Background

Data on the long-term pulmonary sequelae in COVID-19 are lacking.

Purpose

To assess symptoms, functional impairment, and residual pulmonary abnormalities on serial chest CT scans in COVID-19 survivors discharged from hospital at up to 1-year follow-up.

Materials and Methods

Adult patients with COVID-19 discharged between March 2020 and June 2020 were prospectively evaluated at 3 months and 1 year through systematic assessment of symptoms, functional impairment, and thoracic CT scans as part of the PHENOTYPE study, an observational cohort study in COVID-19 survivors. Lung function testing was limited to participants with CT abnormalities and/or persistent breathlessness. Bonferroni correction was used.

Results

Eighty participants (mean age, 59 years ± 13 [SD]; 53 men) were assessed. At outpatient review, persistent breathlessness was reported in 37 of the 80 participants (46%) and cough was reported in 17 (21%). CT scans in 73 participants after discharge (median, 105 days; IQR, 95–141 days) revealed persistent abnormalities in 41 participants (56%), with ground-glass opacification (35 of 73 participants [48%]) and bands (27 of 73 participants [37%]) predominating. Unequivocal signs indicative of established fibrosis (ie, volume loss and/or traction bronchiectasis) were present in nine of 73 participants (12%). Higher admission serum C-reactive protein (in milligrams per liter), fibrinogen (in grams per deciliter), urea (millimoles per liter), and creatinine (micromoles per liter) levels; longer hospital stay (in days); older age (in years); and requirement for invasive ventilation were associated with CT abnormalities at 3-month follow-up. Thirty-two of 41 participants (78%) with abnormal findings at 3-month follow-up CT underwent repeat imaging at a median of 364 days (range, 360–366 days), with 26 (81%) showing further radiologic improvement (median, 18%; IQR, 10%–40%).

Conclusion

CT abnormalities were common at 3 months after COVID-19 but with signs of fibrosis in a minority. More severe acute disease was linked with CT abnormalities at 3 months. However, radiologic improvement was seen in the majority at 1-year follow-up.

ClinicalTrials.gov identifier: NCT04459351.

© RSNA, 2022

Online supplemental material is available for this article.

中文翻译：

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COVID-19 出院后 3 个月和 1 年后 CT 肺部异常

背景

缺乏有关 COVID-19 长期肺部后遗症的数据。

目的

旨在评估出院后长达 1 年随访的 COVID-19 幸存者的症状、功能障碍和连续胸部 CT 扫描的残留肺部异常。

材料和方法

作为 PHENOTYPE 研究（一项针对 COVID-19 的观察性队列研究）的一部分，通过对症状、功能损伤和胸部 CT 扫描的系统评估，对 2020 年 3 月至 2020 年 6 月期间出院的 COVID-19 成年患者进行了 3 个月和 1 年的前瞻性评估幸存者。肺功能测试仅限于 CT 异常和/或持续性呼吸困难的参与者。使用 Bonferroni 校正。

结果

80 名参与者（平均年龄，59 岁±13 [SD]；53 名男性）接受了评估。在门诊审查中，80 名参与者中有 37 名 (46%) 报告持续呼吸困难，17 名 (21%) 报告有咳嗽。出院后 73 名参与者的 CT 扫描（中位时间为 105 天；IQR，95-141 天）显示 41 名参与者 (56%) 存在持续异常，包括毛玻璃样混浊（73 名参与者中的 35 名 [48%]）和条带（27 73 名参与者 [37%]）占主导地位。73 名参与者中有 9 名 (12%) 存在明确的纤维化迹象（即容量减少和/或牵拉性支气管扩张）。入院血清 C 反应蛋白（毫克/升）、纤维蛋白原（克/分升）、尿素（毫摩尔/升）和肌酐（微摩尔/升）水平较高；住院时间更长（以天为单位）；年龄较大（以岁为单位）；有创通气的需求和有创通气的需求与 3 个月随访时 CT 异常相关。41 名参与者中，32 名 (78%) 在 3 个月的随访 CT 中发现异常结果，并在中位 364 天（范围 360-366 天）时进行了重复成像，其中 26 名 (81%) 的放射学表现进一步改善（中位数，18%；IQR，10%–40%）。

结论

CT 异常在 COVID-19 感染后 3 个月内很常见，但少数有纤维化迹象。更严重的急性疾病与 3 个月时 CT 异常有关。然而，在一年的随访中，大多数人看到放射学改善。

ClinicalTrials.gov 标识符：NCT04459351。

© 北美放射学会，2022

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