Lung Function, Exercise Capacity and Health-Related Quality of Life After Severe COVID-19
Lung Function, Exercise Capacity and Health-Related Quality of Life After Severe COVID-19
Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a newly
 emergent coronavirus (SARS-CoV-2) that can progress to severe disease requiring
 hospitalization and oxygen support in around14% of the cases and 5% require admission in
 intensive care unit. The medium and long-term impact in survivors of severe COVID-19 on lung
 function, exercise capacity and health-related quality of life remains to be determined.
Background: Coronavirus disease 2019 (COVID-19) is a respiratory tract infection caused by a
 newly emergent coronavirus (severe acute respiratory syndrome coronavirus 2; SARS-CoV-2) that
 was first recognized in Wuhan, China, in December 2019. Currently, this infection reached
 pandemic levels causing serious diseases in 14% of cases and the potential to progress to
 acute respiratory distress syndrome (ARDS) with the need for invasive ventilatory support and
 prolonged hospitalization in intensive care units (ICU). The overall lethality is 2% and the
 lethality of cases admitted to the ICU varies from 26 to 50%. The medium and long-term impact
 in survivors of severe COVID-19 on lung function, exercise capacity and health related
 quality of life (HRQoL) remains to be determined.

 Aims: To evaluate the early (Visit1: 2-6 months after acute disease) and late (Visit 2: 9-15
 months and Visit 3: 18-24 months) effects of severe acute respiratory syndrome on lung
 function, exercise capacity, respiratory symptoms and HRQoL in patients with confirmed
 diagnosis of SARS-CoV-2 infection.

 Material and methods: Prospective cohort of subjects with laboratory confirmed severe
 COVID-19 (respiratory rate> 30 breaths/ min; severe respiratory distress; oxyhemoglobin
 saturation in room air ≤93% or pulmonary involvement> 50% in chest images). Participants will
 perform spirometry before and after bronchodilator, lung volumes by body plethysmography,
 lung diffusion capacity of carbon monoxide, respiratory system resistance by impulse
 oscillometry and 6-minute walk test (6MWT) after 2-6 months (Visit 1) , 9-15 months (Visit
 2), and 18-24 months (Visit 3) of severe COVID-19. When abnormalities in these pulmonary
 function tests and/or 6MWT were detected, a cardiopulmonary exercise test will be performed.
 Clinical, laboratory and chest image data during the severe COVID-19 hospitalization will be
 obtained from medical records.

 The minimum sample size was estimated as 134 participants to assess at least 5 independent
 factors to predict lung function, HRQoL and exercise capacity at the early assessment.
 Notwithstanding, the investigators plan to invite to participate all survivors of severe
 COVID-19 admitted in hospitals of the state of Rio Grande do Sul (Brazil).
Inclusion Criteria:

 -  Previous laboratory confirmation of SARS-Cov-2 infection defined as a positive result
 of reverse polymerase-transcriptase chain reaction test in real-time of a sample taken
 by nasal and/or pharyngeal swab; and

 -  Severe pneumonia defined by the presence of fever or suspected lower respiratory
 infection, plus one of the following criteria: respiratory rate> 30 movements/min;
 severe respiratory distress; SpO2≤93% in room air; or pulmonary infiltrates>50% on
 chest imaging within 24-48hrs of acute symptoms onset; and/or

 -  Acute respiratory distress syndrome (ARDS) defined according to COVID-19 operational
 management guide of World Health Organization and classified as mild (200 mmHg <PaO2 /
 FiO2 ≤ 300 mmHg), moderate (100 mmHg <PaO2 / FiO2 ≤ 200 mmHg) or severe (PaO2 / FiO2 ≤
 100 mmHg). When the PaO2 is not available, SpO2 / FiO2 ≤ 315 suggests ARDS.

 Exclusion Criteria:

 -  Lack of clinical stability for 2 months before inclusion (including those who remain
 hospitalized);

 -  Active respiratory tract infection (of any cause); or

 -  Any clinical condition that prevents the performance of the study procedures.