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Wallis TJM, Heiden E, Horno J, Welham B, Burke H, Freeman A, Dexter L, Fazleen A, Kong A, McQuitty C, Watson M, Poole S, Brendish NJ, Clark TW, Wilkinson TMA, Jones MG, Marshall BG. Risk factors for persistent abnormality on chest radiographs at 12-weeks post hospitalisation with PCR confirmed COVID-19. Respir Res 2021; 22:157. [PMID: 34020644 PMCID: PMC8139368 DOI: 10.1186/s12931-021-01750-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 05/17/2021] [Indexed: 02/06/2023] Open
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. Supplementary Information The online version contains supplementary material available at 10.1186/s12931-021-01750-8.
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Affiliation(s)
- T J M Wallis
- Department of Respiratory Medicine and Southampton NIHR Biomedical Research Centre, University Hospital Southampton and School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK. .,NIHR Southampton Biomedical Research Centre Research Fellow, University of Southampton, MP218 D-Level South Academic Block University Hospital Southampton, Southampton, SO16 6YD, UK.
| | - E Heiden
- Department of Respiratory Medicine, University Hospital Southampton, Southampton, UK
| | - J Horno
- Department of Respiratory Medicine, University Hospital Southampton, Southampton, UK
| | - B Welham
- Department of Respiratory Medicine, University Hospital Southampton and School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - H Burke
- Department of Respiratory Medicine, University Hospital Southampton and School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - A Freeman
- Department of Respiratory Medicine, University Hospital Southampton and School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - L Dexter
- Department of Respiratory Medicine, University Hospital Southampton, Southampton, UK
| | - A Fazleen
- Department of Respiratory Medicine, University Hospital Southampton and School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - A Kong
- Department of Respiratory Medicine and Southampton NIHR Biomedical Research Centre, University Hospital Southampton and School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - C McQuitty
- Department of Respiratory Medicine and Southampton NIHR Biomedical Research Centre, University Hospital Southampton and School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - M Watson
- Department of Respiratory Medicine, University Hospital Southampton, Southampton, UK
| | - S Poole
- Department of Infection and Southampton NIHR Biomedical Research Centre, University Hospital Southampton and School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - N J Brendish
- Department of Infection, University Hospital Southampton and School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - T W Clark
- Department of Infection and Southampton NIHR Biomedical Research Centre, University Hospital Southampton and School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - T M A Wilkinson
- Department of Respiratory Medicine and Southampton NIHR Biomedical Research Centre, University Hospital Southampton and School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - M G Jones
- Department of Respiratory Medicine and Southampton NIHR Biomedical Research Centre, University Hospital Southampton and School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
| | - B G Marshall
- Department of Respiratory Medicine and Southampton NIHR Biomedical Research Centre, University Hospital Southampton and School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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