Characteristics and Prognostic Factors of Pulmonary Fibrosis After COVID-19 Pneumonia
Elisabetta Cocconcelli, Nicol Bernardinello, Chiara Giraudo, G. Castelli, Adelaide Giorgino, Davide Leoni, Simone Petrarulo, Anna Ferrari, Marina Saetta, Anna Maria Cattelan, Paolo Spagnolo, Elisabetta Balestro
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 (HRCT 0 ), when available, and HRCT 1 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 HRCT 0 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.