Fabbri Laura, Moss Samuel, Khan Fasihul A, Chi Wenjie, Xia Jun, Robinson Karen, Smyth Alan Robert, Jenkins Gisli, Stewart Iain
National Heart & Lung Institute, Imperial College London, London, UK.
Nottingham NIHR Biomedical Research Centre, University of Nottingham, Nottingham, UK.
Thorax. 2023 Feb;78(2):191-201. doi: 10.1136/thoraxjnl-2021-218275. Epub 2022 Mar 25.
Persisting respiratory symptoms in COVID-19 survivors may be related to development of pulmonary fibrosis. We assessed the proportion of chest CT scans and pulmonary function tests consistent with parenchymal lung disease in the follow-up of people hospitalised with COVID-19 and viral pneumonitis.
Systematic review and random effects meta-analysis of proportions using studies of adults hospitalised with SARS-CoV-2, SARS-CoV, MERS-CoV or influenza pneumonia and followed up within 12 months. Searches performed in MEDLINE and Embase. Primary outcomes were proportion of radiological sequelae on CT scans; restrictive impairment; impaired gas transfer. Heterogeneity was explored in meta-regression.
Ninety-five studies (98.9% observational) were included in qualitative synthesis, 70 were suitable for meta-analysis including 60 SARS-CoV-2 studies with a median follow-up of 3 months. In SARS-CoV-2, the overall estimated proportion of inflammatory sequelae was 50% during follow-up (0.50; 95% CI 0.41 to 0.58; I=95%), fibrotic sequelae were estimated in 29% (0.29; 95% CI 0.22 to 0.37; I=94.1%). Follow-up time was significantly associated with estimates of inflammatory sequelae (-0.036; 95% CI -0.068 to -0.004; p=0.029), associations with fibrotic sequelae did not reach significance (-0.021; 95% CI -0.051 to 0.009; p=0.176). Impaired gas transfer was estimated at 38% of lung function tests (0.38 95% CI 0.32 to 0.44; I=92.1%), which was greater than restrictive impairment (0.17; 95% CI 0.13 to 0.23; I=92.5%), neither were associated with follow-up time (p=0.207; p=0.864).
Sequelae consistent with parenchymal lung disease were observed following COVID-19 and other viral pneumonitis. Estimates should be interpreted with caution due to high heterogeneity, differences in study casemix and initial severity.
CRD42020183139.
新冠病毒疾病幸存者持续存在的呼吸道症状可能与肺纤维化的发展有关。我们评估了新冠病毒疾病和病毒性肺炎住院患者随访期间胸部CT扫描结果及肺功能测试结果与实质性肺部疾病相符的比例。
对成人感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）、严重急性呼吸综合征冠状病毒（SARS-CoV）、中东呼吸综合征冠状病毒（MERS-CoV）或流感肺炎并在12个月内进行随访的研究进行系统评价和随机效应荟萃分析。检索MEDLINE和Embase数据库。主要结局指标为CT扫描的影像学后遗症比例、限制性损害、气体交换受损。通过Meta回归分析探讨异质性。
95项研究（98.9%为观察性研究）纳入定性综合分析，70项适合进行荟萃分析，其中包括60项SARS-CoV-2研究，中位随访时间为3个月。在SARS-CoV-2感染中，随访期间炎症后遗症的总体估计比例为50%（0.50；95%置信区间0.41至0.58；I² = 95%），纤维化后遗症估计为29%（0.29；95%置信区间0.22至0.37；I² = 94.1%）。随访时间与炎症后遗症估计值显著相关（-0.036；95%置信区间-0.068至-0.004；p = 0.029），与纤维化后遗症的相关性未达到显著水平（-0.021；95%置信区间-0.051至0.009；p = 0.176）。气体交换受损在肺功能测试中的估计比例为38%（0.38；95%置信区间0.32至0.44；I² = 92.1%），高于限制性损害（0.17；95%置信区间0.13至0.23；I² = 92.5%），两者均与随访时间无关（p = 0.207；p = 0.864）。
新冠病毒疾病和其他病毒性肺炎后观察到与实质性肺部疾病相符的后遗症。由于异质性高、研究病例组合和初始严重程度存在差异，对估计值应谨慎解读。
PROSPERO注册号：CRD42020183139。
