Medium-term chest computed tomography (CT) follow-up of COVID-19 pneumonia patients after recovery to assess the rate of resolution and determine the potential predictors of persistent lung changes

Abstract

Background The data on medium-term follow-up of coronavirus disease-19 (COVID-19) pneumonia survivors is scarce. Medium-term follow-up will generate knowledge and help in devising a structured follow-up plan and to facilitate enrolment in clinical trials assessing the role of antifibrotic drugs in modifying the course of disease in order to avert long-term pulmonary sequelae of disease. The study was aimed to evaluate the lung findings on a medium-term follow-up (3 months or more) chest computed tomography (CT) in COVID-19 pneumonia survivors, assess the rate of resolution or persistence of lung abnormalities and to identify the initial demographic, clinical, and imaging characteristics that could potentially predict the persistence of lung abnormalities on follow-up. Results Out of the total study cohort of 81 patients, 46 (56.8%) demonstrated complete resolution of lung findings and the remaining 35 (43.2%) had residual lung opacities on follow-up CT. The most common type of residual abnormality was ground glass opacity (GGO) (16/35; 45.7%), followed by parenchymal bands (9/35; 25.7%), mixed pattern of GGO and parenchymal bands (6/35; 17.2%), bronchiectasis (6/35; 17.2%), and interlobular septal thickening (4/35; 11.4%). Patients with residual abnormalities were older, had higher BMI, more comorbidities, lower SpO2, longer hospital stay, higher rate of intensive care unit (ICU) admission, higher WBC count, a higher CT severity score, and lower rate of steroid administration with all p values < 0.05. Conclusion Nearly half of post-COVID-19 survivors had residual lung abnormalities after ≥ 3 months of follow-up. Certain clinico-radiological characteristics have the potential to identify the individuals at risk of having residual lung abnormalities on medium-term follow-up.

Post-COVID-19 pulmonary fibrosis and its predictive factors: a prospective study

“…Various CT findings have been reported related to COVID-19 pneumonia with mild to severe lung involvement. Some previous studies also alluded to fibrotic consequences following the infection, which is a considerable issue for the patients’ clinical outcomes [ 5 , 6 ]. For example, a study reported that about one third of the COVID-19 survivors showed fibrotic abnormalities in their CT scans within the 6-month follow-up [ 7 ].…”

Case Report: Bullous Lung Disease Following COVID-19

“…Up to 50% of survivors of SARS CoV-2 infection have residual radiological abnormalities more than 3 months after initial infection, similar to previous coronavirus infections, such as SARS and the Middle East respiratory syndrome (MERS) (5,(9)(10)(11)(12). Older age, pre-existing co-morbidities, longer hospitalization, ICU admission, and a lower rate of steroid administration were more frequently associated with persistent imaging abnormalities (10).…”

“…Up to 50% of survivors of SARS CoV-2 infection have residual radiological abnormalities more than 3 months after initial infection, similar to previous coronavirus infections, such as SARS and the Middle East respiratory syndrome (MERS) ( 5 , 9 – 12 ). Older age, pre-existing co-morbidities, longer hospitalization, ICU admission, and a lower rate of steroid administration were more frequently associated with persistent imaging abnormalities ( 10 ). Commonly reported post-acute radiological sequelae include ground-glass opacities and reticulations, mosaic attenuation, parenchymal bands, interlobular septal thickening, bronchiectasis, and fibrotic-like changes ( 4 , 5 , 10 ).…”

“…Older age, pre-existing co-morbidities, longer hospitalization, ICU admission, and a lower rate of steroid administration were more frequently associated with persistent imaging abnormalities ( 10 ). Commonly reported post-acute radiological sequelae include ground-glass opacities and reticulations, mosaic attenuation, parenchymal bands, interlobular septal thickening, bronchiectasis, and fibrotic-like changes ( 4 , 5 , 10 ). Additionally, some patients have been reported to have round cystic changes on CT, which might be associated with the process of resorption of consolidation potentially leading to the development of bullae ( 13 ).…”

Observational study of clinico-radiological follow-up of COVID-19 pneumonia: a district general hospital experience in the UK

“…Similarly, a retrospective cohort study of 81 COVID-19 pneumonia patients from India found that almost half (43.2%) of the patients had residual lung changes at 3 months or more (range 90-111 days) on follow-up CT, ground-glass opacity being the most common finding. All patients in this study had CT scan at the time of the hospital admission and at 3 months or over (for those who had persistent symptoms or CXR changes at follow-up), which indicate that only patients with a higher degree of disease severity on admission were analysed [ 17 ]. When comparing the persistence of symptoms between the patients with resolved and residual lung findings at follow-up, this study did not demonstrate any statistically significant difference between the two groups.…”