Interstitial lung damage following COVID-19 hospitalisation: an interim analysis of the UKILD Post-COVID study

Abstract

Introduction. Shared characteristics between COVID-19 and pulmonary fibrosis, including symptoms, genetic architecture, and circulating biomarkers, suggests interstitial lung disease (ILD) development may be associated with SARS-CoV-2 infection. Methods. The UKILD Post-COVID study planned interim analysis was designed to stratify risk groups and estimate the prevalence of Post-COVID Interstitial Lung Damage (ILDam) using the Post-HOSPitalisation COVID-19 (PHOSP-COVID) Study. Demographics, radiological patterns and missing data were assessed descriptively. Bayes binomial regression was used to estimate the risk ratio of persistent lung damage >10% involvement in linked, clinically indicated CT scans. Indexing thresholds of percent predicted DLco, chest X-ray findings and severity of admission were used to generate risk strata. Number of cases within strata were used to estimate the amount of suspected Post-COVID ILDam. Results. A total 3702 people were included in the UKILD interim cohort, 2406 completed an early follow-up research visit within 240 days of discharge and 1296 had follow-up through routine clinical review. We linked the cohort to 87 clinically indicated CTs with visually scored radiological patterns (median 119 days; interquartile range 83 to 155, max 240), of which 74 people had ILDam. ILDam was associated with abnormal chest X-ray (RR 1.21 95%CrI 1.05; 1.40), percent predicted DLco<80% (RR 1.25 95%CrI 1.00; 1.56) and severe admission (RR 1.27 95%CrI 1.07; 1.55). A risk index based on these features suggested 6.9% of the interim cohort had moderate to very-high risk of Post-COVID ILDam. Comparable radiological patterns were observed in repeat scans >90 days in a subset of participants. Conclusion. These interim data highlight that ILDam was not uncommon in clinically indicated thoracic CT up to 8 months following SARS-CoV-2 hospitalisation. Whether the ILDam will progress to ILD is currently unknown, however health services should radiologically and physiologically monitor individuals who have Post-COVID ILDam risk factors.

Acute respiratory distress syndrome in adults: diagnosis, outcomes, long-term sequelae, and management

“…15,16,[145][146][147][148] Evidence of persistent interstitial lung disease in patients with ARDS related to COVID-19 who were mechanically ventilated has been reported, but there remains uncertainty as to how relevant this evidence is to a population of patients with non-COVID-19 ARDS. 10,149,150 Of note, some studies have shown better health-related quality of life, 16 and higher return to work rates in patients with COVID-19 ARDS compared with a non-COVID-19 ARDS population. 15,16,148 However, patients with COVID-19 ARDS self-report lower disability and higher health-related quality of life before intensive care unit hospitalisation and therefore might have a greater capacity for improvement following critical illness than patients with non-COVID-19 ARDS.…”

“…15 When adjusted for potential confounders at baseline, Hodgson and colleagues 15 show the incidence of new disability, health-related quality of life, psychological function, and cognitive function was similar at 6 months between patients who are critically ill with and without COVID-19. The emerging effect of long COVID, 151 and long-term effects of COVID-19 on organ function (including interstitial lung disease 10,149,150 and a variety of cardiac sequelae 152 ) raises concerns regarding the full spectrum of morbidity in survivors of ARDS related to COVID-19.…”

Post-COVID-19 respiratory problems: burden and management

“…Post-COVID interstitial lung damage (PCILDam) is a term defined as total lung involvement of reticulations and ground glass opacities of more than 10% on CT scan, by the UKILD Post-COVID Study [37 ▪ ]. To date, it is not known whether these represent stable or resolving changes consistent with residual pneumonitis or post-acute respiratory distress syndrome; or progressive changes consistent with interstitial lung disease (ILD).…”

“…The UKILD Post-COVID Study estimates the prevalence of PCILDam at 5–11% up to 8 months after hospital discharge for individuals admitted to hospital before March 2021 in an interim analysis. Risk of PCILDam was higher in men, age more than 60, individuals with abnormal chest radiograph, impaired DLCO and severity of infection requiring continuous positive airway pressure (CPAP), intermittent mandatory ventiliation (IMV) or extracorporeal membrane oxygenation (ECMO) [37 ▪ ].…”

“…In COVID-19 survivors, persistent CT abnormalities are associated with the severity of acute illness [30,31 ▪▪ ,34,37 ▪ ,40]. Huang et al [30], found 76% of patients who had received non-invasive ventilation (NIV) or invasive ventilation (IV) had ongoing albeit improving ground glass opacities at 12 months, however, there was also an increase in interlobular septal thickening among these patients.…”