Postacute Sequelae of COVID-19 Pneumonia: 6-month Chest CT Follow-up

Caruso, Damiano; Guido, Gisella; Zerunian, Marta; Polidori, Tiziano; Lucertini, Elena; Pucciarelli, Francesco; Polici, Michela; Rucci, Carlotta; Bracci, Benedetta; Nicolai, Matteo; Cremona, Antonio; De Dominicis, Chiara; Laghi, Andrea

BACKGROUND: The long-term post acute pulmonary sequelae of COVID-19 remain unknown. PURPOSE: To evaluate lung injury in patients affected by COVID-19 pneumonia at six-month follow-up compared to baseline chest CT. METHODS: From March 19th,2020 to May 24th,2020, patients with moderate to severe COVID-19 pneumonia and baseline Chest CT were prospectively enrolled at six-months follow-up. CT qualitative findings, semi-quantitative Lungs Severity Score (LSS) and well-aerated lung quantitative Chest CT (QCCT) were analyzed. Baseline LSS and QCCT performances in predicting fibrotic-like changes (reticular pattern and/or honeycombing) at six-month follow-up Chest CT were tested with receiver operating characteristic curves. Univariable and multivariable logistic regression analysis were used to test clinical and radiological features predictive of fibrotic-like changes. The multivariable analysis was performed with clinical parameters alone (clinical model), radiological parameters alone (radiological model) and the combination of clinical and radiological parameters (combined model). RESULTS: One-hundred-eighteen patients, with both baseline and six-month follow-up Chest CT, were included in the study (62 female, mean age 65±12 years). At follow-up Chest CT, 85/118 (72%) patients showed fibrotic-like changes and 49/118 (42%) showed GGOs. Baseline LSS (>14), QCCT (≤3.75L and ≤80%) showed an excellent performance in predicting fibrotic-like changes at Chest CT follow-up. In the multivariable analysis, AUC was .89 (95%CI .77-.96) for the clinical model, .81 (95%CI .68-.9) for the radiological model and .92 (95%CI .81-.98)for the combined model. CONCLUSION: At six-month follow-up Chest CT, 72% of patients showed late sequelae, in particular fibrotic-like changes. Baseline LSS and QCCT of well-aerated lung showed an excellent performance in predicting fibrotic-like changes at six-month Chest CT (AUC>.88). Male sex, cough, lymphocytosis and QCCT well-aerated lung were significant predictors of fibrotic-like changes at six-month with an inverse correlation (AUC .92). See also the editorial by Wells and Devaraj.