Long-term follow-up study of post-COVID-19 patients

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Abstract

Aim. To evaluate dynamic changes in the lungs, hemostasis system, immune system in different terms after coronavirus pneumonia.

Materials and methods. Ventilation-perfusion single-photon emission computed tomography/computed tomography (CT), functional methods of lung investigation, evaluation of hemostasis system, immune status and specific humoral immune response were performed and evaluated in different terms after coronavirus pneumonia. A total of 71 patients were examined according to this protocol. We examined patients with the lesion volume not less than 50% according to chest CT. All patients were divided into 2 groups depending on the distance from the acute stage of coronavirus pneumonia. Group 1 included patients who were examined early (30–60 days after hospital discharge), group 2 included patients who were examined later (61–180 days after hospital discharge).

Results. We obtained gradual regression of pathologically-modified tissue from 67.3% during the inpatient phase to 30.9% during the early period and to 19.7% during the late period of examination, according to CT scan of the chest organs. The same tendency was demonstrated by diffusion capacity of the lungs. Perfusion scintigraphy data showed a decrease in perfusion deficit from 26.0±12.8% during the early period of examination to 19.4±6.2% during the late period of examination. On the contrary, ventilatory scintigraphy demonstrates the increase of isotope passage time through the alveolar-capillary membrane over time (from 48.2±31.3 minutes in the early period to 83.6±37.2 minutes in the late period). An increase in D-dimer was detected in 24% of patients in the early group. The levels of inflammatory markers, indices of immune status, and specific humoral immune response did not differ in the two described groups.

Conclusion. The results demonstrate gradual regression of pathological changes caused by coronavirus infection.

About the authors

Natalia A. Karchevskaya

Sklifosovsky Research Institute for Emergency Medicine

Author for correspondence.
Email: karchevskaia@mail.ru
ORCID iD: 0000-0001-8368-1056

канд. мед. наук, врач-пульмонолог, науч. сотр. отд-ния торако-абдоминальной хирургии

Russian Federation, Moscow

Ivan M. Skorobogach

Sklifosovsky Research Institute for Emergency Medicine

Email: karchevskaia@mail.ru
ORCID iD: 0000-0002-5428-6687

мл. науч. сотр., врач-рентгенолог отд-ния лучевой диагностики

Russian Federation, Moscow

Alexander V. Cherniak

Pletnev City Clinical Hospital; Pulmonology Scientific Research Institute

Email: karchevskaia@mail.ru
ORCID iD: 0000-0002-2001-5504

канд. мед. наук, врач функциональной диагностики отд. функциональной и ультразвуковой диагностики; зав. лаб. функциональных и ультразвуковых методов исследования

Russian Federation, Moscow; Moscow

Ekaterina V. Migunova

Sklifosovsky Research Institute for Emergency Medicine

Email: karchevskaia@mail.ru
ORCID iD: 0000-0001-7521-487X

канд. мед. наук, ст. науч. сотр. отд. лучевой диагностики

Russian Federation, Moscow

Olga V. Leshchinskaya

Sklifosovsky Research Institute for Emergency Medicine

Email: karchevskaia@mail.ru
ORCID iD: 0000-0003-2902-6338

врач-рентгенолог отд. радиоизотопной диагностики

Russian Federation, Moscow

Elena N. Kalmanova

Pletnev City Clinical Hospital

Email: karchevskaia@mail.ru
ORCID iD: 0000-0002-8681-7569

канд. мед. наук, зав. отд. функциональной и ультразвуковой диагностики

Russian Federation, Moscow

Andrey Iu. Bulanov

Sklifosovsky Research Institute for Emergency Medicine

Email: karchevskaia@mail.ru
ORCID iD: 0000-0001-6999-8145

д-р мед. наук, вед. науч. сотр. отд. биотехнологий и трансфузиологии

Russian Federation, Moscow

Elena A. Ostrovskaya

Sklifosovsky Research Institute for Emergency Medicine

Email: karchevskaia@mail.ru
ORCID iD: 0000-0001-7343-0667

врач-гематолог, врач-трансфузиолог отд. производственной, клинической трансфузиологии и гравитационной хирургии крови

Russian Federation, Moscow

Alexander I. Kostin

Sklifosovsky Research Institute for Emergency Medicine

Email: karchevskaia@mail.ru
ORCID iD: 0000-0001-7542-851X

канд. мед. наук, врач-гематолог, зав. отд. производственной клинической трансфузиологии и гравитационной хирургии крови

Russian Federation, Moscow

Valentina P. Nikulina

Sklifosovsky Research Institute for Emergency Medicine

Email: karchevskaia@mail.ru
ORCID iD: 0000-0003-3305-1958

канд. мед. наук, ст. науч. сотр. клинико-диагностической лаб.

Russian Federation, Moscow

Natalia Iu. Kravchenko

Pulmonology Scientific Research Institute

Email: karchevskaia@mail.ru
ORCID iD: 0000-0001-5228-7793

рук. Научно-методического центра мониторинга и контроля болезней органов дыхания

Russian Federation, Moscow

Andrey S. Belevskiy

Pirogov Russian National Research Medical University

Email: karchevskaia@mail.ru
ORCID iD: 0000-0001-6050-724X

д-р мед. наук, проф., зав. каф. пульмонологии

Russian Federation, Moscow

Sergey S. Petrikov

Sklifosovsky Research Institute for Emergency Medicine

Email: karchevskaia@mail.ru
ORCID iD: 0000-0003-3292-8789

чл.-кор. РАН, д-р мед. наук, проф., дир.

Russian Federation, Moscow

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Supplementary files

Supplementary Files
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2. Fig. 1. Ventilation lung scintigraphy with 99mTc-pentatech. Posterior scintigrams indicating zones for plotting alveolar-capillary diffusion rate curves.

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3. Fig. 2. Perfusion lung scintigraphy with 99mTc-macrotech. Scintigrams of the first passage of the radiopharmaceutical with plotting curves from the region of the right ventricle and pulmonary artery (a) and in the "whole body" mode (b) to determine lung capture from the whole body.

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4. Fig. 3. DLCO level depending on the timing of the study.

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5. Fig. 4. DLCO level depending on the timing of the study and the extent of lung tissue damage at the peak of the disease (CT-3, CT-4)

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6. Fig. 5. a – CT scan of the chest (axial and frontal reconstruction) in the acute phase of the disease; b – Lung CT scan processed with Lung CT analysis for COVID-19 software.

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7. Fig. 6. a – the same patient (see Fig. 5). CT of the chest organs (axial and frontal reconstruction) in dynamics after 30 days; b – Lung CT scan processed with the software Lung CT analysis for COVID-19.

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8. Fig. 7. Dynamic changes according to CT of the chest in the hospital, early and long-term after discharge from the hospital.

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9. Fig. 8. a – PS with 99mTc-macrotech in the mode of single- photon emission computed tomography; b – hybrid study: PS with 99mTc-macrotech in the mode of o-emission computed tomography, combined with CT of the chest circumference (frontal, sagittal, axial reconstruction).

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10. Fig. 9. Assessment of perfusion deficit in the early (30–60th day) and late (61–180th day) periods after discharge.

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11. Fig. 10. Assessment of the rate of alveolo-capillary diffusion during VS in the early (30–60th day) and late (61–180th day) periods after discharge.

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12. Fig. 11. a – VS with 99mTc-pentatech in the mode of single photon emission computed tomography; b – hybrid study: VS with 99mTc-pentatech in the mode of one-photon emission computed tomography, combined with CT of the chest circumference (frontal, sagittal, axial reconstruction).

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