Lung Function, Exercise Capacity and Health-Related Quality of Life After Severe COVID-19

NCT ID: NCT04410107

Last Updated: 2023-12-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

COMPLETED

Total Enrollment

144 participants

Study Classification

OBSERVATIONAL

Study Start Date

2020-05-15

Study Completion Date

2023-07-30

Brief Summary

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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.

Detailed Description

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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).

Conditions

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COVID-19 SARS-CoV-2 Infection

Keywords

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Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia Respiratory Distress Syndrome, Adult Respiratory Function Tests Exercise Quality of Life

Study Design

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Observational Model Type

COHORT

Study Time Perspective

PROSPECTIVE

Study Groups

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Severe Pneumonia

Presence of fever or suspected lower respiratory infection, plus one of the following criteria:

1\) respiratory rate\> 30 movements / min; 2) severe respiratory distress 3) Pulse oximetry (SpO2) ≤93% in room air; and/or 3) Pulmonary infiltrates\> 50% on chest imaging within 24-48hrs of symptom onset.

Lung Function tests

Intervention Type DIAGNOSTIC_TEST

Spirometry before and after bronchodilator, lung volumes by body plethysmography, lung diffusion capacity of carbon monoxide (DLCO), respiratory system resistance by impulse oscillometry (IOS)

Exercise capacity

Intervention Type DIAGNOSTIC_TEST

6-minute walk test (6MWT distance)

Exercise physiology

Intervention Type DIAGNOSTIC_TEST

Cardiopulmonary exercise test (CPET)

Health-related quality of life

Intervention Type DIAGNOSTIC_TEST

Short-Form Health Survey Questionnaire (SF-36)

Respiratory symptoms, symptoms of anxiety and depression, and post-traumatic stress screening

Intervention Type DIAGNOSTIC_TEST

1. Adapted translation American Thoracic Society respiratory symptoms questionnaire;
2. Beck Anxiety Inventory (BAI) and Beck's depression Inventory (BDI);
3. Questionnaire for screening for post-traumatic stress symptoms (PTSD).

Acute respiratory distress syndrome (ARDS)

* Onset: acute, i.e. within 1 week of known clinical insult or new or worsening respiratory symptoms; and
* Chest imaging (e.g. X-ray or CT scan): bilateral opacities, not fully explained by effusions, lobar/lung collapse or nodules; and
* Origin of pulmonary edema: respiratory failure not fully explained by cardiac failure or fluid overload; and
* Degree of hypoxemia: arterial oxygen partial pressure to fractional inspired oxygen (PaO2/FiO2) ≤ 300 mm Hg with positive end-expiratory pressure ≥ 5 cm H2O.

Lung Function tests

Intervention Type DIAGNOSTIC_TEST

Spirometry before and after bronchodilator, lung volumes by body plethysmography, lung diffusion capacity of carbon monoxide (DLCO), respiratory system resistance by impulse oscillometry (IOS)

Exercise capacity

Intervention Type DIAGNOSTIC_TEST

6-minute walk test (6MWT distance)

Exercise physiology

Intervention Type DIAGNOSTIC_TEST

Cardiopulmonary exercise test (CPET)

Health-related quality of life

Intervention Type DIAGNOSTIC_TEST

Short-Form Health Survey Questionnaire (SF-36)

Respiratory symptoms, symptoms of anxiety and depression, and post-traumatic stress screening

Intervention Type DIAGNOSTIC_TEST

1. Adapted translation American Thoracic Society respiratory symptoms questionnaire;
2. Beck Anxiety Inventory (BAI) and Beck's depression Inventory (BDI);
3. Questionnaire for screening for post-traumatic stress symptoms (PTSD).

Interventions

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Lung Function tests

Spirometry before and after bronchodilator, lung volumes by body plethysmography, lung diffusion capacity of carbon monoxide (DLCO), respiratory system resistance by impulse oscillometry (IOS)

Intervention Type DIAGNOSTIC_TEST

Exercise capacity

6-minute walk test (6MWT distance)

Intervention Type DIAGNOSTIC_TEST

Exercise physiology

Cardiopulmonary exercise test (CPET)

Intervention Type DIAGNOSTIC_TEST

Health-related quality of life

Short-Form Health Survey Questionnaire (SF-36)

Intervention Type DIAGNOSTIC_TEST

Respiratory symptoms, symptoms of anxiety and depression, and post-traumatic stress screening

1. Adapted translation American Thoracic Society respiratory symptoms questionnaire;
2. Beck Anxiety Inventory (BAI) and Beck's depression Inventory (BDI);
3. Questionnaire for screening for post-traumatic stress symptoms (PTSD).

Intervention Type DIAGNOSTIC_TEST

Eligibility Criteria

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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.
Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Hospital de Clinicas de Porto Alegre

OTHER

Sponsor Role collaborator

Conselho Nacional de Desenvolvimento Científico e Tecnológico

OTHER_GOV

Sponsor Role collaborator

Hospital Moinhos de Vento

OTHER

Sponsor Role collaborator

Federal University of Health Science of Porto Alegre

OTHER

Sponsor Role collaborator

Universidade de Passo Fundo

OTHER

Sponsor Role collaborator

Hospital Nossa Senhora da Conceicao

OTHER

Sponsor Role collaborator

Federal University of Rio Grande do Sul

OTHER

Sponsor Role lead

Responsible Party

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Danilo C Berton, MD

Dr

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Danilo C Berton, Dr

Role: PRINCIPAL_INVESTIGATOR

Universidade Federal do Rio Grande do Sul/Hospital de Clínicas de Porto Alegre

Locations

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Universidade de Passo Fundo

Passo Fundo, Rio Grande do Sul, Brazil

Site Status

Hospital Moinhos de Vento

Porto Alegre, Rio Grande do Sul, Brazil

Site Status

Hospital de Clínicas de Porto Alegre/Universidade Federal do Rio Grande do Sul

Porto Alegre, Rio Grande do Sul, Brazil

Site Status

Univesidade de Ciências da Saúde de Porto Alegre

Porto Alegre, Rio Grande do Sul, Brazil

Site Status

Hospital Nossa Senhora da Conceição

Porto Alegre, Rio Grande do Sul, Brazil

Site Status

Countries

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Brazil

References

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Benedetto IG, Silva RMCD, Hetzel GM, Viana GDS, Guimaraes AR, Folador L, Brentano VB, Garcia TS, Ribeiro SP, Dalcin PTR, Gazzana MB, Berton DC. Impact of impaired pulmonary function on clinical outcomes in survivors of severe COVID-19 without pre-existing respiratory disease. J Bras Pneumol. 2023 May 26;49(3):e20220452. doi: 10.36416/1806-3756/e20220452. eCollection 2023.

Reference Type DERIVED
PMID: 37255163 (View on PubMed)

Other Identifiers

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2020-0169

Identifier Type: -

Identifier Source: org_study_id