Patients with COVID-19 hyperinflammation, high CT results have poor respiratory outcomes

Key takeaways:

• 3 months after discharge, survivors of COVID-19-related hyperinflammation had lower CT severity scores vs. when hospitalized.
• Patients with impaired lung function had higher scores at admission and follow-up.

Higher CT severity scores at hospitalization and 3 months after were linked to poorer lung function in survivors of COVID-19-associated hyperinflammation, according to study results published in BMC Pulmonary Medicine.

“There is no global guideline about the follow-up of hospitalized COVID-19 patients,” Marlou T.H.F. Janssen, MD, of the department of pulmonology at Zuyderland Medical Centre, told Healio. “We think that patients with extensive radiological disease due to COVID-19 should be monitored strictly because these patients have worse respiratory outcomes.”

In a prospective cohort study, Janssen and colleagues analyzed 113 patients (mean age, 63 years; 82.3% men) who survived after being hospitalized with COVID-19-associated hyperinflammation to understand how chest CT severity scores (CT-SS) are related to various respiratory outcomes in these patients at the moment they are admitted and at 3 months after discharge.

Alongside CT scores, researchers looked at results of patients’ pulmonary function and 6-minute walk tests and patient reported dyspnea, depression/anxiety and quality of life to see how they were related to CT-SSs from both time periods.

Of the total cohort, five patients did not have a CT measurement at both hospitalization and at 3 months after hospitalization.

By comparing the mean CT-SS at hospitalization (15.2) with the mean CT-SS after 3 months (8.8), researchers found a 40.4% decline in this score over 3 months (P < .001), which suggests that patients have less CT abnormalities with time after hospitalization.

When evaluating who had high mean hospital admission CT-SSs, researchers identified those who needed higher oxygen supplementation, such as nasal oxygen (13.6), Oxymask/non-rebreathing mask (14.8), high-flow nasal cannula (15.3) and mechanical ventilation (18.2; P < .001), throughout their entire hospital stay.

At hospitalization, patients who had elevated CT-SS showed poorer total lung capacity at the 3-month follow-up visit, at less than 80% predicted (16.6 vs. 80% predicted, 14.8; P = .041) and diffusing capacity for carbon monoxide (DLCO) less than 40% predicted (17.4 vs. > 80% predicted, 14; P = .026).

Similar to the patient population with high CT-SSs at hospitalization, patients who received more oxygen suppletion, such as nasal oxygen (7.1), Oxymask/non-rebreathing mask (8.8), high-flow nasal cannula (9.2) and mechanical ventilation (10.6; P = .007), throughout their entire hospital stay also had heightened scores during the 3-month follow-up but lower than those from hospitalization.

In this follow-up, researchers again found that elevated mean CT-SSs are linked to worse total lung capacity (< 80% predicted, 11.2 vs. 80% predicted, 7.8; P < .001) and DLCO (< 40% predicted, 14.3 vs. > 80% predicted, 7.4; P = .002).

Additionally, researchers identified greater CT-SSs among patients with modified Medical Research Council Dyspnea Scale scores of 3-4 compared with those with a smaller dyspnea score (11.03 vs. 8.31; P = .02).

“Although it seems logical that patients with more extensive disease have worse respiratory outcomes at the acute phase of the disease, this study also showed that these patients have worse respiratory outcomes at 3 months after hospitalization,” Janssen told Healio.

In a subgroup analysis of 63 patients treated with methylprednisolone with/without tocilizumab and 50 control patients treated with standard care/no immunomodulatory therapy, control patients had a greater CT-SS at admission (16.1 vs. 14.6; P = .042), according to researchers. However, this changed in the 3-month period because the treated patients had a higher CT-SS (9.47 vs. 7.91). This difference became statistically significant after the researchers adjusted for confounders (P = .029).

Over the study period, researchers found that patients treated with standard care/no immunomodulatory therapy had a larger CT-SS decline than treated patients (8.19 vs. 5.13: P = .001). However, Janssen told Healio to interpret the results of the subgroup analysis with caution.

“The extent to which the groups are comparable is unknown and the number of patients in the subgroups is relatively small,” Janssen said.

In terms of future studies, fewer patients develop COVID-19-associated hyperinflammation because of vaccines, so it is less prevalent now, Janssen told Healio.

Additionally, Janssen said PCR testing, rather than chest CT, is the current main choice for COVID-19 screening.

For more information:

Marlou T.H.F. Janssen, MD, can be reached at marl.janssen4@zuyderland.nl.