Over 90% of hospitalized COVID-19 patients have lung lesions 2 years following discharge

Key takeaways:

• Between the 6- to 12-month and 18- to 24-month visits, more patients with fibrotic-like lesions worsened vs. improved.
• Requiring invasive mechanical ventilation raised odds for fibrotic lesion development.

Two years after COVID-19 hospitalization, 92% of patients continued to have either non-fibrotic-like or fibrotic-like lesions on CT scans, according to results published in The Lancet Regional Health — Americas.

“We believe this study will have a significant impact for understanding of how the pulmonary health of post-COVID-19 patients evolve at the long-term and provide guidance to the health systems in the identification of patient’s profile that are susceptible to develop lung lesions years after the hospitalization and requiring specialized treatment,” Carlos Roberto Ribeiro Carvalho, full professor at University of São Paulo’s Medical School, and colleagues wrote.

In an ambidirectional study, Carvalho and colleagues analyzed 237 adults (mean age, 56.3 years; 47% men; 68% requiring ICU care) previously hospitalized for COVID-19 between March and August 2020 in São Paulo with CT scans 6 to 12 months after discharge and another visit 18 to 24 months after discharge. They specifically focused on patients with pulmonary lesions 6 to 12 months after discharge to find out how abnormalities evolve via chest CT scans at 18 to 24 months after discharge.

Over half of the total cohort (58%; n = 139) had non-fibrotic-like lesions at both the 6- to 12-month visit and the 18- to 24-month visit, whereas a third (33%; n = 80) had fibrotic-like lesions, such as traction bronchiectasis and architectural distortion, according to researchers.

Several demographics, hospitalization variables and ICU characteristics significantly differed between those with non-fibrotic-like lesions and those with fibrotic-like lesions, including:

• median BMI (33.5 kg/m² vs. 30.5 kg/m²);
• median hospital length of stay (11 days vs. 28 days);
• proportion of patients receiving ICU care (55% vs. 91%);
• median ICU length of stay (8 days vs. 15 days);
• proportion of patients receiving invasive mechanical ventilation (61% vs. 81%); and
• proportion of patients receiving tracheostomy (3% vs. 18%).

Further, researchers observed significant differences in the non-fibrotic-like lesion group vs. the fibrotic-like lesion group when assessing median CT scores (3 vs. 14), the proportion of patients with a CT score of seven or higher (23% vs. 96%), median FEV₁/FVC (81.7 vs. 83.8), median predicted total lung capacity (86 vs. 82.5), median predicted residual volume (83 vs. 76) and median predicted diffusion capacity for carbon monoxide (84% vs. 78%).

In an assessment of 75 of the patients with fibrotic-like lesions and 135 of the patients with non-fibrotic-like lesions, the odds for fibrotic-like lung lesion development significantly went up with invasive mechanical ventilation requirement (OR = 3.11; 95% CI, 1.3-7.58), longer hospital stays (OR = 1.04; 95% CI, 1.01-1.07) and older age (OR = 1.03; 95% CI, 1.01-1.06).

Between the 6- to 12-month visit and the 18- to 24-month visit, more patients evolved to having fibrotic-like lesions vs. transitioning to having non-fibrotic-like lesions (20 patients vs. five patients).

At 18 to 24 months vs. 6 to 12 months, a significantly greater proportion of patients had architectural distortion (28% vs. 21%), traction bronchiectasis (34% vs. 27%), the mosaic attenuation pattern (41% vs. 14%) and bronchial wall thickening (53% vs. 22%).

In contrast, a variable that appeared in significantly fewer patients at 18 to 24 months vs. 6 to 12 months was altered oximetry (17% vs. 4%), according to researchers.

Abnormalities that remained unchanged from the 6- to 12-month visit to the 18- to 24-month visit included restrictive pattern presence (42% vs. 44%), obstructive pattern presence (8% vs. 9%) and reduced diffusion capacity (42% vs. 42%).

Between those who evolved to fibrotic-like lesions and those who continued to have non-fibrotic-like lesions at 18 to 24 months (n = 134), researchers found significant differences in several factors:

• median hospital length of stay (21.5 days vs. 10 days);
• proportion of patients receiving ICU care (95% vs. 54%);
• proportion of patients with dyspnea (25% vs. 62%);
• median CT score (9 vs. 2);
• proportion of patients with a CT score of seven or higher (84% vs. 21%); and
• median FEV₁/FVC (80.3 vs. 83).

“Due to the non-homogenous evolution of chronic post-COVID-19 patients, it is essential to keep the long-term monitoring of their lung health,” Carvalho and colleagues wrote.

Reference:

• Lung complications can worsen two years after hospitalization for severe COVID-19. https://agencia.fapesp.br/lung-complications-can-worsen-two-years-after-hospitalization-for-severe-covid-19/52158. Published July 10, 2024. Accessed July 15, 2024.