The characteristics and evolution of pulmonary fibrosis in COVID-19 patients as assessed by AI-assisted chest HRCT.

Jia-Ni Zou,Yong-Jun Ding,Wen-Cai Huang,Liu Sun,You Zou,Li-Jun Shen,Bin-Ru Wang,Xiao-Jing Jiang,Shi-Ming Chen,Shan Xu,Giordano Madeddu

doi:10.1371/journal.pone.0248957

Abstract

The characteristics and evolution of pulmonary fibrosis in patients with coronavirus disease 2019 (COVID-19) have not been adequately studied. AI-assisted chest high-resolution computed tomography (HRCT) was used to investigate the proportion of COVID-19 patients with pulmonary fibrosis, the relationship between the degree of fibrosis and the clinical classification of COVID-19, the characteristics of and risk factors for pulmonary fibrosis, and the evolution of pulmonary fibrosis after discharge. The incidence of pulmonary fibrosis in patients with severe or critical COVID-19 was significantly higher than that in patients with moderate COVID-19. There were significant differences in the degree of pulmonary inflammation and the extent of the affected area among patients with mild, moderate and severe pulmonary fibrosis. The IL-6 level in the acute stage and albumin level were independent risk factors for pulmonary fibrosis. Ground-glass opacities, linear opacities, interlobular septal thickening, reticulation, honeycombing, bronchiectasis and the extent of the affected area were significantly improved 30, 60 and 90 days after discharge compared with at discharge. The more severe the clinical classification of COVID-19, the more severe the residual pulmonary fibrosis was; however, in most patients, pulmonary fibrosis was improved or even resolved within 90 days after discharge.

Highlights

Pulmonary fibrosis can occur as a serious complication of viral pneumonia, which often leads to dyspnea and impaired lung function
Thirteen patients with critical COVID-19 had mild pulmonary fibrosis (3 patients, 23.08%), moderate pulmonary fibrosis (3 patients, 23.08%) or severe pulmonary fibrosis (7 patients, 53.85%) (Table 1). These results indicated that patients with moderate COVID-19 mainly developed mild-to-moderate pulmonary fibrosis, while patients with critical COVID-19 generally developed severe pulmonary fibrosis (P
Quantitative CT scores have been used to assess the severity of pulmonary fibrosis in patients with idiopathic pulmonary fibrosis [16,17,18,19]

Summary

Introduction

Pulmonary fibrosis can occur as a serious complication of viral pneumonia, which often leads to dyspnea and impaired lung function. It significantly affects quality of life and is associated with increased mortality in severe cases [1, 2]. Patients with confirmed severe acute respiratory syndrome coronavirus (SARS-CoV) or Middle East respiratory syndrome coronavirus. The characteristics of pulmonary fibrosis in COVID-19 patients

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Results

Conclusion