Resumo Fundamento A maioria da evidência sobre o impacto da síndrome COVID pós-aguda (PACS, do inglês, post-acute COVID-19 syndrome) descreve sintomas individuais sem correlacioná-los com exames de imagens. Objetivos Avaliar sintomas cardiopulmonares, seus preditores e imagens relacionadas em pacientes com COVID-19 após alta hospitalar. Métodos Pacientes consecutivos, que sobreviveram à COVID-19, foram contatados 90 dias após a alta hospitalar. A equipe de desfechos clínicos (cega quanto aos dados durante a internação) elaborou um questionário estruturado avaliando sintomas e estado clínico. Uma análise multivariada foi realizada abordando a evolução da COVID-19, comorbidades, ansiedade, depressão, e estresse pós-traumático durante a internação, e reabilitação cardíaca após a alta. O nível de significância usado nas análises foi de 5%. Resultados Foram incluídos 480 pacientes (idade 59±14 anos, 67,5% do sexo masculino) que receberam alta hospitalar por COVID-19; 22,3% necessitaram de ventilação mecânica. A prevalência de pacientes com sintomas cardiopulmonares relacionados à PACS (dispneia, cansaço/fadiga, tosse e desconforto no peito) foi de 16,3%. Vários parâmetros de tomografia computadorizada do tórax e de ecocardiograma foram similares entre os pacientes com e sem sintomas cardiopulmonares. A análise multivariada mostrou que sintomas cardiopulmonares foram relacionados de maneira independente com sexo feminino (OR 3,023; IC95% 1,319-6,929), trombose venosa profunda durante a internação (OR 13,689; IC95% 1,069-175,304), nível elevado de troponina (OR 1,355; IC95% 1,048-1,751) e de proteína C reativa durante a internação (OR 1,060; IC95% 1,023-1,097) e depressão (OR 6,110; IC95% 2,254-16,558). Conclusão Os sintomas cardiopulmonares relacionados à PACS 90 dias após a alta hospitalar são comuns e multifatoriais. Além dos marcadores trombóticos, inflamatórios e de lesão miocárdica durante a internação, sexo feminino e depressão foram associados independentemente com sintomas cardiopulmonares relacionados à PACS. Esses resultados destacaram a necessidade de uma abordagem multifacetada direcionada a pacientes susceptíveis. pósaguda pós aguda PACS, (PACS inglês postacute post acute COVID19 19 COVID-1 syndrome correlacionálos correlacioná los consecutivos COVID19, 19, 9 cega clínico comorbidades ansiedade póstraumático traumático 5 5% 48 idade 5914 59 14 59±1 anos 675 67 67,5 masculino 223 22 3 22,3 mecânica dispneia, dispneia (dispneia cansaçofadiga cansaço fadiga cansaço/fadiga peito 163 16 16,3% OR 3,023 3023 023 IC95 IC 1,3196,929, 13196929 1,319 6,929 , 1 319 6 929 1,319-6,929) 13,689 13689 13 689 1,069175,304, 1069175304 1,069 175,304 069 175 304 1,069-175,304) 1,355 1355 355 1,0481,751 10481751 1,048 1,751 048 751 1,048-1,751 1,060 1060 060 1,0231,097 10231097 1,023 1,097 097 1,023-1,097 6,110 6110 110 2,25416,558. 225416558 2,254 16,558 . 2 254 558 2,254-16,558) multifatoriais trombóticos susceptíveis COVID1 COVID- 4 591 59± 67, 22, 16,3 3,02 302 02 IC9 3196 1,3196,929 1319692 1319 1,31 6929 6,92 31 92 1,319-6,929 13,68 1368 68 069175 1,069175,304 106917530 1069 1,06 175304 175,30 06 17 30 1,069-175,304 1,35 135 35 0481 1,0481,75 1048175 1048 1,04 1751 1,75 04 75 1,048-1,75 106 0231 1,0231,09 1023109 1023 1,02 1097 1,09 09 1,023-1,09 6,11 611 11 25416 2,25416,558 22541655 2254 2,25 16558 16,55 25 55 2,254-16,558 16, 3,0 0 1,3196,92 131969 131 1,3 692 6,9 1,319-6,92 13,6 136 06917 1,069175,30 10691753 1,0 17530 175,3 1,069-175,30 1,0481,7 104817 104 1,7 7 1,048-1,7 10 1,0231,0 102310 102 109 1,023-1,0 6,1 61 2541 2,25416,55 2254165 225 2,2 1655 16,5 2,254-16,55 3, 1,3196,9 13196 1, 69 6, 1,319-6,9 13, 0691 1,069175,3 1069175 1753 175, 1,069-175,3 1,0481, 10481 1,048-1, 1,0231, 10231 1,023-1, 2,25416,5 225416 2, 165 2,254-16,5 1,3196, 1,319-6, 1,069175, 106917 1,069-175, 1,0481 1,048-1 1,0231 1,023-1 2,25416, 22541 2,254-16, 1,3196 1,319-6 1,069175 10691 1,069-175 1,048- 1,023- 2,25416 2,254-16 1,319- 1,06917 1,069-17 2,2541 2,254-1 1,0691 1,069-1 2,254- 1,069-
Abstract Background Most of the evidence about the impact of the post-acute COVID-19 Syndrome (PACS) reports individual symptoms without correlations with related imaging. Objectives To evaluate cardiopulmonary symptoms, their predictors and related images in COVID-19 patients discharged from hospital. Methods Consecutive patients who survived COVID-19 were contacted 90 days after discharge. The Clinic Outcome Team structured a questionnaire evaluating symptoms and clinical status (blinded for hospitalization data). A multivariate analysis was performed to address the course of COVID-19, comorbidities, anxiety, depression, and post-traumatic stress during hospitalization, and cardiac rehabilitation after discharge. The significance level was set at 5%. Results A total of 480 discharged patients with COVID-19 (age: 59±14 years, 67.5% males) were included; 22.3% required mechanical ventilation. The prevalence of patients with PACS-related cardiopulmonary symptoms (dyspnea, tiredness/fatigue, cough, and chest discomfort) was 16.3%. Several parameters of chest computed tomography and echocardiogram were similar in patients with and without cardiopulmonary symptoms. The multivariate analysis showed that PACS-related cardiopulmonary-symptoms were independently related to female sex (OR 3.023; 95% CI 1.319-6.929), in-hospital deep venous thrombosis (OR 13.689; 95% CI 1.069-175.304), elevated troponin I (OR 1.355; 95% CI 1.048-1.751) and C-reactive protein during hospitalization (OR 1.060; 95% CI 1.023-1.097) and depression (OR 6.110; 95% CI 2.254-16.558). Conclusion PACS-related cardiopulmonary symptoms 90 days post-discharge are common and multifactorial. Beyond thrombotic and markers of inflammation/myocardial injury during hospitalization, female sex and depression were independently associated with cardiopulmonary-related PACS. These results highlighted the need for a multifaceted approach targeting susceptible patients. postacute post acute COVID19 COVID 19 COVID-1 PACS (PACS imaging hospital 9 discharge blinded data. data . data) COVID19, 19, comorbidities anxiety posttraumatic traumatic 5 5% 48 age (age 5914 59 14 59±1 years 675 67 67.5 males included 223 22 3 22.3 ventilation PACSrelated dyspnea, dyspnea (dyspnea tirednessfatigue tiredness fatigue tiredness/fatigue cough discomfort 163 16 16.3% cardiopulmonarysymptoms OR 3.023 3023 023 95 1.3196.929, 13196929 1.319 6.929 , 1 319 6 929 1.319-6.929) inhospital 13.689 13689 13 689 1.069175.304, 1069175304 1.069 175.304 069 175 304 1.069-175.304) 1.355 1355 355 1.0481.751 10481751 1.048 1.751 048 751 1.048-1.751 Creactive C reactive 1.060 1060 060 1.0231.097 10231097 1.023 1.097 097 1.023-1.097 6.110 6110 110 2.25416.558. 225416558 2.254 16.558 2 254 558 2.254-16.558) postdischarge multifactorial inflammationmyocardial inflammation myocardial cardiopulmonaryrelated COVID1 COVID- 4 591 59± 67. 22. 16.3 3.02 302 02 3196 1.3196.929 1319692 1319 1.31 6929 6.92 31 92 1.319-6.929 13.68 1368 68 069175 1.069175.304 106917530 1069 1.06 175304 175.30 06 17 30 1.069-175.304 1.35 135 35 0481 1.0481.75 1048175 1048 1.04 1751 1.75 04 75 1.048-1.75 106 0231 1.0231.09 1023109 1023 1.02 1097 1.09 09 1.023-1.09 6.11 611 11 25416 2.25416.558 22541655 2254 2.25 16558 16.55 25 55 2.254-16.558 16. 3.0 0 1.3196.92 131969 131 1.3 692 6.9 1.319-6.92 13.6 136 06917 1.069175.30 10691753 1.0 17530 175.3 1.069-175.30 1.0481.7 104817 104 1.7 7 1.048-1.7 10 1.0231.0 102310 102 109 1.023-1.0 6.1 61 2541 2.25416.55 2254165 225 2.2 1655 16.5 2.254-16.55 3. 1.3196.9 13196 1. 69 6. 1.319-6.9 13. 0691 1.069175.3 1069175 1753 175. 1.069-175.3 1.0481. 10481 1.048-1. 1.0231. 10231 1.023-1. 2.25416.5 225416 2. 165 2.254-16.5 1.3196. 1.319-6. 1.069175. 106917 1.069-175. 1.0481 1.048-1 1.0231 1.023-1 2.25416. 22541 2.254-16. 1.3196 1.319-6 1.069175 10691 1.069-175 1.048- 1.023- 2.25416 2.254-16 1.319- 1.06917 1.069-17 2.2541 2.254-1 1.0691 1.069-1 2.254- 1.069-