Risk factors for persistent abnormality on chest radiographs at 12-weeks post hospitalisation with PCR confirmed COVID-19

Abstract

Background The long-term consequences of COVID-19 remain unclear. There is concern a proportion of patients will progress to develop pulmonary fibrosis. We aimed to assess the temporal change in CXR infiltrates in a cohort of patients following hospitalisation for COVID-19. Methods We conducted a single-centre prospective cohort study of patients admitted to University Hospital Southampton with confirmed SARS-CoV2 infection between 20th March and 3rd June 2020. Patients were approached for standard-of-care follow-up 12-weeks after hospitalisation. Inpatient and follow-up CXRs were scored by the assessing clinician for extent of pulmonary infiltrates; 0–4 per lung (Nil = 0, < 25% = 1, 25–50% = 2, 51–75% = 3, > 75% = 4). Results 101 patients with paired CXRs were included. Demographics: 53% male with a median (IQR) age 53.0 (45–63) years and length of stay 9 (5–17.5) days. The median CXR follow-up interval was 82 (77–86) days with median baseline and follow-up CXR scores of 4.0 (3–5) and 0.0 (0–1) respectively. 32% of patients had persistent CXR abnormality at 12-weeks. In multivariate analysis length of stay (LOS), smoking-status and obesity were identified as independent risk factors for persistent CXR abnormality. Serum LDH was significantly higher at baseline and at follow-up in patients with CXR abnormalities compared to those with resolution. A 5-point composite risk score (1-point each; LOS ≥ 15 days, Level 2/3 admission, LDH > 750 U/L, obesity and smoking-status) strongly predicted risk of persistent radiograph abnormality (0.81). Conclusion Persistent CXR abnormality 12-weeks post COVID-19 was common in this cohort. LOS, obesity, increased serum LDH, and smoking-status were risk factors for radiograph abnormality. These findings require further prospective validation.

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“… 13 These authors also observed that the risk of these persistent abnormalities was associated with obesity. 13 …”

Molecular and Clinical Prognostic Biomarkers of COVID-19 Severity and Persistence

“…Elevated levels of IL-10 in severe patients negatively regulates cystatin C, while mild patients have higher levels of this protease inhibitor, used as a prognostic biomarker [ 32 ]. Levels of LDH higher than 750 U/L, together with other factors such as obesity and smoking status, can strongly predict risk of persistent abnormalities on chest X-rays (CXR) [ 34 ]. They also found elevated levels of a number of serum molecules like D-dimer, PCT, CRP, and albumin in severe patients.…”

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“…A few other outcomes were also assessed. One study found that smokers were more likely to have chest X-ray abnormalities 12 weeks after hospitalization, which correlated with longer hospital stays and longer recovery times [ 26 ]. Another study also indicated that smokers may be at risk of longer hospital stays or longer disease duration, but results were not conclusive [ 27 ].…”