Patil Shital, Kulkarni Devang, Vairagade Abhishek, Gondhali Gajanan
Department of Pulmonary Medicine, Venkatesh Chest Hospital and Critical Care Center, Latur, Maharashtra, India.
Department of Medicine, MIMSR Medical College, Latur, Maharashtra, India.
Ann Afr Med. 2025 Jun 30. doi: 10.4103/aam.aam_22_25.
Radiological outcomes are initially interpreted as post-COVID-19 lung fibrosis in short-term follow-up of recovered COVID-19 cases in post-COVID-19 care settings and during long-term evaluation, these abnormalities are defined as post-COVID-19 sequalae's. In the present study, post-COVID-19 lung abnormalities were evaluated as "residual lung abnormalities (RLAs)" as radiological outcomes phenotypes.
Prospective, observational study initially included 1000 COVID-19 reverse transcription-polymerase chain reaction confirmed cases with lung involvement documented and radiological severity phenotypes categorized on high-resolution computerized tomography (HRCT) thorax as mild, moderate, and severe as per lung segment involvement bilaterally at the entry point. Final radiological outcomes were defined by performing a radiological assessment done at 1 year of discharge from the hospital in cases with specified inclusion criteria. Radiological final outcome phenotypes were defined as radiological lung abnormalities (RLAs) and categorized as resolving, persistent, and progressive types documented in HRCT imaging at 1 year of follow-up. Finally, we have included 209 cases with RLAs. Covariates recordings of age, gender, comorbidity, laboratory parameters, and interventions such as oxygen support and oxygen plus ventilatory support requirement during hospitalization were done. Statistical analysis is done using Chi-square test.
RLAs were documented in 20.73% (209/1000) cases. Final radiological outcomes were documented as resolving at 72.24% (151/209), persistent 19.61% (41/209), and progressive 8.13% (17/209). A significant association was documented between RLAs and duration of illness at the entry point (P < 0.00001), laboratory parameters at the entry point (D-dimer, C-reactive protein, interleukin-6) (P < 0.00001), radiological computerized tomography severity phenotypes (P < 0.00001), and interventions required in the indoor unit (P < 0.00001). A significant association was observed between RLAs with covariates such as age, gender, diabetes mellitus, ischemic heart disease, hypertension, chronic obstructive pulmonary disease, obesity, and lung functions assessment by spirometry at 1 year follow-up (P < 0.00001).
Radiological lung abnormalities (RLAs) are new radiological classification of post-COVID-19 lung sequelae and are categorized as resolving, persistent, and progressive. Final outcomes phenotypic classification showed an important role in further workup and treatment plannings of these RLAs during follow-up. Importantly, the proportionate number of progressive phenotypes has underlying rheumatological predisposition, and the large number of cases in resolving phenotypes doesn't need any treatment; whereas few cases in the persistent category need protocolized follow-up.
在新冠康复病例的短期随访中，放射学结果最初被解释为新冠后肺纤维化，而在长期评估中，这些异常被定义为新冠后遗症。在本研究中，将新冠后肺部异常评估为“残留肺部异常（RLAs）”作为放射学结果表型。
前瞻性观察性研究最初纳入1000例经新冠逆转录聚合酶链反应确诊且有肺部受累记录的病例，并根据入院时双侧肺段受累情况，通过胸部高分辨率计算机断层扫描（HRCT）将放射学严重程度表型分为轻度、中度和重度。对于符合特定纳入标准的病例，在出院1年后进行放射学评估来确定最终放射学结果。放射学最终结果表型被定义为放射学肺部异常（RLAs），并在随访1年时根据HRCT成像分为消散型、持续型和进展型。最后，我们纳入了209例有RLAs的病例。记录了年龄、性别、合并症、实验室参数以及住院期间的干预措施，如氧气支持和氧气加通气支持需求等协变量。使用卡方检验进行统计分析。
20.73%（209/1000）的病例记录有RLAs。最终放射学结果显示，消散型占72.24%（151/209），持续型占19.61%（41/209），进展型占8.13%（17/209）。记录显示RLAs与入院时的病程（P<0.00001）、入院时的实验室参数（D-二聚体、C反应蛋白、白细胞介素-6）（P<0.00001）、放射学计算机断层扫描严重程度表型（P<0.00001）以及室内治疗所需干预措施（P<0.00001）之间存在显著关联。在随访1年时，观察到RLAs与年龄、性别、糖尿病、缺血性心脏病、高血压、慢性阻塞性肺疾病、肥胖以及通过肺量计评估的肺功能等协变量之间存在显著关联（P<0.00001）。
放射学肺部异常（RLAs）是新冠后肺部后遗症的新放射学分类，分为消散型、持续型和进展型。最终结果的表型分类在这些RLAs随访期间的进一步检查和治疗规划中发挥着重要作用。重要的是，进展型表型中有相当比例存在潜在的风湿病易感性，消散型中的大量病例无需任何治疗；而持续型中的少数病例需要按方案进行随访。
