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Radiological pulmonary sequelae after COVID-19 and correlation with clinical and functional pulmonary evaluation: results of a prospective cohort

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Abstract

Objectives

Whether COVID-19 leads to long-term pulmonary sequelae or not remains unknown. The aim of this study was to assess the prevalence of persisting radiological pulmonary fibrotic lesions in patients hospitalized for COVID-19.

Materials and methods

We conducted a prospective single-center study among patients hospitalized for COVID-19 between March and May 2020. Patients with residual symptoms or admitted into intensive care units were investigated 4 months after discharge by a chest CT (CCT) and pulmonary function tests (PFTs). The primary endpoint was the rate of persistent radiological fibrotic lesions after 4 months. Secondary endpoints included further CCT evaluation at 9 and 16 months, correlation of fibrotic lesions with clinical and PFT evaluation, and assessment of predictive factors.

Results

Among the 1151 patients hospitalized for COVID-19, 169 patients performed a CCT at 4 months. CCTs showed pulmonary fibrotic lesions in 19% of the patients (32/169). These lesions were persistent at 9 months and 16 months in 97% (29/30) and 95% of patients (18/19) respectively. There was no significant clinical difference based on dyspnea scale in patients with pulmonary fibrosis. However, PFT evaluation showed significantly decreased diffusing lung capacity for carbon monoxide (p < 0.001) and total lung capacity (p < 0.001) in patients with radiological lesions. In multivariate analysis, the predictive factors of radiological pulmonary fibrotic lesions were pulmonary embolism (OR = 9.0), high-flow oxygen (OR = 6.37), and mechanical ventilation (OR = 3.49).

Conclusion

At 4 months, 19% of patients investigated after hospitalization for COVID-19 had radiological pulmonary fibrotic lesions; they persisted up to 16 months.

Clinical relevance statement

Whether COVID-19 leads to long-term pulmonary sequelae or not remains unknown. The aim of this study was to assess the prevalence of persisting radiological pulmonary fibrotic lesions in patients hospitalized for COVID-19. The prevalence of persisting lesions after COVID-19 remains unclear. We assessed this prevalence and predictive factors leading to fibrotic lesions in a large cohort. The respiratory clinical impact of these lesions was also assessed.

Key Points

• Nineteen percent of patients hospitalized for COVID-19 had radiological fibrotic lesions at 4 months, remaining stable at 16 months.

• COVID-19 fibrotic lesions did not match any infiltrative lung disease pattern.

• COVID-19 fibrotic lesions were associated with pulmonary function test abnormalities but did not lead to clinical respiratory manifestation.

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Abbreviations

ARDS:

Acute respiratory distress syndrome

CCT:

Chest computed tomography

CI:

95% Confidence interval

COMEBAC:

Consultation multi-expertise de Bicêtre après COVID

COVID-19:

Coronavirus disease 2019

CRP:

C-reactive protein

DLCO:

Lung diffusion capacity for carbon monoxide

FEV1:

Forced expiratory volume at the first second

GGO:

Ground-glass opacity

ICU:

Intensive care unit

IQR:

Interquartile range

LDH:

Lactate dehydrogenase

MERS-CoV:

Middle East respiratory syndrome–related coronavirus

mMRC:

Modified Medical Research Council Scale

OR:

Odds ratio

PFT:

Pulmonary function test

RT-PCR:

Reverse transcriptase-polymerase chain reaction

SARS-CoV:

Severe acute respiratory syndrome coronavirus

TLC:

Total lung capacity

VC:

Vital capacity

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Funding

The authors state that this work has not received any funding.

Author information

Authors and Affiliations

  1. Service de Radiologie Diagnostique Et Interventionnelle, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France

    Samer Soliman, Maud Crézé, Emily Rius, Matthieu Devilder, Marie-France Bellin & Olivier Meyrignac

  2. Service de Gastro-Entérologie, Université Paris-Cité, AP-HP Nord, Hôpital Louis Mourier, Colombes, France

    Heithem Soliman

  3. Service de Radiologie Diagnostique, Université Sorbonne Paris-Nord, AP-HP, Hôpital Avicenne, Bobigny, France

    Pierre-Yves Brillet

  4. DMU 5, Thorinno, Service de Pneumologie Et Soins Intensifs Respiratoires, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Inserm UMR_S999, Le Kremlin-Bicêtre, France

    David Montani, Laurent Savale, Xavier Jais, Sophie Bulifon & Etienne-Marie Jutant

  5. DMU 5 Thorinno, Service de Physiologie Et d’Explorations Fonctionnelles Respiratoires, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Inserm UMR_S999, Le Kremlin-Bicêtre, France

    Antoine Beurnier

  6. DMU 11 Psychiatrie, Santé Mentale, Addictologie Et Nutrition, Service de Psychiatrie, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Équipe MOODS, INSERM U1178, CESP (Centre de Recherche en Epidémiologie Et Santé Des Populations), Le Kremlin-Bicêtre, France

    Romain Colle & Matthieu Gasnier

  7. DMU 4 CORREVE Maladies du Cœur Et Des Vaisseaux,Service de Médecine Intensive-Réanimation, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, FHU Sepsis, Le Kremlin-Bicêtre, France

    Tài Pham & Xavier Monnet

  8. Service de Réanimation Pédiatrique Et Médecine Néonatale, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Santé de L’Enfant Et de L’Adolescent, Le Kremlin-Bicêtre, France

    Luc Morin

  9. DMU 7 Endocrinologie-Immunités-Inflammations Cancer-Urgences, Service de Médecine Interne Et Immunologie Clinique, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France

    Nicolas Noel

  10. DMU 13 Santé Publique, Information Médicale, Appui À La Recherche Clinique, Centre de Recherche Clinique Paris-Saclay, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, INSERM U1018, CESP, Le Kremlin-Bicêtre, France

    Anne-Lise Lecoq & Laurent Becquemont

  11. DMU 12 Anesthésie, Réanimation, Douleur, Service de Réanimation Chirurgicale, Université Paris-Saclay, AP-HP, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France

    Samy Figueiredo & Anatole Harrois

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  1. Samer Soliman
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  2. Heithem Soliman
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  3. Maud Crézé
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  6. Laurent Savale
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  7. Xavier Jais
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  15. Tài Pham
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  16. Luc Morin
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  18. Anne-Lise Lecoq
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  23. Xavier Monnet
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  24. Olivier Meyrignac
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Consortia

COMEBAC study group

Corresponding author

Correspondence to Samer Soliman.

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Guarantor

The scientific guarantor of this publication is Olivier Meyrignac (Université Paris-Saclay, AP-HP, Service de Radiologie Diagnostique et Interventionnelle, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France).

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

Heithem Soliman kindly provided statistical advice for this manuscript.

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all patients in this study.

Ethical approval

Institutional Review Board approval was obtained. The ethics committee of the French Intensive Care Society validated the study (CE20-56).

Study subjects or cohorts overlap

Some study subjects or cohorts have been previously reported in two studies:

COMEBAC study Group’s study published in JAMA (https://doi.org/10.1001/jama.2021.3331).

E-M Jutant’s study published in ERJ Open Res (https://doi.org/10.1183/23120541.00479-2021).

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• prospective

• diagnostic or prognostic study

• performed at one institution

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Soliman, S., Soliman, H., Crézé, M. et al. Radiological pulmonary sequelae after COVID-19 and correlation with clinical and functional pulmonary evaluation: results of a prospective cohort. Eur Radiol 34, 1037–1052 (2024). https://doi.org/10.1007/s00330-023-10044-0

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