Persistent lung abnormalities versus established fibrosis: a prospective study of COVID-19 follow-up

Abstract

<b>Introduction:</b> Prospective data on the long-term pulmonary sequelae in COVID-19 survivors is lacking. <b>Aims:</b> To prospectively evaluate the burden of residual lung abnormalities in patients discharged from hospital post COVID-19. <b>Methods:</b> We prospectively evaluated 80 patients discharged from hospital through systematic assessment of symptoms, functional impairments, and thoracic imaging with computed tomography (HRCT/CTPA) as part of the PHENOTYPE study (NCT 04459351, IRAS 284497). <b>Results:</b> Outpatient review was performed at a median of 97 (86-121) days post-discharge and CT thorax performed in 73 patients at a median of 104.5 (94.5-141.3) days post-discharge. Persistent breathlessness and cough were reported by 37/80 (46.3%) and 17/80 (21%) patients respectively. Abnormalities on CT were present in 41/73 (56.2%) patients, with ground-glass opacification (85.4%) and bands (65.9%) predominating. Established fibrosis was only present in 9/73 (12.3%). Higher serum C-reactive protein (p=0.030), fibrinogen (p=0.023), urea (p=0.010) and creatinine (p=0.031) at hospital admission, longer hospital stay (p=0.008), higher age (p=0.038) and invasive ventilation during admission were associated with the presence of CT abnormalities at follow-up, although patient-reported breathlessness was not. In those with CT abnormalities affecting ≥60% of the lung parenchyma, a restrictive pattern of lung function abnormality was noted. <b>Conclusions:</b> CT abnormalities are common in COVID-19 survivors but overt fibrosis is not. Severity of the acute illness is related to persistent CT abnormalities. Patient-reported breathlessness alone may not be useful when determining need for CT imaging.