Abstract
Inflammatory burden is associated with COVID-19 severity and outcomes. Residual computed tomography (CT) lung abnormalities have been reported after COVID-19. The aim was to evaluate the association between inflammatory burden during COVID-19 and residual lung CT abnormalities collected on follow-up CT scans performed 2–3 and 6–7 months after COVID-19, in severe COVID-19 pneumonia survivors. C-reactive protein (CRP) curves describing inflammatory burden during the clinical course were built, and CRP peaks, velocities of increase, and integrals were calculated. Other putative determinants were age, sex, mechanical ventilation, lowest PaO2/FiO2 ratio, D-dimer peak, and length of hospital stay (LOS). Of the 259 included patients (median age 65 years; 30.5% females), 202 (78%) and 100 (38.6%) had residual, predominantly non-fibrotic, abnormalities at 2–3 and 6–7 months, respectively. In age- and sex-adjusted models, best CRP predictors for residual abnormalities were CRP peak (odds ratio [OR] for one standard deviation [SD] increase = 1.79; 95% confidence interval [CI] = 1.23–2.62) at 2–3 months and CRP integral (OR for one SD increase = 2.24; 95%CI = 1.53–3.28) at 6–7 months. Hence, inflammation is associated with short- and medium-term lung damage in COVID-19. Other severity measures, including mechanical ventilation and LOS, but not D-dimer, were mediators of the relationship between CRP and residual abnormalities.
Highlights
Inflammatory burden is associated with COVID-19 severity and outcomes
Of the patients who had an indication for follow-up computed tomography (CT) scan, 259 patients underwent a follow-up CT scan at [2–3] months and were included in the study; 241 of them had a second follow-up CT scan at [6–7] months
C-reactive protein (CRP) peak was strongly correlated with CRP velocity of increase and CRP integral, while the correlation between CRP integral and velocity of increase was weaker (Supplementary Table 2)
Summary
Inflammatory burden is associated with COVID-19 severity and outcomes. The aim was to evaluate the association between inflammatory burden during COVID-19 and residual lung CT abnormalities collected on follow-up CT scans performed [2–3] and 6–7 months after COVID-19, in severe COVID-19 pneumonia survivors. Other putative determinants were age, sex, mechanical ventilation, lowest PaO2/FiO2 ratio, D-dimer peak, and length of hospital stay (LOS). Studies on radiological follow-up of severe COVID-19 pneumonia showed residual abnormalities at follow-up CT scan, with a high prevalence especially in the short- and medium-term[4–8]. The clinical significance of these abnormal findings is unclear and the degree of persistency of residual pulmonary abnormalities will remain uncertain until more longer-term follow-up data are a vailable[6–9]
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