Risk factors for persistent abnormality on chest radiographs at 12-weeks post hospitalisation with PCR confirmed COVID-19

• Published in: Respiratory research Vol. 22; no. 1; pp. 1 - 157
• Main Authors: Wallis, T. J. M, Heiden, E, Horno, J, Welham, B, Burke, H, Freeman, A, Dexter, L, Fazleen, A, Kong, A, McQuitty, C, Watson, M, Poole, S, Brendish, N. J, Clark, T. W, Wilkinson, T. M. A, Jones, M. G, Marshall, B. G
• Format: Journal Article
• Language: English
• Published: London BioMed Central Ltd 21-05-2021; BioMed Central; BMC
• Subjects: Abnormalities; Blood tests; Chest; Chest radiograph; Clinical outcomes; Coronaviruses; COVID-19; Demographics; Demography; Diseases; Ethnicity; Fibrosis; Follow-up study; Hospital care; Infections; LDH; Length of stay; Lung diseases; Multivariate analysis; Obesity; Patients; Pulmonary fibrosis; Radiographs; Radiography; Regression analysis; Respiratory diseases; Risk analysis; Risk factors; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Smoking; Statistics; United Kingdom; United Kingdom > UK
• ISSN: 1465-993X; 1465-9921; 1465-993X; 1465-9921
• DOI: 10.1186/s12931-021-01750-8

Abstract
Background
The long-term consequences of COVID-19 remain unclear. There is concern a proportion of patients will progress to develop pulmonary fibrosis. We aimed to assess the temporal change in CXR infiltrates in a cohort of patients following hospitalisation for COVID-19.
Methods
We conducted a single-centre prospective cohort study of patients admitted to University Hospital Southampton with confirmed SARS-CoV2 infection between 20th March and 3rd June 2020. Patients were approached for standard-of-care follow-up 12-weeks after hospitalisation. Inpatient and follow-up CXRs were scored by the assessing clinician for extent of pulmonary infiltrates; 0–4 per lung (Nil = 0, < 25% = 1, 25–50% = 2, 51–75% = 3, > 75% = 4).
Results
101 patients with paired CXRs were included. Demographics: 53% male with a median (IQR) age 53.0 (45–63) years and length of stay 9 (5–17.5) days. The median CXR follow-up interval was 82 (77–86) days with median baseline and follow-up CXR scores of 4.0 (3–5) and 0.0 (0–1) respectively. 32% of patients had persistent CXR abnormality at 12-weeks. In multivariate analysis length of stay (LOS), smoking-status and obesity were identified as independent risk factors for persistent CXR abnormality. Serum LDH was significantly higher at baseline and at follow-up in patients with CXR abnormalities compared to those with resolution. A 5-point composite risk score (1-point each; LOS ≥ 15 days, Level 2/3 admission, LDH > 750 U/L, obesity and smoking-status) strongly predicted risk of persistent radiograph abnormality (0.81).
Conclusion
Persistent CXR abnormality 12-weeks post COVID-19 was common in this cohort. LOS, obesity, increased serum LDH, and smoking-status were risk factors for radiograph abnormality. These findings require further prospective validation.