Follow-Up Study of the Chest CT Characteristics of COVID-19 Survivors Seven Months After Recovery.

Mengqi Liu,Fajin Lv,Yang Huang,Kaihu Xiao

doi:10.3389/fmed.2021.636298

Abstract

Background: It has remained a concern whether any long-term pulmonary sequelae exist for COVID-19 survivors.Methods: Forty-one patients (22 men and 19 women, 50 ± 14 years) confirmed with COVID-19 performed follow-up chest CT and cardiopulmonary exercise testing at 7 months after discharge. Patients were divided into fibrosis group and non-fibrosis group according to the evidence of fibrosis on follow-up CT. The clinical data and the CT findings were recorded and analyzed.Results: The predominant CT patterns of abnormalities observed at 7 months after discharge were parenchymal band (41%), interlobular septal thickening (32%), and traction bronchiectasis (29%). Sixty-one percent of the patients achieved complete radiological resolution, and 29% of patients developed pulmonary fibrosis. Compared with the patients in the non-fibrosis group, the patients in the fibrosis group were older, with a longer hospital stay, a higher rate of steroid and mechanical ventilation therapy, lower levels of lymphocyte and T cell count, higher levels of D-dimer and lactic dehydrogenase, and higher quantitative CT parameters (opacity score, volume of opacity, and percentage of opacity) at discharge. Besides, oxygen consumption and metabolic equations were decreased and ventilatory equivalent for carbon dioxide was increased in patients in the fibrosis group. Logistic regression analyses revealed that age, steroid therapy, presence of traction bronchiectasis on chest CT at discharge, and opacity score at discharge, were independent risk factors for developing pulmonary fibrosis at 7 months after discharge. Receiver operating characteristic analysis revealed that the combined clinical-radiological model was better than the clinical-only model in the prediction of pulmonary fibrosis.Conclusions: The chest CT lesions could be absorbed without any sequelae for most patients with COVID-19, whereas older patients with severe conditions are more prone to develop fibrosis, which may further lead to cardiopulmonary insufficiency. The combined clinical-radiological model may predict the formation of pulmonary fibrosis early.

Highlights

Since late December 2019, coronavirus disease 2019 (COVID-19) has emerged and promptly spread throughout the world
12 patients (29%, male: 7, female: 5) with evidence of fibrosis on the 7-month follow-up CT were designated as the fibrosis group, and the remaining 29 patients (71%, male: 15, female: 14) without evidence of fibrosis as the non-fibrosis group
Logistic regression analyses revealed that age, steroid therapy, opacity score at discharge, and presence of traction bronchiectasis at discharge, were independent risk factors for developing pulmonary fibrosis at 7 months after discharge, while other clinical or CT indicators were not independent risk factors associated with fibrosis

Summary

Introduction

Since late December 2019, coronavirus disease 2019 (COVID-19) has emerged and promptly spread throughout the world. It has remained a concern to the public whether any pulmonary sequelae exist for COVID-19 survivors. Wang and colleagues reported that clinical sequelae of patients on 3-month follow-up were common, including respiratory symptoms, cardiovascularrelated symptoms, and psychosocial symptoms [5]. Recent studies have shown that pulmonary fibrosis may develop in patients with COVID-19 short term after discharge [6,7,8]. The number of discharged COVID-19 patients keeps increasing worldwide but the definite long-term radiological outcomes of the patients after discharge are scarcely described in the literature. We present the results of the 7-month follow-up chest CT in patients discharged with COVID-19. It has remained a concern whether any long-term pulmonary sequelae exist for COVID-19 survivors

Methods

Results

Conclusion