Tuberk Toraks 2020;68(4):419-429Türktaş H, Oğuzülgen İK.419COVID-19 sonrası akciğer sekelleri: uzun dönem takip ve tedavi

COVID-19 pnömonisi geçiren hastalarda uzun dönemde İPF, kronik hiper-sensitivite pnömonisi ve otoimmun hastalıklarda gördüğümüz hızlı FVC kaybı, tomografide yaygın fibrozis, yaşam kalitesinde azalma ve artmış mor-talite ile karakterize progresif irreversible akciğer fibrozisinin gelişip gelişme-yeceği konusunda henüz yeterli kanıt bulunmamaktadır. Ancak yaşlı hasta-larda daha az ve non-progresif fibrozisler bile ciddi morbidite ve mortalite nedeni olabilir. Dolayısıyla COVID-19’dan etkilenen milyonlarca insanın varlığı düşünüldüğünde nadir görülen bir komplikasyon bile toplum düzeyin-de ciddi bir sağlık sorunu olarak karşımıza çıkabilecektir. Konunun önemi nedeniyle COVID-19 sonrası akciğer fibrozisi ve COVID ilişkili trombozis için risk faktörleri, koruyucu önlemler ve tedavisi konusunda çalışmalar hızla planlanıp hayata geçirilmelidir (1). Bu derlemede COVID-19 pnömonisi geçiren hastalarda uzun dönemde oluşabilecek pulmoner fibrozis ve vaskü-ler komplikasyonların (pulmoner emboli, pulmoner hipertansiyon) sıklığı, klinik önemi, korunma ve tedavisi tartışılmıştır.

Post-COVID-19 pulmonary sequla: longterm follow up and management

Though it has been 8 months since the beginning of COVID-19 pandemic, number of cases and deaths are still seriously increasing. We still don’t have enough evidence about the prognosis of patients who had COVID-19 pneu-monia. In long term follow up we wonder if they will have rapid FVC decline, widespread fibrosis in computed tomography, loss in quality of life or increased mortality that we experience in idiopathic pulmonary fibrosis, chronic hypersensitivity pneumonia or autoimmune interstitial lung diseases. However, in elderly patients less severe dysfunction or non-progressive-fibro-sis can cause morbidity and mortality. Therefore, if we consider millions of people who are affected by COVID-19, even a rare complication can cause serious health problem in social scale. Because of the importance of this issue randomized controlled trials should be rapidly planned on post-COVID fibrosis, COVID associated throm-bosis, risk factors, prevention and treatment (1). In this review, the frequency, clinical importance, prevention and treatment of pos-sible long-term sequels of COVID-19 pneumonia (pulmonary fibrosis, pulmonary embolism and pulmonary hypertension) will be discussed.

Kaynakça

1. Spagnolo P, Balestro E, Aliberti S, Cocconcelli E, Biondini D, Della Casa G, et al. Pulmonary fibrosis secondary to COVID-19: a call to arms? Lancet Respir Med 2020; 8: 752-4.

2. World Health Organization (WHO). Coronavirus disease (COVID-19) pandemic. Available from: www.who.int/ emergencies/diseases/novel-coronavirus-2019

3. T.C. Sağlık Bakanlığı COVID-19 Bilgilendirme Sayfası. Available from: https://covid19.saglik.gov.tr/

4. Barisione E, Grillo F, Bal L, Bianchi R, Grosso M, Morbini P, et al. Fibrotic progression and radiologic correlation in matched lung samples from COVID-19 post-mortems. Virchows 2020; 28: 1-15.

5. Carsana L, Sonzogni A, Nasr A, Rossi RS, Pellegrinelli A, Zerbi P, et al. Pulmonary post-mortem findings in a series of COVID-19 cases from northern Italy: a two-centre descriptive study. Lancet Infect Dis 2020; 20: 1135-40.

6. Fang Y, Zhou J, Ding X, Ling G, Yu S. Pulmonary fibrosis in critical ill patients recovered from COVID-19 pneumonia: preliminary experience. Am J Em Med 2020; 38(10): 2134-8.

7. Pan Y, Guan H, Zhou S, Wang Y, Li Q, Zhu T, et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China. Eur Radiol 2020; 30: 3306-9.

8. Ye Z, Zhang Y, Wang Y, Huang Z, Song B. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. Eur Radiol 2020; 30: 4381-9.

9. Wang Y, Dong C, Hu Y, Li C, Ren Q, Zhang X, et al. Temporal changes of CT findings in 90 patients with COVID-19 pneumonia: a longitudinal study. Radiology 2020; 296: e55-e64.

10. Mo X, Jian W, Su Z, Chen M, Peng H, Peng P, et al. Abnormal pulmonary function in COVID-19 patients at time of hospital discharge. Eur Respir J 2020; 55: 2001217.

11. Daher A, Balfanz P, Cornelissen C, Müller A, Bergs I, Marx I, et al. Follow up of patients with severe coronavirus disease 2019 (COVID-19): Pulmonary and extrapulmonary disease sequelae. Respir Med 2020; 174: 106197.

12. Hu T, Liu Y, Zhao M, Zhuang Q, Xu L, He Q. A comparison of COVID-19, SARS and MERS. Peer J 2020; 8: e9725.

13. Hui DS, Joynt GM, Wong KT, Gomersall CD, Li TS, Antonio G, et al. Impact of severe acute respiratory syndrome (SARS) on pulmonary function, functional capacity and quality of life in a cohort of survivors. Thorax 2005; 60: 401-9.

14. Zhang P, Li J, Liu H, Han N, Ju J, Kou Y, et al. Long-term bone and lung consequences associated with hospital-acquired severe acute respiratory syndrome: a 15-year follow- up from a prospective cohort study. Bone Research 2020; 8: 8.

15. Hui DS, Wong KT, Ko FW, Tam LS, Chan DP, Woo J, et al. The 1-year ımpact of severe acute respiratory syndrome on pulmonary function, exercise capacity, and quality of life in a cohort of survivors. Chest 2005; 128: 2247-61.

16. Ngai JC, Ko FW, Susan SN, To KW, Tong M, Hui DS. The long-term impact of severe acute respiratory syndrome on pulmonary function, exercise capacity and health status. Respirology 2010; 15: 543-50.

17. Das KM, Lee EY, Singh R, Enani MA, Dossari KA, Gorkom KV, et al. Follow-up chest radiographic findings in patients with MERS-CoV after recovery. Indian J Radiol Imaging 2017; 27: 342-9.

18. Liu D, Zhang W, Pan F, Li L, Yang L, Zheng D, et al. The pulmonary sequalae in discharged patients with COVID- 19: a short-term observational study. Respir Res 202; 21: 125.

19. Raghu G, Wilson KC. COVID-19 interstitial pneumonia: monitoring the clinical course in survivors. Lancet Respir Med 2020: 8; 839-42.

20. George PM, Barratt SL, Condliffe R, Desai SR, Devaraj A, Forrest I, et al. Respiratory follow-up of patients with COVID-19 pneumonia. Thorax 2020; 0: 1-8.

21. Lechowicz K, Drozdzal S, Machaj F, Rosik J, Szostak B, Zegan-Bara M, et al. COVID-19: The potential treatment of pulmonary fibrosis associated with SARS-CoV-2 infection. J Clin Med 2020; 9: 1917.

22. Gentile F, Aimo A, Forfori F, Catapano G, Clemente A, Cademartiri F, et al. COVID-19 and risk of pulmonary fibrosis: the importance of planning ahead. Eur J Preven Cardiol 2020; 27(13): 1442-6.

23. Yu M, Liu Y, Xu D, Zhang R, Lan L, Xu H. Prediction of the development of pulmonary fibrosis using serial thin-section CT and clinical features in patients discharged after treatment for COVID-19 pneumonia. Korean J Radiol 2020; 21(6): 746-55.

24. Ojo AS, Balogun SA, Williams OT, Ojo OS. Pulmonary fibrosis in COVID-19 survivors: predictive factors and risk reduction strategies. Pulm Med 2020; 6175964.

25. Huang W, Wu Q, Chen Z, Xiong Z,Wang K, Tian J, et al. The potential indicators for pulmonary fibrosis in survivors of severe COVID-19. J Infect 2020; (20)30632-0.

26. World Health Organization (WHO). Corticoteroids for COVID-19. Available from: https://www.who.int/publications/ i/item/WHO-2019-nCoV-Corticosteroids-2020.1

27. Villar J, Confalonieri M, Pastores SM, Meduri GM. Rationale for prolonged corticosteroid treatment in the acute respiratory distress syndrome caused by coronavirus disease 2019. Crit Care Expl 2020; 2: e0111.

28. Buckley LF, Wohlford GF, Ting C, Alahmed A, Van Tassell BW, Abbate A, et al. Role for anti-cytokine therapies in severe coronavirus disease 2019. Crit Care Expl 2020; 2: e0178.

29. Richeldi L, du Bois RM, Raghu G, Azuma A, Brown KK, Costabel U, et al. Efficacy and safety of nintedanib in ıdiopathic pulmonary fibrosis. N Engl J Med 2014; 370: 2071- 82.

30. Noble PW, Albera C, Bradford WZ, Costabel U, Glassberg MK, Kardatzke D, et al. Pirfenidone in patients with idiopathic pulmonary fibrosis (CAPACITY): two randomised trials. Lancet 2011; 377: 1760-9.

31. Flaherty KR, Wells AU, Cottin V, Devaraj A, Walsh SLF, Inoue Y, et al. Nintedanib in progressive fibrosing ınterstitial lung diseases. N Engl J Med 2019: 381(18): 1718-27.

32. Maher TM, Corte TJ, Fischer A, Kreuter M, Lederer DJ, Molina-Molina M, et al. Pirfenidone in patients with unclassifiable progressive fibrosing interstitial lung disease: a double-blind, randomised, placebo-controlled, phase 2 trial. Lancet Respir Med 2020; 8(2): 147-57.

33. George PM, Wells AU, Jenkins RG. Pulmonary fibrosis and COVID-19: the potential role for antifibrotic therapy. Lancet Respir Med 2020; 8: 807-15.

34. Seifirad S. Pirfenidone: a novel hypothetical treatment for COVID-19. Med Hypotheses 2020; 144: 110005.

35. Ferrara F, Granata G, Pelliccia C, La Porta R, Vitiello A. The added value of pirfenidone to fight inflammation and fibrotic state induced by SARS-CoV-2 anti-inflammatory and anti-fibrotic therapy could solve the lung complications of the infection? Eur J Clin Pharma 2020; 76: 1615-8.

36. Chaudhary S, Natt B, Bime C, Knox KS, Glassberg MK. Antifibrotics in COVID-19 lung disease: let us stay focused. Front Med 2020; 7: 539.

37. Delpino MV, Quarleri J. SARS-CoV-2 pathogenesis: imbalance in the renin-angiotensin system favors lung fibrosis. Front Cell Infect Microbiol 2020; 10: 340.

38. Barut F, Ozacmak VH, Turan I, Sayan-Ozacmak H, Aktunc E. Reduction of acute lung ınjury by administration of spironolactone after intestinal ıschemia and reperfusion in rats. Clin Investig Med Med 2016; 39: e15-e24.

39. Yavas G, Yavas C, Celik E, Sen E, Ata O, Afsar RE. The impact of spironolactone on the lung injury induced by concomitant trastuzumab and thoracic radiotherapy. Int J Radiat Res 2019; 17(1): 87-95.

40. Nadkarni GN, Lala A, Bagiella E, Chang HL, Moreno PR, Pujadas E, et al. Anticoagulation, bleeding, mortality, and pathology in hospitalized patients with COVID-19. J Am Coll Cardiol 2020; 76: 1815-26.

41. UpToDate. Cuker A, Peyvandi F. Coronavirus disease 2019 (COVID-19): hypercoagulability. Available from: www. u p t o d a t e . c o m / c o n t e n t s / c o r o n av i r u s - d i s - ease-2019-covid-19-hypercoagulability.

42. Spyropoulos AC, Levy JH, Ageno W, Connors JM, Hunt BJ, Iba T, et al. Scientific and Standardization Committee Communication: Clinical guidance on the diagnosis, prevention, and treatment of venous thromboembolism in hospitalized patients with COVID-19. J Thromb Haemost 2020; 18(8): 1859-65.

43. Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM, et al. Incidence of thrombotic complications in critically ill ICU patients with COVID- 19.Thromb Res 2020; 191: 145-7.

44. Cui S, Chen S, Li X, Liu S, Wang F. Prevalence of venous thromboembolism in patients with severe novel coronavirus pneumonia. J Thromb Haemost 2020; 18(6): 1421-4.

45. O'Sullivan JM, Gonagle DM, Ward SE, Preston RJS, O'Donnell JS. Endothelial cells orchestrate COVID-19 coagulopathy. Lancet Haematol 2020; 7(8): e553-e5.

46. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020; 18: 844-7.

47. Fogarty H, Townsend L, Cheallaigh CN, Bergin C, Martin- Loeches I, Browne P, et al. COVID-19 coagulopathy in Caucasian patients. Br J Haematol 2020; 189: 1044-9.

48. Ackermann M, Verleden SE, Kuehnel M, Haverich A, Welte T, Laenger F, et al. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in COVID-19. N Engl J Med 2020; 383(2): 120-8.

49. McGonagle D, O’Donnell JS, Sharif K, Emery P, Bridgewood C. Immune mechanisms of pulmonary intravascular coagulopathy in COVID-19 pneumonia. Lancet Rheumatol 2020; 2: e437-e45.

50. Goshua G, Pine AB, Meizlish ML, Chang C-Hong, Zhang H, Bahel P et al. Endotheliopathy in COVID-19- associated coagulopathy: evidence from a single-centre, cross-sectional study. Lancet Haematol 2020; 7(8): e575-e82.

51. Moores LK, Tritschler T, Brosnahan S, Carrier M, Collen JF, Doerschug K, et al. Prevention, diagnosis, and treatment of VTE in patients with coronavirus disease 2019: CHEST guideline and expert panel report. Chest 2020; 158(3): 1143-63.

52. COVID-19 Treatment Guidelines. Coronavirus disease 2019 (COVID-19) treatment guidelines. Available from: https://www.covid19treatmentguidelines.nih.gov/ Accessed date: 10/7/2020.

53. T.C. Sağlık Bakanlığı, Halk Sağlığı Genel Müdürlüğü. COVID-19 (SARS-CoV-2 enfeksiyonu) antisitokin-antiinflamatuar tedaviler, koagülopati yönetimi. Available from: https://covid19.saglik.gov.tr. Accessed date: 2 Kasım 2020.

54. Barnes GD, Burnett A, Allen A, Blumenstein M, Clark NP, Cuker A, et al. Thromboembolism and anticoagulant therapy during the COVID-19 pandemic: interim clinical guidance from the anticoagulation forum. J Thromb Thrombolysis 2020; 50(1): 72-81.

55. British Thoracic Society. BTS Guidance on Venous Thromboembolic Disease in Patients with COVID-19. Available from: www.brit-thoracic.org.uk/document-library/ quality-improvement/covid-19/bts-guidance-on-venous- thromboembolic-disease-in-patients-with-covid-19. V2.0 Accessed date: 4 May 2020.

56. Rosenberg D, Eichorn A, Alarcon M, McCullagh L, McGinn T, Spyropoulos AC. External validation of the risk assessment model of the International Medical Prevention Registry on Venous Thromboembolism (IMPROVE) for medical patients in a tertiary health system. J Am Heart Assoc 2014; 3(06): e001152.

57. Gerotziafas GT, Catalano M, Colgan MP, Pecsvarady Z, Wautrecht JC, Fazeli B, et al. Guidance for the Management of Patients with Vascular Disease or Cardiovascular Risk Factors and COVID-19: Position Paper from VAS-European Independent Foundation in Angiology/Vascular Medicine. Thromb Haemost 2020; 120: 1597-628.

58. George PM, Barratt SL, Condliffe R, Desai SR, Devaraj A, Forrest I, et al. Respiratory follow-up of patients with COVID-19 pneumonia. Thorax 2020; 75: 1009-16.

59. Guan W-J, Ni Z-Y, Hu Y, Liang W-H, Ou C-Q, He J-X, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med Overseas Ed 2020; 382: 1708-20.

60. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia. J Thromb Haemost 2020; 18: 844-7.

Kaynak Göster