Lung abnormalities persist in 91% of COVID-19 patients

More than 90% of patients who developed COVID-19 showed lung parenchymal abnormalities on chest CT and x-ray three months after recovery in a study published in the September issue of Clinical Infectious Diseases.

The findings highlight the need for further investigation into COVID-19's long-term effects, wrote a team led by Dr. Bram van den Borst of Radboud University Medical Center in Nijmegen, the Netherlands.

"Long-term health consequences of this coronavirus disease ... are yet largely unknown, but many patients are likely to experience long-lasting morbidity," the authors wrote. "Indeed, based on observations from diseases that share COVID-19 characteristics ... it is hypothesized that, in the long-term, a significant number of patients with COVID-19 will suffer from lung function impairment, residual pulmonary parenchymal abnormalities, decreased physical capacity, loss of muscle mass, anxiety, depression, cognitive deficits, post-traumatic stress disorder, fatigue, and poor health status" (Clin Infect Dis, September 2021, Vol. 73:5, pp. e1089-e1098).

The study included 124 patients who had been treated for COVID-19 at Radboud in 2020. Of the 124 patients, 27 had mild, 51 had moderate, 26 had severe, and 20 had critical disease. Each participated in a follow-up examination three months after recovery that consisted of lung function measurement tests, chest CT and x-ray, a six-minute walking test, and a body composition evaluation; each participant also responded to a questionnaire about their mental, cognitive, and health status, as well as their quality of life.

Although the majority of patients showed reduced ground-glass opacities on CT and normal chest x-rays at the three-month follow-up, the researchers also found that 91% had persistent parenchymal lung abnormalities, including ground-glass opacities, pleural lines and parenchymal bands, bronchiolectasis, and fibrosis. Nearly a third of patients had three lung abnormalities on CT at follow-up, and nearly a quarter had four.

CT imaging results in COVID-19 patients 3 months after recovery
Type of abnormality
Ground-glass opacity	86%
Lines and bands	64%
Bronchiolectasis	60%
Fibrosis	26%
No. of abnormalities
0	9%
1	20%
2	20%
3	27%
4	24%

The team also found the following:

• 72% of patients reported lower quality of life.
• 69% showed fatigue.
• 64% demonstrated functional impairment.
• 36% showed mental and/or cognitive function difficulties.

"Our results indicate that a substantial proportion of patients still experience severe problems in various health domains three months after COVID-19," the group wrote.

The study suggests that more research on the long-term effects of COVID-19 is needed, according to the authors.

"Longer follow-up studies are warranted to elucidate natural trajectories of COVID-19 recovery, to find predictors of complicated long-term trajectories, and to develop strategies to decrease long-term COVID-19 morbidity," they concluded.