Chest radiography is a poor predictor of respiratory symptoms and functional impairment in survivors of severe COVID-19 pneumonia

D'Cruz, Rebecca F.; Waller, Michael D.; Perrin, Felicity; Periselneris, Jimstan; Norton, Sam; Smith, Laura-Jane; Patrick, Tanya; Walder, David; Heitmann, Amadea; Lee, Kai; Madula, Rajiv; McNulty, William; Macedo, Patricia; Lyall, Rebecca; Warwick, Geoffrey; Galloway, James B.; Birring, Surinder S.; Patel, Amit; Patel, Irem; Jolley, Caroline J.

BACKGROUND: A standardised approach to assessing COVID-19 survivors has not been established, largely due to the paucity of data on medium- and long-term sequelae. Interval chest radiograph is recommended following community-acquired pneumonia, however its utility in monitoring recovery from COVID-19 pneumonia remains unclear. METHODS: Prospective single-centre observational cohort study. Patients hospitalised with severe COVID-19 pneumonia (admission duration ≥48 h and oxygen requirement ≥40% or critical care admission) underwent face-to-face assessment 4–6 weeks post-discharge. Primary outcome: radiological resolution of COVID-19 pneumonitis (Radiographic Assessment of Lung Oedema score <5). Secondary outcomes: clinical outcomes, symptom questionnaires, mental health screening (Trauma Screening Questionnaire, GAD-7, PHQ-9), physiological testing (4-metre gait speed (4MGS), 1-minute sit-to-stand test (STS)). RESULTS: 119 patients assessed between 3(rd) June and 2(nd) July 2020 at median (IQR) 61 (51–67) days post-discharge. Mean±sd age 58.7±14.4 years, body mass index 30.0 (25.9–35.2) kg·m(−2), 62% male, 68% ethnic minority. Despite radiographic resolution of pulmonary infiltrates in 87%, mMRC breathlessness scores were above pre-COVID baseline in 46% and patients reported persistent fatigue (68%), sleep disturbance (57%) and breathlessness (32%). Screening thresholds were breached for post-traumatic stress disorder (25%), anxiety (22%) and depression (18%). 4MGS was slow (<0.8 m·s(−1)) in 38%, 35% desaturated by ≥4% during STS. Of 56 thoracic computed tomography scans performed, 75% demonstrated COVID-related interstitial and/or airways disease. CONCLUSIONS: Persistent symptoms, adverse mental health outcomes and physiological impairment are common 2 months after severe COVID-19 pneumonia. Follow-up chest radiograph is a poor marker of recovery, therefore holistic face-to-face assessment is recommended to facilitate early recognition and management of post-COVID sequelae.