Study Finds Over Half of Patients with COVID-19 Pneumonia Have Pulmonary Abnormalities One Year Later

In a new study looking at one-year follow-up chest computed tomography (CT) exams in patients who had COVID-19 pneumonia, researchers found persistent lung abnormalities in more than half of the study participants.

Ninety-one of the originally enrolled 142 patients had the follow-up chest CTs, according to the study, which was recently published in Radiology. The study authors noted that 20 percent of the patients had extensive findings of ground-glass opacities (GGO), reticulations, and bronchial dilation while 34 percent had more subtle findings of GGO, subpleural reticulation or both.

According to the study, 22 of the 49 patients with CT abnormalities were treated in the intensive care unit (ICU), 25 patients received treatment in a general hospital ward and two patients were treated on an outpatient basis. This demonstrates that long-term abnormalities on CT are not exclusive to patients who had critical COVID-19, according to study co-author Gerlig Widmann, MD, a chief thoracic radiologist at Innsbruck Medical University in Austria, and colleagues

“Our findings provide additional evidence that independent of progressing to (acute respiratory distress syndrome) or barotrauma, the natural course of COVID-19 pneumonia itself contributes to the structural lung damage,” wrote Dr. Widmann and colleagues.

The study authors noted that persistent abnormalities on CT at one year were associated with male gender, those older than 60 years of age and critical COVID-19 severity.

Dr. Widman and colleagues noted that 19 patients with consolidation, bronchial dilation or an organizing pneumonia pattern at two months proceeded to have abnormalities on chest CT after one year. They also pointed out that the pure GGO and/or reticulation CT findings at the initial one-year follow-up for 49 patients resolved in 39 percent of those patients within the next year.

“Physicians should exercise caution in presuming that CT findings such as subpleural cysts, bronchial dilatation, and linear bands represent fibrosis, particularly during the first 3-6 months after acute infection, as these findings have been observed to resolve in some COVID-19 survivors,” wrote Ann N. Leung, MD, a professor, associate chair of clinical affairs and division chief of thoracic imaging in the Department of Radiology at the Stanford University Medical Center, in an accompanying editorial.

The study authors noted multiple limitations with the study including a lack of lung function testing correlation for CT abnormalities and that one-third of the enrolled study participants were lost to follow-up at one year. They also acknowledged that none of the patients, who were enrolled in the study during the initial wave of the pandemic in Europe, received corticosteroid treatment for early infection and such treatment is currently recommended to reduce acute inflammatory responses in patients with severe COVID-19.