Covid-19 Pnömoni Sonrası Kısa Dönem Akciğer Bulgularının Bilgisayarlı Tomografi ile Değerlendirilmesi: Retrospektif Çalışma

Bu çalışmada amacımız koronovirüs hastalığı-2019 (COVID-19) pnömoni sonrası kısa dönemde oluşan akciğer bulgularını bilgisayarlı tomografi (BT) ile değerlendirmektir. Mart 2019 – Aralık 2021 tarihleri arasında hastanemize başvuran, COVID-19 enfeksiyonu nedeniyle tedavi edilen ve kontrol görüntülemesi yapılan olgular retrospektif olarak incelendi. Hastaların yaş, cinsiyet, altta yatan komorbidite, pnömoni şiddeti, semptom başlangıç zamanı, hastane yatışı ve yatış süresi bilgileri kaydedildi. Hastaların tanı anında ve ortalama 3 ay sonra çekilen toraks BT görüntüleri değerlendirildi. BT şiddet skorlaması her bir akciğer lobuna 0-5 aralığında puan verilerek 0-25 arasında puanlandı. Tek değişkenli ve çok değişkenli logistic regresiyon analizi ile akciğerde persisten anormallik oluşumu için risk faktörleri araştırıldı. Toplamda 62 hasta (33 erkek, 29 kadın; ortalama yaş 55,2±13,2; yaş aralığı 31-80) çalışmaya dahil edildi. Hastalar total rezolüsyon (27/62; %44) ve rezidü (35/62; %56) grubu olarak ikiye ayrıldı. Rezidü grubunda kontrol BT’de en sık görülen bulgular buzlu cam opasitesi (25/35; %71) ardından parankimal bant (24/35; %69) idi. Retikülasyon (4/35; %11) ve plevral kalınlaşma (14/35; %40) sadece kontrol BT’de görülen bulgulardı. Volüm kaybı hem tanı BT’de (4/35; %11) hem de kontrol BT’de (8/35; %23) görüldü (p=0,344). İleri yaşın (>50 yaş) (OR:23,447 p=0,03) rezidüel akciğer bulgularının oluşmasında bağımsız risk faktörü olduğu saptandı. Post-COVID 3. Ayda kısa dönemde toraks BT’de persistan anormallik oluşma riski ileri yaşta (>50 yaş) yüksektir. Persistan toraks BT bulgularının ne kadarının gerçek fibrozisi yansıttığı uzun dönem takip sonucu ortaya konabilir.

Anahtar Kelimeler:

: COVID-19, Post-COVID akciğer değişiklikleri, Bilgisayarlı tomografi

Retrospective Evaluation of Short Term Lung Findings at after COVID-19 Pneumonia with Computed Tomography

The purpose of this study was evaluate the short term radiological findings after coronavirus disease-2019 (COVID-19) pneumonia with computed tomography (CT). Patients who were treated for COVID-19 pneumonia and underwent follow-up imaging between March 2019 and December 2021 were retrospectively analysed. Age, gender, underlying comorbidity, pneumonia severity, symptom onset-admission interval, hospitalization and length of stay in hospital were recorded. Chest CT was performed at admission and after 3 months from symptom onset. CT severity scoring was for each lung lobe in the range of 0-5 and scored between 0-25. Risk factors for persistent lung abnormalities were investigated by logistic regression analysis. A total of 62 patients (33 males, 29 females; mean age 55,2±13,2 years; range 31-80) were included in the study. Patients were divided into total resolution (27/62; %44) and residual (35/62; %56) groups. In the residual group, the most common findings on control CT were ground glass opacity (25/35; %71), followed by parenchymal band (24/35; %69). Reticular lesion (4/35; %11) and pleural thickening (14/35; %40) were only seen on control CT. Volume loss was seen on both initial (4/35; %11) and control CT (8/35; %23) (p=0,344). Older age (>50 years) (OR:23,447 p=0,03) was found to be independent risk factor for the development of residual lung findings. The risk of post-COVID persistent pulmonary abnormalities at short term is higher in older age (>50 years). Long-term follow-up can reveal how much of the persistent chest CT findings reflect true fibrosis.

Keywords:

COVID-19, Post-COVID lung changes, Computed tomography,

PDF

___

World Health Organization. Director-General's remarks at the media briefing on 2019-nCoV on 11 February 2020. http://www.who.int/dg/speeches/detail/who-director-general-s-remarks- at-the-media-briefing-on-2019-ncov-on-11-february-2020 (Erişim tarihi Mart 9, 2022).
World Health Organization. Coronavirus disease 2019 (COVID-19) Situation Report – 28. https://www.who.int/docs/default-source/coronaviruse/situation-reports20200217-sitrep-28-covid-19.pdf?sfvrsn=a19cf2ad_2(Erişim tarihi Mart 9, 2022).
Zhang P, Li J, Liu H, et al. Long-term bone and lung consequences associated with hospital-acquired severe acute respiratory syndrome: a 15-year follow-up from a prospective cohort study. Bone Res. 2020;8:8.
Das KM, Lee EY, Singh R, et al. Follow-up chest radiographic findings in patients with MERS-CoV after recovery. Indian J Radiol Imaging. 2017;27(3):342-9
Zhao YM, Shang YM, Song WB, et al. Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery. EClinicalMedicine. 2020;25:100463.
Han X, Fan Y, Alwalid O, et al. Six-month Follow-up Chest CT Findings after Severe COVID-19 Pneumonia. Radiology. 2021;299(1):E177-E186.
Vijayakumar B, Tonkin J, Devaraj A, et al. CT Lung Abnormalities after COVID-19 at 3 Months and 1 Year after Hospital Discharge. Radiology. 2021;211746.
National Institutes of Health. October 19, 202. Clinical Spectrum of SARS-CoV-2 Infection National Institutes of Health. https://www.covid19treatmentguidelines.nih.gov/overview/clinical-spectrum/ (Erişim tarihi Mart9, 2022).
Francone M, Iafrate F, Masci GM, et al. Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis. Eur Radiol. 2020;30(12):6808-17.
Guler SA, Ebner L, Aubry-Beigelman C, et al. Pulmonary function and radiological features 4 months after COVID-19: first results from the national prospective observational Swiss COVID-19 lung study. Eur Respir J. 2021;57(4):2003690.
Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China [published correction appears in Lancet. 2020 Jan 30]. Lancet. 2020;395(10223):497-506.
Tsui PT, Kwok ML, Yuen H, et al. Severe acute respiratory syndrome: clinical outcome and prognostic correlates. Emerg Infect Dis. 2003;9(9):1064-9.
Cheung OY, Chan JW, Ng CK, et al. The spectrum of pathological changes in severe acute respiratory syndrome (SARS). Histopathology. 2004;45(2):119-24.
Ketai L, Paul NS, Wong KT. Radiology of severe acute respiratory syndrome (SARS): the emerging pathologic-radiologic correlates of an emerging disease. J Thorac Imaging. 2006;21(4):276-83.
Hui DS, Wong KT, Ko FW, et al. The 1-year impact of severe acute respiratory syndrome on pulmonary function, exercise capacity, and quality of life in a cohort of survivors. Chest. 2005;128(4):2247-61.
Ngai JC, Ko FW, Ng SS, et al. The long-term impact of severe acute respiratory syndrome on pulmonary function, exercise capacity and health status. Respirology. 2010;15(3):543-50.
Balbi M, Conti C, Imeri G, et al. Post-discharge chest CT findings and pulmonary function tests in severe COVID-19 patients. Eur J Radiol. 2021;138:109676.
Yu M, Liu Y, Xu D, et al. Prediction of the Development of Pulmonary Fibrosis Using Serial Thin-Section CT and Clinical Features in Patients Discharged after Treatment for COVID-19 Pneumonia. Korean J Radiol. 2020;21(6):746-55.
Wu X, Liu X, Zhou Y, et al. 3-month, 6-month, 9-month, and 12-month respiratory outcomes in patients following COVID-19-related hospitalisation: a prospective study. Lancet Respir Med. 2021;9(7):747-54.
Pan F, Yang L, Liang B, et al. Chest CT Patterns from Diagnosis to 1 Year of Follow-up in Patients with COVID-19. Radiology. 2022;302(3):709-19.
Kwee TC, Kwee RM. Chest CT in COVID-19: What the Radiologist Needs to Know Radiographics. 2020;40(7):1848-65.
Wang Y, Dong C, Hu Y, et al. Temporal Changes of CT Findings in 90 Patients with COVID-19 Pneumonia: A Longitudinal Study. Radiology. 2020;296(2):E55-E64.
Kucuk C, Turkkani MH, Arda K. A case report of reversible bronchiectasis in an adult: Pseudobronchiectasis. Respir Med Case Rep. 2019;26:315-6.
Hu Q, Liu Y, Chen C, et al. Reversible Bronchiectasis in COVID-19 Survivors With Acute Respiratory Distress Syndrome: Pseudobronchiectasis. Front Med (Lausanne). 2021;8:739857.
Liu D, Zhang W, Pan F, et al. The pulmonary sequalae in discharged patients with COVID-19: a short-term observational study. Respir Res. 2020;21(1):125.