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Risk factors for persistent abnormality on chest radiographs at 12-weeks post hospitalisation with PCR confirmed COVID-19

Risk factors for persistent abnormality on chest radiographs at 12-weeks post hospitalisation with PCR confirmed COVID-19
Risk factors for persistent abnormality on chest radiographs at 12-weeks post hospitalisation with PCR confirmed COVID-19

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.

COVID-19, Chest radiograph, Follow-up study, LDH, SARS-CoV-2
1465-9921
Wallis, T J M
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Heiden, E
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Horno, J
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Welham, B
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Burke, H
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Freeman, A
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Dexter, L
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Fazleen, A
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Kong, A
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McQuitty, C
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Poole, S
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Brendish, N J
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Clark, T W
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Wilkinson, T M A
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Jones, M G
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Marshall, B G
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Wallis, T J M
cf385c2a-ef94-4435-8066-31acf23f6f99
Heiden, E
2921110b-b184-4e61-8633-116b1b8129cc
Horno, J
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Welham, B
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Burke, H
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Freeman, A
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Dexter, L
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Fazleen, A
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Kong, A
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McQuitty, C
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Poole, S
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Brendish, N J
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Clark, T W
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Wilkinson, T M A
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Jones, M G
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Marshall, B G
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Wallis, T J M, Heiden, E, Horno, J, Welham, B, Burke, H, Freeman, A, Dexter, L, Fazleen, A, Kong, A, McQuitty, C, Poole, S, Brendish, N J, Clark, T W, Wilkinson, T M A, Jones, M G and Marshall, B G (2021) Risk factors for persistent abnormality on chest radiographs at 12-weeks post hospitalisation with PCR confirmed COVID-19. Respiratory Research, 22 (1), [157]. (doi:10.1186/s12931-021-01750-8).

Record type: Article

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.

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e-pub ahead of print date: 21 May 2021
Published date: 21 May 2021
Additional Information: Funding Information: The corresponding author TJMW receives a research fellowship grant from the NIHR Southampton Clinical Research Facility (Southampton, UK). Publisher Copyright: © 2021, The Author(s). Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
Keywords: COVID-19, Chest radiograph, Follow-up study, LDH, SARS-CoV-2

Identifiers

Local EPrints ID: 449544
URI: http://eprints.soton.ac.uk/id/eprint/449544
ISSN: 1465-9921
PURE UUID: 76256925-f376-41bc-be41-bea5b7bcd393
ORCID for T J M Wallis: ORCID iD orcid.org/0000-0001-7936-9764
ORCID for A Freeman: ORCID iD orcid.org/0000-0003-3495-2520
ORCID for N J Brendish: ORCID iD orcid.org/0000-0002-9589-4937
ORCID for T W Clark: ORCID iD orcid.org/0000-0001-6026-5295
ORCID for M G Jones: ORCID iD orcid.org/0000-0001-6308-6014

Catalogue record

Date deposited: 07 Jun 2021 16:31
Last modified: 02 Nov 2024 03:03

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Contributors

Author: T J M Wallis ORCID iD
Author: E Heiden
Author: J Horno
Author: B Welham
Author: H Burke
Author: A Freeman ORCID iD
Author: L Dexter
Author: A Fazleen
Author: A Kong
Author: C McQuitty
Author: S Poole
Author: N J Brendish ORCID iD
Author: T W Clark ORCID iD
Author: T M A Wilkinson
Author: M G Jones ORCID iD
Author: B G Marshall

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