Predicting lung fibrosis in post-COVID-19 patients after discharge with follow-up chest CT findings

Abstract

BackgroundCoronavirus disease has spread widely all over the world since the beginning of 2020, and this required rapid adequate management. High-resolution computed tomography (HRCT) has become an initial valuable tool for screening, diagnosis, and assessment of disease severity. This study aimed to assess the clinical, radiographic, and laboratory findings of COVID-19 with HRCT follow-up in discharged patients to predict lung fibrosis after COVID-19 infection in survived patients.ResultsThis study included two-hundred and ten patients who were tested positive for the novel coronavirus by nasopharyngeal swap, admitted to the hospital, and discharged after recovery. Patients with at least a one-time chest CT scan after discharge were enrolled. According to the presence of fibrosis on follow-up CT after discharge, patients were classified into two groups and assigned as the “non-fibrotic group” (without evident fibrosis) and “fibrotic group” (with evident fibrosis). We compared between these two groups based on the recorded clinical data, patient demographic information (i.e., sex and age), length of stay (LOS) in the hospital, admission to the ICU, laboratory results (peak C-reactive protein [CRP] level, lowest lymphocyte level, serum ferritin, high-sensitivity troponin, d-dimer, administration of steroid), and CT features (CT severity score and CT consolidation/crazy-paving score). CT score includes the CT during the hospital stay with peak opacification and follow-up CT after discharge. The average CT follow-up time after discharge is 41.5 days (range, 20 to 65 days). There was a statistically significant difference between both groups (p ˂0.001). Further, a multivariate analysis was performed and found that the age of the patients, initial CT severity score, consolidation/crazy-paving score, and ICU admission were independent risk factors associated with the presence of post-COVID-19 fibrosis (p<0.05). Chest CT severity score shows a sensitivity of 86.1%, a specificity of 78%, and an accuracy of 81.9% at a cutoff point of 10.5.ConclusionThe residual pulmonary fibrosis in COVID-19 survivors after discharge depends on many factors with the patient’s age, CT severity, consolidation/crazy-paving scores, and ICU admission as independent risk factors associated with the presence of post-COVID-19 fibrosis.