1. Post-discharge chest CT findings and pulmonary function tests in severe COVID-19 patients
- Author
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Andrea Corsi, Caterina Conti, Anna Caroli, Pietro Andrea Bonaffini, Maurizio Balbi, Alberto Arrigoni, Fabiano Di Marco, Gianluca Imeri, Alessandra Surace, Elisa Mercanzin, Giulia Villa, and Sandro Sironi
- Subjects
mMRC, modified Medical Research Council ,Aftercare ,DLCO, diffusing capacity for carbon monoxide ,030218 nuclear medicine & medical imaging ,Pulmonary function testing ,0302 clinical medicine ,DLCO ,Severe acute respiratory syndrome coronavirus 2 ,Lung volumes ,Survivors ,Lung ,Tomography ,COVID-19, coronavirus disease 2019 ,Respiratory distress ,medicine.diagnostic_test ,General Medicine ,Respiratory function tests ,respiratory system ,FEV1, forced expiratory volume in the first second ,Patient Discharge ,CT, computed tomography ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,VA, alveolar volume ,Radiology ,KCO, carbon monoxide transfer coefficient ,medicine.medical_specialty ,Article ,WHO, World Health Organization ,03 medical and health sciences ,FEV1/FVC ratio ,COVID-19 ,Lung diseases ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,SARS, severe acute respiratory syndrome ,Retrospective Studies ,SARS-CoV-2 ,business.industry ,medicine.disease ,OP, organizing pneumonia ,PFT, pulmonary function test ,respiratory tract diseases ,Pneumonia ,GGO, ground-glass opacity ,FVC, forced vital capacity ,CXR, chest radiograph ,Tomography, X-Ray Computed ,business ,Chest radiograph - Abstract
PURPOSE: To evaluate chest computed tomography (CT) and pulmonary function test (PFT) findings in severe COVID-19 patients after discharge and correlate CT pulmonary involvement with PFT results. METHODS: COVID-19 patients admitted to our hospital between February 25 and May 2, 2020, were retrospectively included according to the following criteria: (a) COVID-19 defined as severe based on the WHO interim guidance (i.e., clinical signs of pneumonia plus respiratory rate > 30 breaths/min, severe respiratory distress, and/or SpO2 < 90 % on room air); (b) chest radiograph in the acute setting; (c) post-discharge unenhanced chest CT; and (d) post-discharge comprehensive PFT. Imaging findings were retrospectively evaluated in consensus by two readers, and volume of abnormal lung was measured on CT using 3D Slicer software. Differences between demographics, comorbidities, acute radiographic findings, PFT, and post-discharge clinical and laboratory data of patients with normal and abnormal CT findings were assessed by Mann-Whitney or Fisher tests, and the compromised lung volume-PFT association by Pearson correlation after removing possible outliers. RESULTS: At a median of 105 days from symptom onset, 74/91 (81 %) patients had CT abnormalities. The most common CT pattern was combined ground-glass opacity and reticular pattern (46/74, 62 %) along with architectural distortion (68/74, 92 %) and bronchial dilatation (66/74, 89 %). Compromised lung volume had a median value of 15 % [11-23], was higher in dyspneic patients, and negatively correlated with the percentage of predicted DLCO, VA, and FVC values (r = -0.39, -0.5, and -0.42, respectively). These PFT parameters were significantly lower in patients with CT abnormalities. Impairment of DLCO and KCO was found in 12 (13 %) cases, possibly implying an underlying pulmonary vasculopathy in this subgroup of patients. CONCLUSIONS: Most severe COVID-19 survivors still had physiologically relevant CT abnormalities about three months after the disease onset, with an impairment of diffusion capacity on PFT. A pulmonary vasculopathy was suggested in a minor proportion of patients.
- Published
- 2021
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