CT-based Assessment at 6-Month Follow-up of COVID-19 Pneumonia patients in China | Scientific Reports – Nature.com

Participant characteristics

A total of 271 participants (meanSD, 61years12) were assessed, and 113 participants were women (41.7%). The baseline and clinical characteristics are summarized in Table 1. Of the 271 participants, the median body mass index was 21.8kg/m2 (IQR, 17.129.1), and 80 (29.5%) were smokers. 148 participants (54.6%) had different types of comorbidities and common comorbidities included hypertension (82 participants, 30.3%), type II diabetes mellitus (80 participants, 29.5%), ischemic heart disease (61 participants, 22.5%), chronic obstructive pulmonary disease (18 participants, 6.6%) and previous venous thromboembolism (10 participants, 3.7%). The median hospital stay was 12days (IQR, 420days), with 68 participants (25.1%) requiring the highest level of ventilatory support in the form of invasive ventilation or noninvasive positive pressure ventilation. Participants are treated with medications mainly including paxlovid (183 participants, 67.5%), azvudine (60 participants, 22.1%) and glucocorticoid (69 participants, 25.5%).

Compared of baseline and clinical characteristics, age (mean, 58years11 vs 65years12, P<0.001), smoker (42 participants [24.3%] vs 38 participants [38.8%], P=0.04), heart rate (mean, 83 times per minute14 vs 92 times per minute16, P=0.02), respiratory rate (mean, 20 times per minute7 vs 24 times per minute9, P=0.03), oxygen saturation on room air (SaO2, 96%, IQR, 8899% vs 92%, IQR, 8098%, P=0.001), chronic obstructive pulmonary disease (COPD, 10 participants [5.8%] vs 8 participants [8.1%], P=0.02), length of hospital stay (11days, IQR, 414days vs 16days, IQR, 1027days, P<0.001), invasive ventilation (2 participants [1.6%] vs 15 participants [15.3%], P<0.001) and using paxlovid (147 participants [85.0%] vs 36 participants [36.7%], P<0.001) demonstrated a statistically significant difference between participants with normal and abnormal chest CT at 6-month follow-up.

All participants underwent a 6-month follow-up chest CT at a median of 177days (IQR, 155203days) after hospital admission and pulmonary residual abnormalities were found in 98 participants (36.2%). Compared to the initial CT (Table 2), participants with GGO decreased from 270 (99.6%) to 66 (24.4%) and consolidation decreased from 111 (41.0%) to 20 (7.4%) (Fig.2). Meanwhile, participants with reticulation increased from 19 (7.0%) to 57 (21.0%). The ARDS pattern in three participants (1.1%) and crazy paving pattern in two participants (0.7%) at initial CT had disappeared at 6-month follow-up CT. Participants with organizing pneumonia pattern increased from four (1.5%) to seven (2.6%). Among CT evidence of fibrotic-like changes, participants with linear atelectasis increased from four (1.5%) to seven (2.6%) (Fig.3), participants with bronchiectasis and parenchymal bands increased from six (2.2%) to 31 (11.4%) (Fig.4) and 14 (5.2%) (Fig.5) respectively. There was no change in the three participants (1.1%) with honeycombing. In summary, 39 participants (14.4%) demonstrated new suspicious fibrotic-like changes at 6-month follow-up CT.

Serial chest CT scans in a 45-year-old man with severe coronavirus disease 2019 pneumonia. (A, B) Initial CT scans obtained on day 5 after the onset of symptoms showed extensive ground-glass opacities (GGO) with some areas of consolidation bilaterally. (C, D) CT scans obtained on day 9 showed extensive consolidation with few GGOs bilaterally. (E, F) CT scans obtained on day 179 showed almost absorption of the abnormalities with mild GGOs and interstitial thickening remaining.

Serial chest CT scans in a 61-year-old man with coronavirus disease 2019 pneumonia. (A, B) Initial CT scans obtained on day 4 after the onset of symptoms showed multiple ground-glass opacities and consolidation bilaterally. (C) CT scans obtained on day 22 showed moderate consolidation and reticulation in the lower lung lobes bilaterally. (D) CT scans obtained on day 191 showed obviously absorption of the abnormalities with subtle reticulation and linear atelectasis (arrow) in the lower lung lobes.

Serial chest CT scans in a 60-year-old man with coronavirus disease 2019 pneumonia. (A, B) Initial CT scans obtained on day 8 after the onset of symptoms showed multiple ground-glass opacities and interstitial thickening bilaterally. (C, D) CT scans obtained on day 180 showed traction bronchiectasis (white arrow) and interlobar pleural traction (black arrow) in the upper lobe of right lung.

Serial chest CT scans in a 54-year-old man with coronavirus disease 2019 pneumonia. (A) Initial CT scans obtained on day 9 after the onset of symptoms showed multiple ground-glass opacities and interstitial thickening bilaterally. (B)CT scans obtained on day 169 showed traction bronchiectasis (white arrow) and parenchymal bands (black arrow) in the lower lung lobes.

In the Chest CT scores (Table 3), a significantly decrease was found for any abnormality (P<0.001), GGO (P<0.001), and consolidation (P<0.001), whereas a significantly increase for fibrotic-like abnormalities (P<0.001) compared with the initial CT scans. Meanwhile, reticulation showed insignificantly change between two CT scans (P=0.33).

In the univariate analysis, paxlovid (odd ratio [OR]: 0.08; 95% CI 0.03, 0.21; P<0.001), invasive ventilation (OR 9.3; 95% CI 2.8, 29; P<0.001), age>60years (OR 6.5; 95% CI 2.7, 17; P<0.001), SaO2 less than 93% at admission (OR 4.5; 95% CI 1.4, 14; P<0.001), hospitalization more than 15days (OR 3.8; 95% CI 1.3, 11; P=0.002), and respiratory rate more than 23 times per minute at admission (OR 3.3; 95% CI 1.3, 8.7; P=0.004) were associated with pulmonary residual abnormalities at 6-month follow-up CT. In the multivariate analysis, the predictive factors were invasive ventilation (OR 13.6; 95% CI 1.9, 45; P<0.001), age>60years (OR 9.1; 95% CI 2.3, 39; P=0.01), paxlovid (OR 0.11; 95% CI 0.04, 0.48; P=0.01), hospitalization more than 15days (OR 6.1; 95% CI 1.2, 26; P=0.002), heart rate greater than 100 times per minute (OR 5.9; 95% CI 1.1, 27; P=0.03), and SaO2 less than 93% at admission (OR 5.6; 95% CI 1.4, 13; P=0.02) (Table 4).

In the univariate analysis, paxlovid (OR 0.11; 95% CI 0.04, 0.32; P<0.001), invasive ventilation (OR 8.8; 95% CI 2.1, 26; P<0.001), smoker (OR 7.4; 95% CI 3.0, 16; P<0.001), SaO2 less than 93% at admission (OR 4.5; 95% CI 1.2, 16; P=0.002) and age>60years (OR 4.2; 95% CI 1.3, 11; P=0.002) were associated with pulmonary fibrotic-like changes at 6-month follow-up CT. In the multivariate analysis, the predictive factors were invasive ventilation (OR 10.3; 95% CI 2.9, 33; P=0.002), smoker (OR 9.9; 95% CI 2.4, 31; P=0.01), paxlovid (OR 0.1; 95% CI 0.03, 0.48; P=0.01), SaO2 less than 93% at admission (OR 7.8; 95% CI 1.5, 19; P=0.02), age>60years (OR 6.1; 95% CI 2.3, 22; P=0.03) and heart rate greater than 100 times per minute (OR 4.9; 95% CI 1.7, 11; P=0.04) (Table 5).

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CT-based Assessment at 6-Month Follow-up of COVID-19 Pneumonia patients in China | Scientific Reports - Nature.com