Long-term consequences in lung and bone associated with hospital-acquired severe acute respiratory syndrome: a 15-year follow-up from a prospective cohort study

BACKGROUND: Severe acute respiratory syndrome (SARS) broke out in China and spread to all over the world in 2003. Without comprehensive protection, during a severe hospital outbreak in the Peking University People's Hospital (PKUPH), there were 78 patients diagnosed with SARS and two deaths. During treatment, most patients received large doses of steroid shock therapy, which may result in complications of femoral head necrosis and pulmonary fibrosis. We aimed to follow up the condition of lung and bone in those patients. METHODS: We did an observational cohort study of patients with SARS from 2003 to 2018. We carried out pulmonary CT scans, hip joint MRI tests, pulmonary function tests, and hip joint functional assessment to evaluate the recovery condition of lung damage and femoral head necrosis according to patients' willingness. We used linear regression, and mixed-model repeated-measures analysis to measure the change of lung interstitial and femoral head necrosis volume. This study was authorised by the Ethics Committee of Peking University People's Hospital (2018PHB010-01). All recruited SARS patients signed informed consent for the study. This study is registered with ClinicalTrials.gov, number NCT03443102. FINDINGS: There were 80 medical staff patients with SARS altogether in Peking University People's Hospital. Two patients died of SARS in 2003 and 78 patients were enrolled in this study from August, 2003, to March, 2018. 71 patients completed the 15 years' follow-up and seven patients were missing. Pulmonary injury scope on lung CT improved from 2003 (9·40%, SD 7·83) to 2004 (3·20%, 4·78; p≤0·001), and thereafter remained steady to 2018 (4·60%, 6·37). Pulmonary function items in patients with SARS did not differ between 2006 and 2018. The recovery extent of pulmonary function items between 2006 and 2018 in patients with lung interstitial change (n=13), was less than that without lung interstitial changes (n=23), especially in one-second ratio (FEV1/FVC, t=2·21, p=0·04) and mid-flow of maximum expiration (FEF25–75%, t=2·76, p=0·01). The volume of femoral head necrosis decreased significantly from 2003 (38·83%, SD 21·01) to 2005 (30·38%, 20·23; p=0·0002), then decreased slowly from 2005 to 2013 (28·99%, 20·59) and thereafter remained steady to 2018 (25·52%, 15·51)%. INTERPRETATION: Damaged lung interstitial and functional decline induced by SARS mainly recovered in the next 1–2 years after rehabilitation. The natural process of femoral head necrosis caused by large doses of steroid shock therapy in SARS patients was not progressive, while partially reversible. FUNDING: Chinese National Ministry of Science and Technology 973 Project (number 2014CB542201), Beijing science and technology new star cross subject (2018019), Fund for Fostering Young Scholars of Peking University Health Science Center (BMU2017PY013), National Natural Science Foundation (numbers 31771322,31571235, 31571236, 31271284).