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Severe COVID-19 with persistent respiratory failure—A retrospective cohort study in a tertiary centre in Malaysia
INTRODUCTION: Management of severe COVID-19 patients with persistent respiratory failure after acute phase treatment is not only challenging, but evidence for treatment is scarce, despite some authors reporting favourable clinical responses to corticosteroid therapy in histologically proven secondar...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9671325/ https://www.ncbi.nlm.nih.gov/pubmed/36395182 http://dx.doi.org/10.1371/journal.pone.0276848 |
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author | Wong, Chee Kuan Sia, Leng Cheng Ooi, Noreen Zhi Min Chan, Wai Yee Pang, Yong-kek |
author_facet | Wong, Chee Kuan Sia, Leng Cheng Ooi, Noreen Zhi Min Chan, Wai Yee Pang, Yong-kek |
author_sort | Wong, Chee Kuan |
collection | PubMed |
description | INTRODUCTION: Management of severe COVID-19 patients with persistent respiratory failure after acute phase treatment is not only challenging, but evidence for treatment is scarce, despite some authors reporting favourable clinical responses to corticosteroid therapy in histologically proven secondary organising pneumonia (OP). This study aimed to report the course of the disease, radiological pattern and clinical outcomes of severe COVID-19 patients with persistent respiratory failure. METHODS: This was a retrospective cohort study of severe COVID-19 patients who were admitted to a single tertiary centre from 1 January 2021 to 30 June 2021. The clinical data of the patients during admission and clinic follow-up, including radiological images, were traced using electronic medical records. RESULTS: In our cohort, the mortality rate for those with severe COVID-19 was 23.1% (173/749). Among the survivors, 46.2% (266/576) had persistent respiratory failure (PRF) after 14 days of illness. Of them, 70.3% (187/266) were followed up, and 68% (128/187) received oral corticosteroid (prednisolone) maintenance treatment. OP pattern made up the majority (81%) of the radiological pattern with a mean severity CT score of 10 (SD±3). The mean prednisolone dose was 0.68mg/kg/day with a mean treatment duration of 47 days (SD±18). About one-third of patients (67/187) had respiratory symptoms at 4 weeks (SD±3). Among 78.1% (146/187) who had a repeated CXR during follow-up, only 12 patients (8.2%, SD±3) had radiological improvement of less than 50% at 6 weeks (SD±3), with 2 of them later diagnosed as pulmonary tuberculosis. Functional assessments, such as the 6-minute walk test and the spirometry, were only performed in 52.4% and 15.5% of the patients, respectively. CONCLUSION: Almost half of the patients with severe COVID-19 had PRF, with a predominant radiological OP pattern. More than two-thirds of the PRF patients required prolonged oral corticosteroid treatment. Familiarising clinicians with the disease course, radiological patterns, and potential outcomes of this group of patients may better equip them to manage their patients. |
format | Online Article Text |
id | pubmed-9671325 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-96713252022-11-18 Severe COVID-19 with persistent respiratory failure—A retrospective cohort study in a tertiary centre in Malaysia Wong, Chee Kuan Sia, Leng Cheng Ooi, Noreen Zhi Min Chan, Wai Yee Pang, Yong-kek PLoS One Research Article INTRODUCTION: Management of severe COVID-19 patients with persistent respiratory failure after acute phase treatment is not only challenging, but evidence for treatment is scarce, despite some authors reporting favourable clinical responses to corticosteroid therapy in histologically proven secondary organising pneumonia (OP). This study aimed to report the course of the disease, radiological pattern and clinical outcomes of severe COVID-19 patients with persistent respiratory failure. METHODS: This was a retrospective cohort study of severe COVID-19 patients who were admitted to a single tertiary centre from 1 January 2021 to 30 June 2021. The clinical data of the patients during admission and clinic follow-up, including radiological images, were traced using electronic medical records. RESULTS: In our cohort, the mortality rate for those with severe COVID-19 was 23.1% (173/749). Among the survivors, 46.2% (266/576) had persistent respiratory failure (PRF) after 14 days of illness. Of them, 70.3% (187/266) were followed up, and 68% (128/187) received oral corticosteroid (prednisolone) maintenance treatment. OP pattern made up the majority (81%) of the radiological pattern with a mean severity CT score of 10 (SD±3). The mean prednisolone dose was 0.68mg/kg/day with a mean treatment duration of 47 days (SD±18). About one-third of patients (67/187) had respiratory symptoms at 4 weeks (SD±3). Among 78.1% (146/187) who had a repeated CXR during follow-up, only 12 patients (8.2%, SD±3) had radiological improvement of less than 50% at 6 weeks (SD±3), with 2 of them later diagnosed as pulmonary tuberculosis. Functional assessments, such as the 6-minute walk test and the spirometry, were only performed in 52.4% and 15.5% of the patients, respectively. CONCLUSION: Almost half of the patients with severe COVID-19 had PRF, with a predominant radiological OP pattern. More than two-thirds of the PRF patients required prolonged oral corticosteroid treatment. Familiarising clinicians with the disease course, radiological patterns, and potential outcomes of this group of patients may better equip them to manage their patients. Public Library of Science 2022-11-17 /pmc/articles/PMC9671325/ /pubmed/36395182 http://dx.doi.org/10.1371/journal.pone.0276848 Text en © 2022 Wong et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Wong, Chee Kuan Sia, Leng Cheng Ooi, Noreen Zhi Min Chan, Wai Yee Pang, Yong-kek Severe COVID-19 with persistent respiratory failure—A retrospective cohort study in a tertiary centre in Malaysia |
title | Severe COVID-19 with persistent respiratory failure—A retrospective cohort study in a tertiary centre in Malaysia |
title_full | Severe COVID-19 with persistent respiratory failure—A retrospective cohort study in a tertiary centre in Malaysia |
title_fullStr | Severe COVID-19 with persistent respiratory failure—A retrospective cohort study in a tertiary centre in Malaysia |
title_full_unstemmed | Severe COVID-19 with persistent respiratory failure—A retrospective cohort study in a tertiary centre in Malaysia |
title_short | Severe COVID-19 with persistent respiratory failure—A retrospective cohort study in a tertiary centre in Malaysia |
title_sort | severe covid-19 with persistent respiratory failure—a retrospective cohort study in a tertiary centre in malaysia |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9671325/ https://www.ncbi.nlm.nih.gov/pubmed/36395182 http://dx.doi.org/10.1371/journal.pone.0276848 |
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