Fibrotic Changes Depicted by Thin-Section CT in Patients With COVID-19 at the Early Recovery Stage: Preliminary Experience.

Zhen Lu Yang,Lu Huang,Chong Chen,Yu Na Hu,Shu Chang Zhou,Li Ming Xia,Yan Li

doi:10.3389/fmed.2020.605088

Zhen Lu Yang, Lu Huang + Show 5 more

Open Access

https://doi.org/10.3389/fmed.2020.605088

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Abstract

Objectives: To analyze follow-up CTs of patients recovering from COVID-19 in Wuhan, focusing on fibrotic change and its relevant risk factors.Methods: From January 13 to February 27, 2020, 166 hospitalized patients meeting our criteria were included. The scores of fibrotic patterns on follow-up CT were evaluated. Patients were designated as group 1 (with CT evidence of fibrotic pattern) and group 2 (without CT evidence of fibrotic pattern). Multivariate logistic regression was performed to explore risk factors for fibrotic change in patients with COVID-19.Results: The follow-up CTs were obtained on 56 days (median, IQR 51–63 days) after symptom onset. Of the 166 patients (mean age, 57 ± 15 years; 69/166 male), 46% (76/166) had CT evidence of fibrotic change and 77% (127/166) were severe or critical cases. Among patients with fibrotic change on CT, 84% (64/76) got a minimal or mild score of fibrosis. The high total score on peak CT, peak eosinophils, erythrocyte sedimentation rate (ESR) and advancing age were related to lung fibrotic change in patients with COVID-19.Conclusion: Forty six percentages of patients (mainly severe or critical cases) with COVID-19 showed fibrotic change on follow-up CT at early recovery phase, while the extent of fibrosis was not large. The advancing age, high total score on peak CT, peak eosinophils and ESR were associated with fibrotic change depicted by CT in patients recovering from COVID-19. An extended follow up by CT imaging and pulmonary function testing is necessary to fully assess the sequela of COVID-19.

Highlights

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), started in December 2019 and rapidly reached a global pandemic [1, 2]
(Figure 1): (a) The interval from symptom onset to last followup computerized tomography (CT) was more than 50 days no matter whether lesions were absorbed or not [we set 50 days as the cut-off value for inclusion criterion based on the time when the fibrosis appeared on chest CT of Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS) patients [16, 17]]; or (b) Lung lesions on last follow-up CT were completely absorbed within 50 days after symptom onset
As to last follow-up chest CT images, we evaluated the evidence of fibrotic changes, including parenchymal bands, traction bronchiectasis, irregular interfaces, lung distortion, and honeycombing [16, 22,23,24]

Summary

Introduction

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), started in December 2019 and rapidly reached a global pandemic [1, 2]. Since the outbreak of COVID-19, many studies have been conducted to reveal the epidemiological features, symptoms/signs, laboratory data, radiographic findings and treatments of this disease to facilitate the diagnosis and management of patients [6,7,8,9,10,11]. Chest CT is critical in early diagnosis, dynamic observation, treatment evaluation and prognostic prediction [12, 13], and its patterns have been well-described in the acute and early recovery phases [2, 7, 8, 14, 15]. Previous literatures reported that 62% of patients with Severe Acute Respiratory Syndrome (SARS) and 33% patients with

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