Identification of factors impairing exercise capacity after severe COVID-19 pulmonary infection: a 3-month follow-up of prospective COVulnerability cohort.

Ribeiro Baptista B; d’Humieres T; Schlemmer F; Bendib I; Justeau G;
Al-Assaad L; Hachem M; Codiat R; Bardel B; Abou Chakra L; Belmondo T;
Audureau E; Hue S; Mekontso-Dessap A; Derumeaux G; Boyer L

Respiratory Research. 23(1):68, 2022 Mar 22.

BACKGROUND: Patient hospitalized for coronavirus disease 2019 (COVID-19)
pulmonary infection can have sequelae such as impaired exercise capacity.
We aimed to determine the frequency of long-term exercise capacity
limitation in survivors of severe COVID-19 pulmonary infection and the
factors associated with this limitation.

METHODS: Patients with severe COVID-19 pulmonary infection were enrolled
3 months after hospital discharge in COVulnerability, a prospective
cohort. They underwent cardiopulmonary exercise testing, pulmonary
function test, echocardiography, and skeletal muscle mass evaluation.

RESULTS: Among 105 patients included, 35% had a reduced exercise capacity
(VO2peak < 80% of predicted). Compared to patients with a normal exercise
capacity, patients with reduced exercise capacity were more often men
(89.2% vs. 67.6%, p = 0.015), with diabetes (45.9% vs. 17.6%, p = 0.002)
and renal dysfunction (21.6% vs. 17.6%, p = 0.006), but did not differ in
terms of initial acute disease severity. An altered exercise capacity was
associated with an impaired respiratory function as assessed by a decrease
in forced vital capacity (p < 0.0001), FEV1 (p < 0.0001), total lung
capacity (p < 0.0001) and DLCO (p = 0.015). Moreover, we uncovered a
decrease of muscular mass index and grip test in the reduced exercise
capacity group (p = 0.001 and p = 0.047 respectively), whilst 38.9% of
patients with low exercise capacity had a sarcopenia, compared to 10.9% in
those with normal exercise capacity (p = 0.001). Myocardial function was
normal with similar systolic and diastolic parameters between groups
whilst reduced exercise capacity was associated with a slightly shorter
pulmonary acceleration time, despite no pulmonary hypertension.

CONCLUSION: Three months after a severe COVID-19 pulmonary infection,
more than one third of patients had an impairment of exercise capacity
which was associated with a reduced pulmonary function, a reduced skeletal
muscle mass and function but without any significant impairment in cardiac