Thousands of Coronavirus Disease 2019 (COVID-19) patients have been discharged from hospitals Persistent follow-up studies are required to evaluate the prevalence of post-COVID-19 fibrosis. This study involves 462 laboratory-confirmed patients with COVID-19 who were admitted to Shenzhen Third People’s Hospital from January 11, 2020 to April 26, 2020. A total of 457 patients underwent thin-section chest CT scans during the hospitalization or after discharge to identify the pulmonary lesion. A total of 287 patients were followed up from 90 to 150 days after the onset of the disease, and lung function tests were conducted about three months after the onset. The risk factors affecting the persistence of pulmonary fibrosis were identified through regression analysis and the prediction model of the persistence of pulmonary fibrosis was established. Parenchymal bands, irregular interfaces, reticulation and traction bronchiectasis were the most common CT features in all COVID-19 patients. During the 0–30, 31–60, 61–90, 91–120 and > 120 days after onset, 86.87%, 74.40%, 79.56%, 68.12% and 62.03% patients developed with pulmonary fibrosis and 4.53%, 19.61%, 18.02%, 38.30% and 48.98% patients reversed pulmonary fibrosis, respectively. It was observed that Age, BMI, Fever, and Highest PCT were predictive factors for sustaining fibrosis even after 90 days from onset. A predictive model of the persistence with pulmonary fibrosis was developed based-on the Logistic Regression method with an accuracy, PPV, NPV, Sensitivity and Specificity of the model of 76%, 71%, 79%, 67%, and 82%, respectively. More than half of the COVID-19 patients revealed abnormal conditions in lung function after 90 days from onset, and the ratio of abnormal lung function did not differ on a statistically significant level between the fibrotic and non-fibrotic groups. Persistent pulmonary fibrosis was more likely to develop in patients with older age, higher BMI, severe/critical condition, fever, a longer viral clearance time, pre-existing disease and delayed hospitalization. Fibrosis developed in COVID-19 patients could be reversed in about a third of the patients after 120 days from onset. The pulmonary function of less than half of COVID-19 patients could turn to normal condition after three months from onset. An effective prediction model with an average area under the curve (AUC) of 0.84 was established to predict the persistence of pulmonary fibrosis in COVID-19 patients for early diagnosis.

中文翻译：

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新型冠状病毒肺炎出院患者肺纤维化及其相关因素的队列研究


数千名 2019 冠状病毒病 (COVID-19) 患者已出院。需要持续的随访研究来评估 COVID-19 后纤维化的患病率。本研究涉及2020年1月11日至2020年4月26日期间深圳市第三人民医院收治的462名实验室确诊的COVID-19患者。共有457名患者在住院期间或出院后接受了薄层胸部CT扫描识别肺部病变。共有287名患者在发病后90至150天进行随访，并在发病后约三个月进行肺功能检查。通过回归分析确定影响肺纤维化持续存在的危险因素，并建立肺纤维化持续存在的预测模型。实质带、不规则界面、网状和牵拉性支气管扩张是所有 COVID-19 患者最常见的 CT 特征。发病后0-30、31-60、61-90、91-120和>120天期间，86.87%、74.40%、79.56%、68.12%和62.03%的患者出现肺纤维化，4.53%、19.61%的患者出现肺纤维化。分别有18.02%、38.30%和48.98%的患者逆转了肺纤维化。据观察，即使在发病 90 天后，年龄、BMI、发烧和最高 PCT 仍是持续纤维化的预测因素。基于Logistic回归方法建立了肺纤维化持续性的预测模型，模型的准确度、PPV、NPV、敏感性和特异性分别为76%、71%、79%、67%和82% 。 超过一半的COVID-19患者在发病90天后发现肺功能异常，并且纤维化组和非纤维化组之间肺功能异常的比例没有统计学上的显着差异。年龄较大、BMI较高、病情严重/危重、发烧、病毒清除时间较长、已有疾病和延迟住院的患者更容易发生持续性肺纤维化。 COVID-19 患者出现的纤维化在发病 120 天后，大约三分之一的患者可以逆转。不到一半的COVID-19患者的肺功能可以在发病三个月后恢复正常。建立了平均曲线下面积（AUC）为0.84的有效预测模型，用于预测COVID-19患者肺纤维化的持续程度，以便早期诊断。