parameters that may predict unfavorable cardiorespiratory outcome over 6 months of follow-up in hospitalized patients due to COVID-19 infection. Methods: Prospective observational and longitudinal clinical study with approximately 50 patients, aged 18 or over, diagnosed and hospitalized with COVID-19 infection. All patients included will be evaluated clinically and will under go to laboratory tests, high-resolution tomography of the chest and 12-lead electrocardiogram at the time of admission. Patients who survive the acute period of infection by COVID-19 will be monitored periodically and at 1, 3 and 6 months after hospital discharge, in order to determine the presence of sequelae or an unfavorable cardiorespiratory outcome after COVID-19 infection. Patients will undergo periodic clinical evaluation and the following complementary tests at 1, 3 and 6 months: electrocardiogram, echocardiogram, high-resolution tomography of the chest, spirometry, 6-minute walk test, questionnaire quality of life and dyspnea scale. The unfavorable outcomes will be considered: death, the persistence of lung injury on chest tomography, the presence of abnormalities of lung function without a diagnosis prior to infection, the presence of ventricular dysfunction without a diagnosis prior to infection, the appearance or persistence of diagnosed electrocardiographic changes upon admission, reduced functional capacity in the walking test, persistent dyspnea and/or readmission, cardiovascular and/or pulmonary event, or death from any cause in the 6-month follow-up. Descriptive statistics will be performed on clinical and laboratory data obtained during the entire period of hospitalization of patients. Statistical analysis will be performed to determine clinical, laboratory and complementary exam markers that correlate with an unfavorable cardiorespiratory outcome throughout the follow-up. Expected results: It is expected that patients with greater severity of the disease during hospitalization as needing intensive therapy or mechanical ventilation, with changes in markers such as troponin, BNP, D-dimer, CRP and with rhythm disturbances on the admission electrocardiogram, may present worse cardiovascular evolution when compared to patients without these changes. It is expected that patients with greater impairment of the pulmonary parenchyma and/or with coagulation disorders will present worse clinical and respiratory evolution. It is expected that patients who present more severe hypoxemia, greater impairment of the pulmonary parenchyma at hospital admission or those who require mechanical ventilation during hospitalization will present impairment of lung function in the follow-up. (AU)