Diana Badenes-Bonet

Chronic interstitial lung changes are potential long-term sequelae of severe COVID-19. This study aims to evaluate the prevalence and type of interstitial changes over time and identify serum biomarkers associated with persistent lung abnormalities. Prospective, multicenter, observational cohort study of patients with severe COVID-19 pneumonia between March 2020 and June 2021. Clinical evaluation, pulmonary function tests (PFTs), and chest high-resolution computed tomography (HRCT) were performed at baseline and up to 24 months. Serum biomarkers were assessed at baseline and at 12 months. Of the 290 patients enrolled, 247 completed the follow-up. Mild dyspnea (mMRC1) was the most common residual symptom. PFTs showed significant improvement: mean FVC increased from 88.8% to 99.5%, and DLCO from 71.6% to 82%. Among patients with baseline DLCO < 80% (n = 67), only 38.8% achieved normalization. Radiological improvement was observed in all patients, though 32% of the 118 patients assessed at 24 months still had residual changes, primarily mild reticulation, ground glass opacities, and lower lobes traction bronchiectasis. Pulmonary functional improvement correlated with radiological resolution, especially during the first year. Elevated baseline levels of MMP-7 and KL6 were associated with persistent interstitial abnormalities at 12 months. Severe COVID-19 survivors exhibit progressive functional and radiological improvement, particularly within the first year. However, a subset of patients shows long-term interstitial changes. Elevated MMP-7 and KL-6 levels may help identify individuals at higher risk for persistent interstitial changes.

Background: Vertebral compression fractures (VCF) are common in COPD patients, with osteoporosis being the main cause. The clinical impact of VCF derives mostly from both pain and chest deformity, which may lead to ventilatory and physical activity limitations. Surprisingly, the consequences of VCF on the quality outcomes of hospital care are poorly known. Objective: To assess these indicators in patients hospitalized due to a COPD exacerbation (ECOPD) who also have VCF. Methods: Clinical characteristics and quality care indicators were assessed in two one-year periods, one retrospective (exploratory) and one prospective (validation), in all consecutive patients hospitalized for ECOPD. Diagnosis of VCF was based on the reduction of >20% height of the vertebral body evaluated in standard lateral chest X-ray (three independent observers). Results: From the 248 patients admitted during the exploratory phase, a third had at least one VCF. Underdiagnosis rate was 97.6%, and patients with VCF had more admissions (normalized for survival), longer hospital stays, and higher mortality than patients without (4 [25th–75th percentiles, 2–8] vs 3 [1–6] admissions, PP PPConclusion: Although VCF is frequently underdiagnosed in patients hospitalized for ECOPD, it is strongly associated with a worse prognosis and quality care outcomes.