Radiological and functional lung sequelae of COVID-19: a systematic review and meta-analysis.
COVID-19
Computed tomography
Lung sequelae
Pulmonary function test
Journal
BMC pulmonary medicine
ISSN: 1471-2466
Titre abrégé: BMC Pulm Med
Pays: England
ID NLM: 100968563
Informations de publication
Date de publication:
22 Mar 2021
22 Mar 2021
Historique:
received:
14
11
2020
accepted:
09
03
2021
entrez:
23
3
2021
pubmed:
24
3
2021
medline:
26
3
2021
Statut:
epublish
Résumé
The coronavirus disease 2019 (COVID-19) causes a wide spectrum of lung manifestations ranging from mild asymptomatic disease to severe respiratory failure. We aimed to clarify the characteristics of radiological and functional lung sequelae of COVID-19 patients described in follow-up period. PubMed and EMBASE were searched on January 20th, 2021 to investigate characteristics of lung sequelae in COVID-19 patients. Chest computed tomography (CT) and pulmonary function test (PFT) data were collected and analyzed using one-group meta-analysis. Our search identified 15 eligible studies with follow-up period in a range of 1-6 months. A total of 3066 discharged patients were included in these studies. Among them, 1232 and 1359 patients were evaluated by chest CT and PFT, respectively. The approximate follow-up timing on average was 90 days after either symptom onset or hospital discharge. The frequency of residual CT abnormalities after hospital discharge was 55.7% (95% confidential interval (CI) 41.2-70.1, I This systematic review suggested that about half of the patients with COVID-19 still had residual abnormalities on chest CT and PFT at about 3 months. Further studies with longer follow-up term are warranted.
Sections du résumé
BACKGROUND
BACKGROUND
The coronavirus disease 2019 (COVID-19) causes a wide spectrum of lung manifestations ranging from mild asymptomatic disease to severe respiratory failure. We aimed to clarify the characteristics of radiological and functional lung sequelae of COVID-19 patients described in follow-up period.
METHOD
METHODS
PubMed and EMBASE were searched on January 20th, 2021 to investigate characteristics of lung sequelae in COVID-19 patients. Chest computed tomography (CT) and pulmonary function test (PFT) data were collected and analyzed using one-group meta-analysis.
RESULTS
RESULTS
Our search identified 15 eligible studies with follow-up period in a range of 1-6 months. A total of 3066 discharged patients were included in these studies. Among them, 1232 and 1359 patients were evaluated by chest CT and PFT, respectively. The approximate follow-up timing on average was 90 days after either symptom onset or hospital discharge. The frequency of residual CT abnormalities after hospital discharge was 55.7% (95% confidential interval (CI) 41.2-70.1, I
CONCLUSIONS
CONCLUSIONS
This systematic review suggested that about half of the patients with COVID-19 still had residual abnormalities on chest CT and PFT at about 3 months. Further studies with longer follow-up term are warranted.
Identifiants
pubmed: 33752639
doi: 10.1186/s12890-021-01463-0
pii: 10.1186/s12890-021-01463-0
pmc: PMC7983097
doi:
Types de publication
Journal Article
Meta-Analysis
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
97Références
Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395(10224):565–74.
doi: 10.1016/S0140-6736(20)30251-8
World Health Organization. COVID-19 dashboard. https://covid19.who.int/ .
Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area. JAMA. 2020;323(20):2052.
doi: 10.1001/jama.2020.6775
Carfì A, Bernabei R, Landi F. Gemelli against COVID-19 post-acute care study group. Persistent symptoms in patients after acute COVID-19. JAMA. 2020;324(6):603–5.
doi: 10.1001/jama.2020.12603
Antonio GE, Wong KT, Hui DS, et al. Thin-section CT in patients with severe acute respiratory syndrome following hospital discharge: preliminary experience. Radiology. 2003;228(3):810–5.
doi: 10.1148/radiol.2283030726
Wu X, Dong D, Ma D. Thin-section computed tomography manifestations during convalescence and long-term follow-up of patients with severe acute respiratory syndrome (SARS). Med Sci Monit. 2016;22:2793–9.
doi: 10.12659/MSM.896985
Xie L, Liu Y, Fan B, et al. Dynamic changes of serum SARS-coronavirus IgG, pulmonary function and radiography in patients recovering from SARS after hospital discharge. Respir Res. 2005;6:5.
doi: 10.1186/1465-9921-6-5
Xie L, Liu Y, Xiao Y, et al. Follow-up study on pulmonary function and lung radiographic changes in rehabilitating severe acute respiratory syndrome patients after discharge. Chest. 2005;127:2119–24.
doi: 10.1378/chest.127.6.2119
Hui DS, Joynt GM, Wong KT, et al. Impact of severe acute respiratory syndrome (SARS), on pulmonary function, functional capacity and quality of life in a cohort of survivors. Thorax. 2005;60:401–9.
doi: 10.1136/thx.2004.030205
Hui DS, Wong KT, Ko FW, et al. The 1-year impact of severe acute respiratory syndrome on pulmonary function, exercise capacity, and quality of life in a cohort of survivors. Chest. 2005;128:2247–61.
doi: 10.1378/chest.128.4.2247
Das KM, Lee EY, Singh R, et al. Follow-up chest radiographic findings in patients with MERSCoV after recovery. Indian J Radiol Imaging. 2017;27(3):342–9.
doi: 10.4103/ijri.IJRI_469_16
Park WB, Jun KI, Kim G, et al. Correlation between pneumonia severity and pulmonary complications in middle east respiratory syndrome. J Korean Med Sci. 2018;33:e169.
doi: 10.3346/jkms.2018.33.e169
Hoy D, Brooks P, Woolf A, et al. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol. 2012;65:934–9.
doi: 10.1016/j.jclinepi.2011.11.014
World Health Organization. Clinical management of severe acute respiratory infection when COVID-19 is suspected. https://www.who.int/publications/i/item/clinical-management-of-covid-19 . Date last updated: 27 May 2020.
National Health Commission & State Administration of Traditional Chinese Medicine. Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (Trial Version 7). www.who.int/docs/default-source/wpro---documents/countries/china/covid-19-briefing-nhc/1-clinical-protocols-for-the-diagnosis-and-treatment-of-covid-19-v7.pdf?sfvrsn=c6cbfba4_2 . Date last updated: 3 March 2020.
Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ. 1997;315(7109):629–34.
doi: 10.1136/bmj.315.7109.629
You J, Zhang L, Ni-Jia-Ti MY, Zhang J, Hu F, Chen L, Dong Y, Yang K, Zhang B, Zhang S. Anormal pulmonary function and residual CT abnormalities in rehabilitating COVID-19 patients after discharge. J Infect. 2020;81(2):e150–2.
doi: 10.1016/j.jinf.2020.06.003
Huang Y, Tan C, Wu J, Chen M, Wang Z, Luo L, Zhou X, Liu X, Huang X, Yuan S, Chen C, Gao F, Huang J, Shan H, Liu J. Impact of coronavirus disease 2019 on pulmonary function in early convalescence phase. Respir Res. 2020;21(1):163.
doi: 10.1186/s12931-020-01429-6
Liu D, Zhang W, Pan F, Li L, Yang L, Zheng D, Wang J, Liang B. The pulmonary sequalae in discharged patients with COVID-19: a short-term observational study. Respir Res. 2020;21(1):125.
doi: 10.1186/s12931-020-01385-1
Zhao YM, Shang YM, Song WB, Li QQ, Xie H, Xu QF, Jia JL, Li LM, Mao HL, Zhou XM, Luo H, Gao YF, Xu AG. Follow-up study of the pulmonary function and related physiological characteristics of COVID-19 survivors three months after recovery. EClinicalMedicine. 2020;25:100463.
doi: 10.1016/j.eclinm.2020.100463
Zhong L, Zhang S, Wang J, Zhao X, Wang K, Ding W, Xing Z, Shen J. Analysis of chest CT results of coronavirus disease 2019 (COVID-19) patients at first follow-up. Can Respir J. 2020;1(2020):5328267.
Liang L, Yang B, Jiang N, Fu W, He X, Zhou Y, Ma WL, Wang X. Three-month follow-up study of survivors of coronavirus disease 2019 after discharge. J Korean Med Sci. 2020;35(47):e418.
doi: 10.3346/jkms.2020.35.e418
Tabatabaei SMH, Rajebi H, Moghaddas F, Ghasemiadl M, Talari H. Chest CT in COVID-19 pneumonia: what are the findings in mid-term follow-up? Emerg Radiol. 2020;27(6):711–9.
doi: 10.1007/s10140-020-01869-z
van den Borst B, Peters JB, Brink M, Schoon Y, Bleeker-Rovers CP, Schers H, van Hees HWH, van Helvoort H, van den Boogaard M, van der Hoeven H, Reijers MH, Prokop M, Vercoulen J, van den Heuvel M. Comprehensive health assessment three months after recovery from acute COVID-19. Clin Infect Dis. 2020; ciaa1750.
Smet J, Stylemans D, Hanon S, Ilsen B, Verbanck S, Vanderhelst E. Clinical status and lung function 10 weeks after severe SARS-CoV-2 infection. Respir Med. 2021;176:106276.
doi: 10.1016/j.rmed.2020.106276
Shah AS, Wong AW, Hague CJ, Murphy DT, Johnston JC, Ryerson CJ, Carlsten C. A prospective study of 12-week respiratory outcomes in COVID-19-related hospitalisations. Thorax. 2020; thoraxjnl-2020-216308.
Lerum TV, Aaløkken TM, Brønstad E, Aarli B, Ikdahl E, Lund KMA, Durheim MT, Rodriguez JR, Meltzer C, Tonby K, Stavem K, Skjønsberg OH, Ashraf H, Einvik G. Dyspnoea, lung function and CT findings three months after hospital admission for COVID-19. Eur Respir J. 2020;10:2003448.
doi: 10.1183/13993003.03448-2020
Bellan M, Soddu D, Balbo PE, Baricich A, Zeppegno P, Avanzi GC, Baldon G, Bartolomei G, Battaglia M, Battistini S, Binda V, Borg M, Cantaluppi V, Castello LM, Clivati E, Cisari C, Costanzo M, Croce A, Cuneo D, De Benedittis C, De Vecchi S, Feggi A, Gai M, Gambaro E, Gattoni E, Gramaglia C, Grisafi L, Guerriero C, Hayden E, Jona A, Invernizzi M, Lorenzini L, Loreti L, Martelli M, Marzullo P, Matino E, Panero A, Parachini E, Patrucco F, Patti G, Pirovano A, Prosperini P, Quaglino R, Rigamonti C, Sainaghi PP, Vecchi C, Zecca E, Pirisi M. Respiratory and psychophysical sequelae among patients with COVID-19 four months after hospital discharge. JAMA Netw Open. 2021;4(1):e2036142.
doi: 10.1001/jamanetworkopen.2020.36142
Huang C, Huang L, Wang Y, Li X, Ren L, Gu X, Kang L, Guo L, Liu M, Zhou X, Luo J, Huang Z, Tu S, Zhao Y, Chen L, Xu D, Li Y, Li C, Peng L, Li Y, Xie W, Cui D, Shang L, Fan G, Xu J, Wang G, Wang Y, Zhong J, Wang C, Wang J, Zhang D, Cao B. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet. 2021;397(10270):220–32.
doi: 10.1016/S0140-6736(20)32656-8
Guler SA, Ebner L, Beigelman C, Bridevaux PO, Brutsche M, Clarenbach C, Garzoni C, Geiser TK, Lenoir A, Mancinetti M, Naccini B, Ott SR, Piquilloud L, Prella M, Que YA, Soccal PM, von Garnier C, Funke-Chambour M. Pulmonary function and radiological features four months after COVID-19: first results from the national prospective observational Swiss COVID-19 lung study. Eur Respir J. 2021;8:2003690.
doi: 10.1183/13993003.03690-2020
Han X, Fan Y, Alwalid O, Li N, Jia X, Yuan M, Li Y, Cao Y, Gu J, Wu H, Shi H. Six-month follow-up chest CT findings after severe COVID-19 pneumonia. Radiology. 2021;26:203153.
Magro C, Mulvey JJ, Berlin D, Nuovo G, Salvatore S, Harp J, Baxter-Stoltzfus A, Laurence J. Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases. Transl Res. 2020;220:1.
doi: 10.1016/j.trsl.2020.04.007
Connors JM, Levy JH. Thromboinflammation and the hypercoagulability of COVID-19. J Thromb Haemost. 2020;18(7):1559.
doi: 10.1111/jth.14849
Menter T, Haslbauer JD, Nienhold R, Savic S, Hopfer H, Deigendesch N, Frank S, Turek D, Willi N, Pargger H, Bassetti S, Leuppi JD, Cathomas G, Tolnay M, Mertz KD, Tzankov A. Postmortem examination of COVID-19 patients reveals diffuse alveolar damage with severe capillary congestion and variegated findings in lungs and other organs suggesting vascular dysfunction. Histopathology. 2020;77(2):198–209.
doi: 10.1111/his.14134
Ackermann M, Verleden SE, Kuehnel M, Haverich A, Welte T, Laenger F, Vanstapel A, Werlein C, Stark H, Tzankov A, Li WW, Li VW, Mentzer SJ, Jonigk D. Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19. N Engl J Med. 2020;383(2):120.
doi: 10.1056/NEJMoa2015432
Klok FA, Kruip MJHA, van der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM, Kaptein FHJ, van Paassen J, Stals MAM, Huisman MV, Endeman H. Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020;191:145–7.
doi: 10.1016/j.thromres.2020.04.013
Bilaloglu S, Aphinyanaphongs Y, Jones S, Iturrate E, Hochman J, Berger JS. Thrombosis in hospitalized patients with COVID-19 in a New York City health system. JAMA. 2020;324(8):799–801.
doi: 10.1001/jama.2020.13372
Bikdeli B, Madhavan MV, Jimenez D, Chuich T, Dreyfus I, Driggin E, Nigoghossian C, Ageno W, Madjid M, Guo Y, Tang LV, Hu Y, Giri J, Cushman M, Quéré I, Dimakakos EP, Gibson CM, Lippi G, Favaloro EJ, Fareed J, Caprini JA, Tafur AJ, Burton JR, Francese DP, Wang EY, Falanga A, McLintock C, Hunt BJ, Spyropoulos AC, Barnes GD, Eikelboom JW, Weinberg I, Schulman S, Carrier M, Piazza G, Beckman JA, Steg PG, Stone GW, Rosenkranz S, Goldhaber SZ, Parikh SA, Monreal M, Krumholz HM, Konstantinides SV, Weitz JI, Lip GYH. Global COVID-19 Thrombosis Collaborative Group, Endorsed by the ISTH, NATF, ESVM, and the IUA, Supported by the ESC Working Group on Pulmonary Circulation and Right Ventricular Function. COVID-19 and thrombotic or thromboembolic disease: implications for prevention, antithrombotic therapy, and follow-up: JACC state-of-the-art review. J Am Coll Cardiol. 2020;75(23):2950–2973.
George PM, Barratt SL, Condliffe R, Desai SR, Devaraj A, Forrest I, Gibbons MA, Hart N, Jenkins RG, McAuley DF, Patel BV, Thwaite E, Spencer LG. Respiratory follow-up of patients with COVID-19 pneumonia. Thorax. 2020: thoraxjnl-2020-215314.