Zhao Lin-Mei, Lancaster Andrew C, Patel Ritesh, Zhang Helen, Duong Tim Q, Jiao Zhicheng, Lin Cheng Ting, Healey Terrance, Wright Thaddeus, Wu Jing, Bai Harrison X
Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
Department of Radiology, Xiangya Hospital, Central South University, Changsha, Hunan, China.
Heliyon. 2024 May 22;10(11):e31751. doi: 10.1016/j.heliyon.2024.e31751. eCollection 2024 Jun 15.
The purpose of this study is to identify clinical and imaging characteristics associated with post-COVID pulmonary function decline.
This study included 22 patients recovering from COVID-19 who underwent serial spirometry pulmonary function testing (PFT) before and after diagnosis. Patients were divided into two cohorts by difference between baseline and post-COVID follow-up PFT: Decline group (>10 % decrease in FEV1), and Stable group (≤10 % decrease or improvement in FEV1). Demographic, clinical, and laboratory data were collected, as well as PFT and chest computed tomography (CT) at the time of COVID diagnosis and follow-up. CTs were semi-quantitatively scored on a five-point severity scale for disease extent in each lobe by two radiologists. Mann-Whitney U-tests, T-tests, and Chi-Squared tests were used for comparison. P-values <0.05 were considered statistically significant.
The Decline group had a higher proportion of neutrophils (79.47 ± 4.83 % vs. 65.45 ± 10.22 %; p = 0.003), a higher absolute neutrophil count (5.73 ± 2.68 × 10/L vs. 3.43 ± 1.74 × 10/L; p = 0.031), and a lower proportion of lymphocytes (9.90 ± 4.20 % vs. 21.21 ± 10.97 %; p = 0.018) compared to the Stable group. The Decline group also had significantly higher involvement of ground-glass opacities (GGO) on follow-up chest CT [8.50 (4.50, 14.50) vs. 3.0 (1.50, 9.50); p = 0.032] and significantly higher extent of reticulations on chest CT at time of COVID diagnosis [6.50 (4.00, 9.00) vs. 2.00 (0.00, 6.00); p = 0.039] and follow-up [5.00 (3.00, 13.00) vs. 2.00 (0.00, 5.00); p = 0.041]. ICU admission was higher in the Decline group than in the Stable group (71.4 % vs. 13.3 %; p = 0.014).
This study provides novel insight into factors influencing post-COVID lung function, irrespective of pre-existing pulmonary conditions. Our findings underscore the significance of neutrophil counts, reduced lymphocyte counts, pulmonary reticulation on chest CT at diagnosis, and extent of GGOs on follow-up chest CT as potential indicators of decreased post-COVID lung function. This knowledge may guide prediction and further understanding of long-term sequelae of COVID-19 infection.
本研究旨在确定与新冠后肺功能下降相关的临床和影像学特征。
本研究纳入了22例从新冠中康复的患者，这些患者在诊断前后接受了系列肺量计肺功能测试（PFT）。根据新冠后随访PFT与基线的差异，将患者分为两个队列：下降组（FEV1下降>10%）和稳定组（FEV1下降≤10%或改善）。收集了人口统计学、临床和实验室数据，以及新冠诊断和随访时的PFT和胸部计算机断层扫描（CT）。两名放射科医生根据每个肺叶疾病范围的五点严重程度量表对CT进行半定量评分。采用曼-惠特尼U检验、T检验和卡方检验进行比较。P值<0.05被认为具有统计学意义。
与稳定组相比，下降组中性粒细胞比例更高（79.47±4.83%对65.45±10.22%；p = 0.003），绝对中性粒细胞计数更高（5.73±2.68×10/L对3.43±1.74×10/L；p = 0.031），淋巴细胞比例更低（9.90±4.20%对21.21±10.97%；p = 0.018）。下降组在随访胸部CT上磨玻璃影（GGO）的累及程度也显著更高[8.50（4.50，14.50）对3.0（1.50，9.50）；p = 0.032]，在新冠诊断时胸部CT上网状影的范围显著更高[6.50（4.00，9.00）对2.00（0.00，6.00）；p = 0.039]，随访时也更高[5.00（3.00，13.00）对2.00（0.00，5.00）；p = 0.041]。下降组的ICU入院率高于稳定组（71.4%对13.3%；p = 0.014）。
本研究为影响新冠后肺功能的因素提供了新的见解，无论既往是否存在肺部疾病。我们的研究结果强调了中性粒细胞计数、淋巴细胞计数减少、诊断时胸部CT上的肺网状影以及随访胸部CT上GGO的范围作为新冠后肺功能下降潜在指标的重要性。这些知识可能有助于预测和进一步了解新冠病毒感染的长期后遗症。
