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
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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21 May 2021
Wallis, T J M
cf385c2a-ef94-4435-8066-31acf23f6f99
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, 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).
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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CXRpostCOVIDFinal
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s12931-021-01750-8
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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
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Date deposited: 07 Jun 2021 16:31
Last modified: 20 Apr 2024 02:18
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Contributors
Author:
T J M Wallis
Author:
E Heiden
Author:
J Horno
Author:
B Welham
Author:
H Burke
Author:
A Freeman
Author:
L Dexter
Author:
A Fazleen
Author:
A Kong
Author:
C McQuitty
Author:
S Poole
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