Predictors of pulmonary sequelae after COVID-19 pneumonia: A 12-month follow-up study

Nicol Bernardinello; Elisabetta Cocconcelli; Chiara Giraudo; Matteo Daverio; Gioele Castelli; Simone Petrarulo; Matteo Bovo; Giulia Fichera; Silvia Cavinato; Anna Maria Cattelan; Marina Saetta; Paolo Spagnolo; Elisabetta Balestro

doi:10.3389/fmed.2023.1084002

Predictors of pulmonary sequelae after COVID-19 pneumonia: A 12-month follow-up study

Front Med (Lausanne). 2023 Feb 2:10:1084002. doi: 10.3389/fmed.2023.1084002. eCollection 2023.

Affiliations

¹ Respiratory Disease Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova and Padova City Hospital, Padova, Italy.
² Department of Medicine, Institute of Radiology, University of Padova and Padova City Hospital, Padova, Italy.
³ School of Medicine and Surgery, University of Padova, Padova, Italy.
⁴ Pediatric Radiology Unit, University of Padova and Padova City Hospital, Padova, Italy.
⁵ Division of Infectious and Tropical Diseases, University of Padova and Padova City Hospital, Padova, Italy.

Abstract

Background: Since the beginning of the SARS-CoV-2 pandemic, over 550 million people have been infected worldwide. Despite these large numbers, the long-term pulmonary consequences of COVID-19 remain unclear.

Aims: The aim of this single-center observational cohort study was to identify and characterize pulmonary sequelae of COVID-19 at 12 months from hospitalization and to reveal possible predictors for the persistence of long-term lung consequences.

Methods: Based on the persistence or absence of radiological changes after 12 months from hospitalization, the whole population was categorized into NOT-RECOVERED (NOT-REC) and RECOVERED (REC) groups, respectively. Clinical and pulmonary function data tests and clinical data were also collected and compared in the two groups. In the NOT-REC group, high resolution computed tomography (HRCT) images were semiquantitatively scored analyzing ground-glass opacities (GGO), interstitial thickening (IT), consolidations (CO), linear and curvilinear band opacities, and bronchiectasis for each lung lobe. Logistic regression analyses served to detect the factors associated with 12-month radiological consequences.

Results: Out of the 421 patients followed after hospitalization for SARS-CoV-2 pneumonia, 347 met inclusion and exclusion criteria and were enrolled in the study. The NOT-REC patients (n = 24; 6.9%) were significantly older [67 (62-76) years vs. 63 (53-71) years; p = 0.02], more frequently current smokers [4 (17%) vs. 12 (4%); p = 0.02], and with more severe respiratory failure at the time of hospitalization [PaO₂/FiO₂ at admission: 201 (101-314) vs. 295 (223-343); p = 0.01] compared to REC group (n = 323; 93.1%). On multivariable analysis, being a current smoker resulted in an independent predictor for lung sequelae after 12 months from hospitalization [5.6 OR; 95% CI (1.41-22.12); p = 0.01].

Conclusion: After 12 months from hospital admission, a limited number of patients displayed persistent pulmonary sequelae with minimal extension. Being a current smoker at the time of SARS-CoV-2 infection is an independent predictive factor to lung consequences, regardless of the disease severity.

Keywords: 12-month follow-up; COVID-19; CT scan; SARS-CoV-2; pulmonary fibrosis.