Fibrotic Interstitial Lung Abnormalities at 1-year Follow-up CT after Severe COVID-19

Han, Xiaoyu; Fan, Yanqing; Alwalid, Osamah; Zhang, Xin; Jia, Xibin; Zheng, Yuting; Shi, Heshui

doi:10.1148/radiol.2021210972

Cited by 80 publications

(90 citation statements)

References 7 publications

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“…and "irregular lines" with small patient cohorts recovering from severe disease 18,21 and the majority with relatively short-term (up to 6 months) follow-up. [22][23][24][25] Studies evaluating serial radiologic changes after COVID-19 are lacking. Therefore, the aim of the present study was to critically review chest CT abnormalities in COVID-19 survivors at up to 1-year follow-up in concert with symptomatology and indices of functional impairment, identify associations with inpatient characteristics, and evaluate serial radiologic findings.…”

Section: N P R E S Smentioning

confidence: 99%

CT Lung Abnormalities after COVID-19 at 3 Months and 1 Year after Hospital Discharge

Vijayakumar¹,

Tonkin²,

Devaraj³

et al. 2022

Radiology

117

110

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Background Data on the long-term pulmonary sequelae in COVID-19 are lacking. Purpose To assess symptoms and functional impairment and residual pulmonary abnormalities on serial chest CT in COVID-19 survivors discharged from hospital at up to 1-year follow-up. Materials and Methods Adult patients with COVID-19 discharged between March 2020 and June 2020 were prospectively evaluated at 3 months and 1 year, through systematic assessment of symptoms, functional impairments, and thoracic CT as part of the PHENOTYPE study, an observational cohort study in COVID-19 survivors. Lung function testing was limited to participants with CT abnormalities and/or persistent breathlessness. All statistical analyses were performed using Graphpad PRISM Version 9.0 (86) for Mac, GraphPad Software, ( www.graphpad.com ); Bonferroni corrected p values are stated. Results Eighty participants (mean age, 59 ±13 years; 53 men) were assessed. Persistent breathlessness 37 (46%) and cough 17 (21%) were reported at outpatient review (median 97 days [IQR 86-121]). CT scans in 73 participants post-discharge (median 105 days [IQR 95-141]) revealed persistent abnormalities in 41/73 participants (56%), with ground-glass opacification (35/73 [48%]) and bands (27/73 [37%]) predominating. Unequivocal signs indicative of established fibrosis (i.e. volume loss +/- traction bronchiectasis) were present in 9/73 (12%) participants. Higher admission serum C-reactive protein (mg/L), fibrinogen (g/dl), urea (mmol/L) and creatinine (micromol/L), longer hospital stay (days), older age (years) and requirement for invasive ventilation were associated with CT abnormalities at 3-month follow-up. 32/41 (78%) of participants with abnormal 3-month follow-up CT underwent repeat imaging at a median of 364 (360-366) days, with 26/32 (81%) showing further radiological improvement (median 18% [IQR 10–40%]). Conclusion CT abnormalities were common at 3 months after COVID-19 but with signs of fibrosis in a minority. More severe acute disease was linked with CT abnormalities at 3 months. However, radiologic improvement was seen in the majority at 1-year follow-up. ClinicalTrials.gov Identifier: NCT04459351

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Section: N P R E S Smentioning

confidence: 99%

CT Lung Abnormalities after COVID-19 at 3 Months and 1 Year after Hospital Discharge

Vijayakumar¹,

Tonkin²,

Devaraj³

et al. 2022

Radiology

117

110

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“…However, a 1-year follow-up study on patients recovered from 2003 SARS showed that one-third of the patients had persistent pulmonary function impairment, and poorer health, in general, than the healthy population (9). So far, there are few follow-up studies over 1 year assessing the sequelae in the patients recovered from COVID-19 infection (10)(11)(12)(13). Furthermore, the studies on multi-system assessment of long-term consequences in COVID-19 survivors are limited.…”

Section: Introductionmentioning

confidence: 99%

Assessment of Sequelae of COVID-19 Nearly 1 Year After Diagnosis

et al. 2021

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Background: A previous study has shown that 81% of the COVID-19 patients had mild or moderate symptoms. However, most studies on the sequelae in COVID-19 patients focused on severe cases and the long-term follow-up studies on the health consequences in non-severe cases are limited. The current study aimed to assess the sequelae of COVID-19 in patients nearly 1 year after diagnosis with a particular focus on the recovery of patients with non-severe COVID-19.Methods: We enrolled 120 patients infected with SARS-CoV-2 discharged from Wuhan Union hospital west district (designated hospital for COVID-19) and Fangcang shelter hospitals between January 29, 2020 and April 1, 2020. All participants were asked to complete a series of questionnaires to assess their symptoms and quality of life and for psychological evaluation. Also, pulmonary function test, chest CT, 6-min walking test (6MWT), routine blood test, liver and kidney function tests, fasting blood glucose test, lipid test, and immunoglobulin G antibody test were performed to evaluate their health.Results: The mean age of the study population was 51.6 ± 10.8 years. Of the 120 patients, 104 (86.7%) were cases of non-severe COVID-19. The follow-up study was performed between November 23, 2020 and January 11, 2021, and the median time between the diagnosis and the follow-up was 314.5 (IQR, 296–338) days. Sleep difficulties, shortness of breath, fatigue, and joint pain were common symptoms observed during follow-up and nearly one-third of the non-severe cases had these symptoms. A total of 50 (41.7%) and 45 (37.5%) patients reported anxiety and depression, respectively. And 18.3% of the patients showed negative results in the IgG test at the follow-up, which correlated with the severity of the infection (R = 0.203, p = 0.026), and the proportion of IgG negative cases in non-severe COVID-19 patients was higher than that in the severe cases (20.2 vs. 6.3%). Pulmonary diffusion impairment was reported in 30 (26.1%) out of 115 patients, and 24 (24.2%) out of the 99 non-severe cases. The values of forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FVC/FEV1, vital capacity (VC), total lung capacity (TLC), and residual volume (RV) were less than the normal range in 1.7, 8.6, 0.9, 11.2, 7.0, and 0.9% of the patients, respectively. A total of 55 (56.7%) out of the 97 patients showed abnormal CT findings, including ground-glass opacities (GGO), bronchiectasis, nodules, lines and bands, and fibrosis. Furthermore, there was a correlation between all the SF-36-domain scores and the duration of hospitalization, pulmonary function, and a 6MWT.Conclusions: At the nearly 1-year follow-up, COVID-19 survivors still had multi-system issues, including those in the respiratory functioning, radiography, quality of life, and anxiety and depression. Moreover, non-severe cases also showed some sequelae and the proportion of IgG negative cases in the non-severe patients was higher than that in severe cases. Therefore, conducting follow-ups and preventing the reinfection of SARS-CoV-2 in this group is necessary.

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“…A chest CT is significant in the assessment of lung lesions caused by COVID-19 [17,18]. A CT is widely used for admission screening, discharge assessment, and followup of COVID-19 patients [7,[19][20][21]. Therefore, our radiomic models based on admission and discharge chest CTs of COVID-19 survivors can be well validated.…”

Section: Discussionmentioning

confidence: 99%

CT-Based Radiomics Helps to Predict Residual Lung Lesions in COVID-19 Patients at Three Months after Discharge

Huang

Chen

et al. 2021

Diagnostics

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Background: In this study, our focus was on pulmonary sequelae of coronavirus disease 2019 (COVID-19). We aimed to develop and validate CT-based radiomic models for predicting the presence of residual lung lesions in COVID-19 survivors at three months after discharge. Methods: We retrospectively enrolled 162 COVID-19 confirmed patients in our hospital (84 patients with residual lung lesions and 78 patients without residual lung lesions, at three months after discharge). The patients were all randomly allocated to a training set (n = 114) or a test set (n = 48). Radiomic features were extracted from chest CT images in different regions (entire lung or lesion) and at different time points (at hospital admission or at discharge) to build different models, sequentially, or in combination, as follows: (1) Lesion_A model (based on the lesion region at admission CT); (2) Lesion_D model (based on the lesion region at discharge CT); (3) Δlesion model (based on the lesion region at admission CT and discharge CT); (4) Lung_A model (based on the lung region at admission CT); (5) Lung_D model (based on the lung region at discharge CT); (6) Δlung model (based on the lung region at admission CT and discharge CT). The area under the receiver operating characteristic curve (AUC), sensitivity, and specificity were used to evaluate the predictive performances of the radiomic models. Results: Among the six models, the Lesion_D and the Δlesion models achieved better predictive efficacy, with AUCs of 0.907 and 0.927, sensitivity of 0.898 and 0.763, and specificity of 0.855 and 0.964 in the training set, and AUCs of 0.875 and 0.837, sensitivity of 0.920 and 0.680, and specificity of 0.826 and 0.913 in the test set, respectively. Conclusions: The CT-based radiomic models showed good predictive effects on the presence of residual lung lesions in COVID-19 survivors at three months after discharge, which may help doctors to plan follow-up work and to reduce the psychological burden of COVID-19 survivors.

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Fibrotic Interstitial Lung Abnormalities at 1-year Follow-up CT after Severe COVID-19

Cited by 80 publications

References 7 publications

CT Lung Abnormalities after COVID-19 at 3 Months and 1 Year after Hospital Discharge

CT Lung Abnormalities after COVID-19 at 3 Months and 1 Year after Hospital Discharge

Assessment of Sequelae of COVID-19 Nearly 1 Year After Diagnosis

CT-Based Radiomics Helps to Predict Residual Lung Lesions in COVID-19 Patients at Three Months after Discharge

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