2024-03-17 16:00:41
Lead author Dr. Catherine A. Bonham, a critical care pulmonologist and scientific director of the UVA Health Pulmonary Research Program, notes that up to 30% of patients hospitalized with severe COVID-19 continue to suffer. of persistent symptoms months following recovering from the virus. Many of these patients develop lung scarring, some early in their hospitalization and others within 6 months of the acute infection.
The team sought to understand why these scars occur, determine whether they are similar to progressive pulmonary fibrosis and looked at ways to identify patients at risk. Finding such a way might help doctors better personalize treatment for each patient.
The study followed 16 patients who survived a severe form of COVID, including 14 hospitalized and placed on a ventilator. All continued to suffer from difficulty breathing and fatigue. Their first assessment confirmed pulmonary dysfunction. After 6 months, the researchers observed 2 developments, which allowed them to divide the participants into 2 groups:
- a group whose lung health had improved,
- the other group who continued to suffer from pulmonary problems and fibrosis.
Examination of blood samples taken before these two developments reveals that:
- participants who will not recover from these respiratory problems, present
fewer monocyte immune cells circulating in the blood.
- These white blood cells, which play an essential role in the ability to fend off disease, are abnormally depleted in patients who continue to suffer from pulmonary problems, versus those who have recovered;
- This reduction in the number of monocytes also appears to be correlated with the severity of persistent symptoms.
This suggests that a simple blood test assessing the concentration of monocytes in circulation might allow an initial identification of patients likely to develop these respiratory symptoms in the long term. The researchers note that “About half of the patients examined still have persistent, bothersome symptoms and abnormal tests 6 months following infection.” However, by detecting this risk upstream, it would be possible to better prevent these pulmonary disorders.
Severe COVID or idiopathic pulmonary fibrosis, same effects? Research reveals that the 2 conditions have very different effects on immune cells, suggesting that even when the symptoms are similar, they are linked to very different underlying causes. This “Idiopathic pulmonary fibrosis is progressive and kills patients within 3 to 5 years, which is not at all the case for patients with a severe or long form of COVID,” conclude the authors.
The research is therefore intended to be reassuring on the risk, all in all very modest, of permanent lung scarring with COVID. This type of persistent lung damage would imply that patients’ respiratory capacity continues to deteriorate over time, which is not observed in the vast majority of COVID patients.
“We are just beginning to understand the biology of how the immune system impacts pulmonary fibrosis.”
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