A Prospective Study of Lung Lesions in COVID-19 Survivors
Keywords:
COVID-19, Lung Diseases, Spiral Computed Tomography, AftercareAbstract
Background: We investigated chest Computed tomography (CT) findings of patients with COVID-19 admitted to Intensive Care Unit (ICU) and wards two months after recovery.
Objective: We evaluated the relationship between 2-month follow-up CT findings with the lung involvement severity in their first CT scan upon admission and with the medications administered for them.
Methods: Forty-six COVID-19 patients were enrolled, including 23 admitted to the wards and 23 ICU admitted ones. A Chest CT scan was performed and the initial involvement score was recorded. Patients were recalled two months after recovery for follow-up CT. The prevalence of abnormalities in follow-up CT was compared between the two groups. Also, we evaluated the relationship between the first CT score and medications with follow-up CT involvement.
Results: Our results indicated that two-month follow-up CT abnormalities were found in 91.3% of ICU patients and in 47.8% of ward-admitted ones. The ground glass opacity(GGO) was the commonest (84.4%) abnormality of studied cases after two months, followed by reticulation(65.6%), and atelectasis(43.8%). The presence of abnormalities was related to age (P=0.002), initial total lung involvement scores (TLI) (P=0.007), and admission to ICU versus wards (P=0.001). ROC analysis showed that a TLI score equal to 11 had 65% sensitivity and 72% specificity to predict the presence of abnormalities in follow-up CT (P=0.007). We did not find any relationship between the administered medications and follow-up CT abnormalities, except for meropenem.
Conclusions: Two-month follow-up chest CT abnormalities are significantly more frequent in older patients, ICU-admitted survivors, and those with a higher TLI score in the initial chest CT scan.
Statements:
Funding: The study was supported by the Vice-Chancellor of Research, Mashhad University of Medical Sciences, Mashhad, Iran under thesis research number 990061.
Conflicts of interest: None.
Acknowledgments: We would like to express our gratitude to the Clinical Research Development Unit of Ghaem Hospital.
Ethical considerations: The ethical protocol of this study was based on principles of the Declaration of Helsinki (IR.MUMS.REC.1399.063). (webpage of ethical approval code is: https://ethics.research.ac.ir/EthicsProposalView.php?id=127653 )
References
1. Lewnard JA, Liu VX, Jackson ML, Schmidt MA, Jewell BL, Flores JP, et al. Incidence, clinical outcomes, and transmission dynamics of severe coronavirus disease 2019 in California and Washington: prospective cohort study. bmj. 2020;369.
2. Moradzadeh R. The challenges and considerations of community-based preparedness at the onset of COVID-19 outbreak in Iran, 2020. Epidemiology & Infection. 2020;148.
3. Sohrabi C, Alsafi Z, O'neill N, Khan M, Kerwan A, Al-Jabir A, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). International journal of surgery. 2020;76:71-6.
4. Chen Y, Li L. SARS-CoV-2: virus dynamics and host response. The Lancet Infectious Diseases. 2020;20(5):515-6.
5. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The lancet. 2020;395(10223):497-506.
6. Chung M, Bernheim A, Mei X, Zhang N, Huang M, Zeng X, et al. CT imaging features of 2019 novel coronavirus (2019-nCoV). Radiology. 2020;295(1):202-7.
7. Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT findings in coronavirus disease-19 (COVID-19): relationship to duration of infection. Radiology. 2020:200463.
8. Ye Z, Zhang Y, Wang Y, Huang Z, Song B. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. European radiology. 2020;30(8):4381-9.
9. Tabatabaei SMH, Talari H, Moghaddas F, Rajebi H. CT features and short-term prognosis of COVID-19 pneumonia: a single-center study from Kashan, Iran. Radiology: Cardiothoracic Imaging. 2020;2(2):e200130.
10. Parry AH, Wani AH, Shah NN, Yaseen M, Jehangir M. Chest CT features of coronavirus disease-19 (COVID-19) pneumonia: which findings on initial CT can predict an adverse short-term outcome? BJR| Open. 2020;2:20200016.
11. Carfì A, Bernabei R, Landi F. Persistent symptoms in patients after acute COVID-19. Jama. 2020;324(6):603-5.
12. Halpin SJ, McIvor C, Whyatt G, Adams A, Harvey O, McLean L, et al. Postdischarge symptoms and rehabilitation needs in survivors of COVID‐19 infection: A cross‐sectional evaluation. Journal of medical virology. 2021;93(2):1013-22.
13. Han X, Fan Y, Alwalid O, Li N, Jia X, Yuan M, et al. Six-month follow-up chest CT findings after severe COVID-19 pneumonia. Radiology. 2021;299(1):E177-E86.
14. Chan K, Zheng J, Mok Y, Li Y, LIU YN, Chu C, et al. SARS: prognosis, outcome and sequelae. Respirology. 2003;8:S36-S40.
15. Hansell DM, Bankier AA, MacMahon H, McLoud TC, Muller NL, Remy J. Fleischner Society: glossary of terms for thoracic imaging. Radiology. 2008;246(3):697-722.
16. Chang Y-C, Yu C-J, Chang S-C, Galvin JR, Liu H-M, Hsiao C-H, et al. Pulmonary sequelae in convalescent patients after severe acute respiratory syndrome: evaluation with thin-section CT. Radiology. 2005;236(3):1067-75.
17. Aminzadeh B, Layegh P, Foroughian M, Tavassoli A, Emadzadeh M, Teimouri A, et al. Evaluation of the Prognostic Value of Chest Computed Tomography Scan in COVID-19 Patients. Iranian Journal of Radiology. 2021;18(2).
18. Nikpouraghdam M, Farahani AJ, Alishiri G, Heydari S, Ebrahimnia M, Samadinia H, et al. Epidemiological characteristics of coronavirus disease 2019 (COVID-19) patients in IRAN: A single center study. Journal of Clinical Virology. 2020;127:104378.
19. Yang X, Yu Y, Xu J, Shu H, Liu H, Wu Y, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. The Lancet Respiratory Medicine. 2020;8(5):475-81.
20. Li K, Wu J, Wu F, Guo D, Chen L, Fang Z, et al. The clinical and chest CT features associated with severe and critical COVID-19 pneumonia. Investigative radiology. 2020.
21. Huang G, Gong T, Wang G, Wang J, Guo X, Cai E, et al. Timely diagnosis and treatment shortens the time to resolution of coronavirus disease (COVID-19) pneumonia and lowers the highest and last CT scores from sequential chest CT. American Journal of Roentgenology. 2020;215(2):367-73.
22. Li K, Fang Y, Li W, Pan C, Qin P, Zhong Y, et al. CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19). European radiology. 2020;30(8):4407-16.
23. Li Y, Xia L. Coronavirus disease 2019 (COVID-19): role of chest CT in diagnosis and management. American Journal of Roentgenology. 2020;214(6):1280-6.
24. Zhu Y, Gao Z-H, Liu Y-L, Xu D-Y, Guan T-M, Li Z-P, et al. Clinical and CT imaging features of 2019 novel coronavirus disease (COVID-19). The Journal of infection. 2020;81(1):147.
25. Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): a systematic review of imaging findings in 919 patients. American Journal of Roentgenology. 2020;215(1):87-93.
26. Wyrwich KW, Yu H, Sato R, Powers JH. Observational longitudinal study of symptom burden and time for recovery from community-acquired pneumonia reported by older adults surveyed nationwide using the CAP Burden of Illness Questionnaire. Patient related outcome measures. 2015;6:215.
27. Wootton DG, Dickinson L, Pertinez H, Eneje O, Keogan L, Macfarlane L, et al. A longitudinal modelling study estimates acute symptoms of community acquired pneumonia recover to baseline by 10 days. European Respiratory Journal. 2017;49(6).
28. Yang R, Li X, Liu H, Zhen Y, Zhang X, Xiong Q, et al. Chest CT severity score: an imaging tool for assessing severe COVID-19. Radiology: Cardiothoracic Imaging. 2020;2(2):e200047.
29. Heustess AM, Allard MA, Thompson DK, Fasinu PS. Clinical Management of COVID-19: A Review of Pharmacological Treatment Options. Pharmaceuticals. 2021;14(6):520.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Copyright (c) 2022 Updates in Emergency Medicine Creative Commons License This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
