Complications after discharge with COVID-19 infection and risk factors associated with development of post-COVID pulmonary fibrosis

Abstract

Introduction: Survivors of COVID-19 infection may develop post-covid pulmonary fibrosis (PCF) and suffer from long term multi-system complications. The magnitude and risk factors associated with these are unknown. Objectives: We investigated the prevalence and risk factors associated with PCF and other complications in patients discharged after COVID-19 infection. Methods: Patients had phone assessment 6 weeks post hospital discharge after COVID-19 infection using a set protocol. Those with significant respiratory symptoms were investigated with a CTPA, Pulmonary Function Tests and echocardiogram. Prevalence of myalgia, fatigue, psychological symptoms and PCF was obtained. Risk factors associated with these were investigated. Results: A large number of patients had persistent (45.1%) fatigue, breathlessness (36.5%), myalgia (20.5%) and psychological symptoms (19.5%). PCF was seen in 9.5% of the patients and was associated with persistent breathlessness at 6 weeks and inpatient ventilation [adjusted OR 5.02(1.76-14.27) and 4.45(1.27-15.58)] respectively. It was more common in men and in patients with peak CRP >171.5 mg/L, peak WBC count ≥12 x 10 9/L, severe inpatient COVID-19 CXR changes and CT changes. Ventilation was also a risk factor for persisting fatigue and myalgia, the latter was also more common in those with severe cytokine storm and severe COVID-19 inpatient CXR changes. Conclusions: All the patients discharged after COVID-19 should be assessed using a set protocol by a multidisciplinary team. Patients who had severe COVID-19 infection particularly those who were intubated and who have persistent breathlessness are at risk of developing PCF. They should have a CT Chest and have respiratory follow-up.

Post COVID-19 pulmonary fibrosis; a meta-analysis study

“…Previous studies have been quite heterogeneous regarding the prevalence of PCPF. Aul et al reported a low prevalence of 9.3% [ 21 ]. Meanwhile, the rest of the available studies have reported a much higher prevalence, ranging from 25.5% to 84.15% [ [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] ], with the highest being reported by Zou and associates [ 31 ].…”

“…Most of the available literature shared similar findings regarding this aspect [ [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] , [32] , [33] ]. However, Aul et al reported that the age difference was insignificant between the fibrotic and non-fibrotic patients [ 21 ]. The literature has had contradictory findings regarding the effect of gender and smoking status on the development of fibrosis.…”

“…The literature has had contradictory findings regarding the effect of gender and smoking status on the development of fibrosis. Despite some studies suggesting a higher prevalence of PCPF in males [ 21 , 22 , 25 , 26 ], the majority of the studies disregard it [ 23 , 24 , [27] , [28] , [29] , [30] , [31] , [32] , [33] ]. Multiple studies consider smoking as a risk factor for PCPF [ 21 , 22 , 25 ]; meanwhile, others do not highlight this connection [ 26 , 32 ].…”

Dihydroartemisinin attenuates pulmonary inflammation and fibrosis in rats by suppressing JAK2/STAT3 signaling

“…Some studies analyzed the chest CT characteristics of patients with COVID-19, and patchy ground-glass opacities were the most common changes [7]. The results of further imaging studies for COVID-19 further confirmed that PF might be one of the major complications in patients with COVID-19 [6,10,11].…”

“…The disease causes a wide range of symptoms, from asymptomatic to respiratory failure [ 3 , 4 ]. Pulmonary fibrosis (PF) is a possible complication of pulmonary involvement in COVID-19, which is a chronic, progressive, and fatal form of fibrosing interstitial pneumonia [ 5 , 6 ].…”