CT-based evaluation of COVID-19 pneumonia patients in China for 6 months


Participant Characteristics

A total of 271 participants (mean ± SD, 61 years 12 ) were evaluated and 113 participants were women (41.7%). Baseline and clinical characteristics are summarized in Table 1. Of the 271 participants, the average body mass index was 21.8 kg/m2 (IQR, 17.1–29.1), and 80 (29.5%) were smokers. 148 participants (54.6%) had a variety of comorbidities and common comorbidities included hypertension (82 participants, 30.3%), type II diabetes mellitus (80 participants, 29.5%), ischemic heart disease (61 participants, 22.5%), chronic Obstructive pulmonary involvement. disease (18 participants, 6.6%) and previous venous thromboembolism (10 participants, 3.7%). The median hospital stay was 12 days (IQR, 4–20 days), with 68 participants (25.1%) requiring the highest level of ventilatory support in the form of invasive ventilation or noninvasive positive pressure ventilation. Participants were treated with medications, mainly including paclovid (183 participants, 67.5%), azavudine (60 participants, 22.1%) and glucocorticoids (69 participants, 25.5%).

Table 1 Comparison of baseline and clinical characteristics between participants with normal and abnormal CT in the lungs at 6-month follow-up.

In comparison of baseline and clinical characteristics, age (mean, 58 years ± 11 vs. 65 years ± 12, P < 0.001), smoking ( 42 participants) [24.3%] vs 38 participants [38.8%]P = 0.04), heart rate (mean, 83 times per minute ± 14 vs. 92 times per minute ± 16, P = 0.02 ) , respiratory rate (mean, 20 times per minute - 7 vs 24 times per minute - 9, P - = 0.03), oxygen saturation (SaO2) on room air, 96%, IQR, 88-99% vs 92%, IQR , 80-98%, p = 0.001), chronic obstructive pulmonary disease (COPD, 10 participants [5.8%] vs 8 participants [8.1%]P = 0.02), length of hospital stay (11 days, IQR, 4-14 days vs. 16 days, IQR, 10-27 days, P < 0.001), invasive ventilation (2 Participant [1.6%] vs 15 participants [15.3%]P < 0.001) and use of Paxlovid (147 participants) [85.0%] vs 36 participants [36.7%]P < 0.001) demonstrated a statistically significant difference between participants with normal and abnormal chest CT at 6-month follow-up.

Comparison of CT findings

All participants underwent a 6-month follow-up chest CT at a median of 177 days (IQR, 155–203 days) after hospital admission and residual pulmonary abnormalities were found in 98 participants (36.2%). Compared with initial CT (Table 2), participants with GGO decreased from 270 (99.6%) to 66 (24.4%) and consolidation decreased from 111 (41.0%) to 20 (7.4%) (Figure 2). Meanwhile, the number of participants with reticulation increased from 19 (7.0%) to 57 (21.0%). The ARDS pattern in three participants (1.1%) at the initial CT and the paranoid paving pattern in two participants (0.7%) had disappeared at the 6-month follow-up CT. The number of participants with pneumonia pattern increased from four (1.5%) to seven (2.6%). Among CT evidence of fibrotic-like changes, the number of participants with linear atelectasis increased from four (1.5%) to seven (2.6%) (Fig. 3), the number of participants with bronchiectasis and parenchymal bands increased from six (2.2%) 31 (11.4). % (Figure 4) and 14 (5.2%) (Figure 5) respectively. There was no change in three participants (1.1%) with honeycombing. In summary, 39 participants (14.4%) demonstrated new suspicious fibrotic-like changes at 6-month follow-up CT.

Table 2 Comparison of CT findings in the lungs between the initial and 6-month follow-up CT.
Figure 2
Figure 2

Serial chest CT scans in a 45-year-old man with severe coronavirus disease 2019 pneumonia. ,A, b) The initial CT scan obtained on the 5th day after the onset of symptoms showed extensive ground-glass opacities (GGO) with some areas of consolidation bilaterally. ,C, D) CT scan obtained on day 9 showed extensive consolidation with some GGO bilaterally. ,I, F) CT scan obtained on day 179 showed near-absorption of the abnormalities with mild GGO and interstitial thickening remaining.

Figure 3
Figure 3

Serial chest CT scans in a 61-year-old man with coronavirus disease 2019 pneumonia. ,A, b) The initial CT scan obtained on the fourth day after the onset of symptoms showed multiple ground-glass opacities and consolidation bilaterally. ,C) CT scan obtained on day 22 showed moderate consolidation and reticulation in the lower lung lobes bilaterally. ,D) CT scan obtained on day 191 clearly showed absorption abnormalities in the lower lung lobes with subtle reticulation and linear atelectasis (arrows).

picture 4
picture 4

Serial chest CT scans in a 60-year-old man with coronavirus disease 2019 pneumonia. ,A, b) The initial CT scan obtained on day 8 after the onset of symptoms showed multiple ground-glass opacities and interstitial thickening bilaterally. ,C, D) CT scan obtained on day 180 showed traction bronchiectasis (white arrow) and interlobar pleural traction (black arrow) in the upper lobe of the right lung.

Figure 5
Figure 5

Serial chest CT scans in a 54-year-old man with coronavirus disease 2019 pneumonia. ,A) The initial CT scan obtained on day 9 after the onset of symptoms showed multiple ground-glass opacities and interstitial thickening bilaterally. ,b)CT scan obtained on day 169 showed traction bronchiectasis (white arrow) and parenchymal bands (black arrow) in the lower lung lobe.

Comparison of chest CT scores

In chest CT scores (Table 3), we found significant reductions for any abnormality (p < 0.001), GGO (p < 0.001), and consolidation (p <  Went. ‰0.001), while there was a significant increase in fibrotic-like abnormalities (p < 0.001) compared to the initial CT scan. Meanwhile, reticulation showed minor changes between the two CT scans (p = 0.33).

Table 3 Comparison of chest CT scores between initial and 6-month follow-up CT.

Factors associated with pulmonary residual abnormalities

In univariate analysis, paxlowid (odds ratio [OR]:0.08; 95% CI 0.03, 0.21; P < 0.001), invasive ventilation (OR 9.3; 95% CI 2.8, 29; P < 0.001), आयु > years (OR 6.5; 95% CI 2.7), 17; p < 0.001), SaO2 less than 93% at admission (OR 4.5; 95% CI 1.4, 14; p < 0.001), hospitalization more than 15 days (OR 3.8; 95% CI 1.3, 11; P = 0.002), and respiratory rate greater than 23 times per minute at the time of admission (OR 3.3; 95% CI 1.3, 8.7; P = 0.004) were associated. were accompanied by residual pulmonary abnormalities at 6-month follow-up CT. In multivariate analysis, the predictive factor was invasive ventilation (OR 13.6; 95% CI 1.9, 45; P < 0.001), उम्र >age 60 years (OR 9.1; 95% CI 2.3, 39; P = 0.01), paxlovid (OR 0.11; 95% CI 0.04, 0.48; P = 0.01), hospitalization more than 15 days admission (OR 6.1; 95% CI 1.2, 26; P = 0.002), heart rate greater than 100 beats per minute (OR 5.9; 95% CI 1.1, 27; P = 0.03 ), and SaO2 less than 93% at admission (OR 5.6; 95% CI 1.4, 13; p = 0.02) (Table 4).

Table 4 Univariable and multivariable analysis of pulmonary residual abnormalities on 6-month follow-up CT.

Factors associated with pulmonary fibrotic-like changes

In univariate analysis, paxlovid (OR 0.11; 95% CI 0.04, 0.32; P < 0.001), invasive ventilation (OR 8.8; 95% CI 2.1, 26; P < 0.001), धूम्रपान करने वाला (OR 7.4; 95% CI 3.0, 16; P = 0.001), प्रवेश के समय SaO2 93% से कम (OR 4.5; 95% CI 1.2, 16; P = 0.002) और आयु >Age ≥60 years (OR 4.2; 95% CI 1.3, 11; P = 0.002) was associated with pulmonary fibrotic-like changes at 6-month follow-up CT. In multivariate analysis, predictive factors were invasive ventilation (OR 10.3; 95% CI 2.9, 33; P = 0.002), smoking (OR 9.9; 95% CI 2.4, 31; P =â€) were ‰0.01), paxolovid (OR 0.1; 95% CI 0.03, 0.48; p = 0.01), SaO2 less than 93% on admission (OR 7.8; 95% CI 1.5, 19; p =â €‰0.02), age >60 years (OR 6.1; 95% CI 2.3, 22; p = 0.03) and heart rate more than 100 beats per minute (OR 4.9; 95% CI 1.7), 11; p = 0.04) (Table 5).

Table 5 Univariable and multivariable analysis of pulmonary fibrotic-like changes on 6-month follow-up CT.

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