Post-COVID-19 interstitial lung disease: Insights from a machine learning radiographic model.

INTRODUCTION

Post-acute sequelae of COVID-19 seem to be an emerging global crisis. Machine learning radiographic models have great potential for meticulous evaluation of post-COVID-19 interstitial lung disease (ILD).

METHODS

In this multicenter, retrospective study, we included consecutive patients that had been evaluated 3 months following severe acute respiratory syndrome coronavirus 2 infection between 01/02/2021 and 12/5/2022. High-resolution computed tomography was evaluated through Imbio Lung Texture Analysis 2.1.

RESULTS

Two hundred thirty-two ( = 232) patients were analyzed. FVC% predicted was ≥80, between 60 and 79 and <60 in 74.2% ( = 172), 21.1% ( = 49), and 4.7% ( = 11) of the cohort, respectively. DLCO% predicted was ≥80, between 60 and 79 and <60 in 69.4% ( = 161), 15.5% ( = 36), and 15.1% ( = 35), respectively. Extent of ground glass opacities was ≥30% in 4.3% of patients ( = 10), between 5 and 29% in 48.7% of patients ( = 113) and <5% in 47.0% of patients ( = 109). The extent of reticulation was ≥30%, 5-29% and <5% in 1.3% ( = 3), 24.1% ( = 56), and 74.6% ( = 173) of the cohort, respectively. Patients ( = 13, 5.6%) with fibrotic lung disease and persistent functional impairment at the 6-month follow-up received antifibrotics and presented with an absolute change of +10.3 ( = 0.01) and +14.6 ( = 0.01) in FVC% predicted at 3 and 6 months after the initiation of antifibrotic.

CONCLUSION

Post-COVID-19-ILD represents an emerging entity. A substantial minority of patients presents with fibrotic lung disease and might experience benefit from antifibrotic initiation at the time point that fibrotic-like changes are "immature." Machine learning radiographic models could be of major significance for accurate radiographic evaluation and subsequently for the guidance of therapeutic approaches.