Characteristics and Prognostic Factors of Pulmonary Fibrosis After COVID-19 Pneumonia

Elisabetta Cocconcelli; Nicol Bernardinello; Chiara Giraudo; Gioele Castelli; Adelaide Giorgino; Davide Leoni; Simone Petrarulo; Anna Ferrari; Marina Saetta; Annamaria Cattelan; Paolo Spagnolo; Elisabetta Balestro

doi:10.3389/fmed.2021.823600

Characteristics and Prognostic Factors of Pulmonary Fibrosis After COVID-19 Pneumonia

Front Med (Lausanne). 2022 Jan 31:8:823600. doi: 10.3389/fmed.2021.823600. eCollection 2021.

Affiliations

¹ Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, Padova, Italy.
² Department of Medicine, Institute of Radiology, University of Padova and Padova City Hospital, Padova, Italy.
³ Division of Infectious and Tropical Diseases, University of Padova and Padova City Hospital, Padova, Italy.

Abstract

Background: Few is known about the long-term pulmonary sequelae after COVID-19 infection. Hence, the aim of this study is to characterize patients with persisting pulmonary sequelae at follow-up after hospitalization. We also aimed to explore clinical and radiological predictors of pulmonary fibrosis following COVID-19.

Methods: Two hundred and 20 consecutive patients were evaluated at 3-6 months after discharge with high-resolution computed tomography (HRCT) and categorized as recovered (REC) or not recovered (NOT-REC). Both HRCTs at hospitalization (HRCT₀), when available, and HRCT₁ during follow-up were analyzed semiquantitatively as follows: ground-glass opacities (alveolar score, AS), consolidations (CONS), and reticulations (interstitial score, IS).

Results: A total of 175/220 (80%) patients showed disease resolution at their initial radiological evaluation following discharge. NOT-REC patients (45/220; 20%) were mostly older men [66 (35-85) years vs. 56 (19-87); p = 0.03] with a longer in-hospital stay [16 (0-75) vs. 8 (1-52) days; p < 0.0001], and lower P/F at admission [233 (40-424) vs. 318 (33-543); p = 0.04]. Moreover, NOT-REC patients presented, at hospital admission, higher ALV [14 (0.0-62.0) vs. 4.4 (0.0-44.0); p = 0.0005], CONS [1.9 (0.0-26.0) vs. 0.4 (0.0-18.0); p = 0.0064], and IS [11.5 (0.0- 29.0) vs. 0.0 (0.0-22.0); p < 0.0001] compared to REC patients. On multivariate analysis, the presence of CONS and IS at HRCT₀ was independent predictors of radiological sequelae at follow-up [OR 14.87 (95% CI: 1.25-175.8; p = 0.03) and 28.9 (95% CI: 2.17-386.6; p = 0.01, respectively)].

Conclusions: In our population, only twenty percent of patients showed persistent lung abnormalities at 6 months after hospitalization for COVID-19 pneumonia. These patients are predominantly older men with longer hospital stay. The presence of reticulations and consolidation on HRCT at hospital admission predicts the persistence of radiological abnormalities during follow-up.

Keywords: SARS-CoV-2; coronavirus disease 2019; high-resolution computed tomography; pulmonary fibrosis; pulmonary sequelae.