Long-term radiological and pulmonary function abnormalities at 3 years after COVID-19 hospitalisation: a longitudinal cohort study

Abstract

BackgroundThis study aimed to evaluate the longitudinal progression of residual lung abnormalities (ground-glass opacities, reticulation and fibrotic-like changes) and pulmonary function at 3 years following coronavirus disease 2019 (COVID-19).MethodsThis prospective, longitudinal cohort study enrolled COVID-19 survivors who exhibited residual lung abnormalities upon discharge from two hospitals. Follow-up assessments were conducted at 6 months, 12 months, 2 years and 3 years post-discharge, and included pulmonary function tests, 6-min walk distance (6MWD), chest computed tomography (CT) scans and symptom questionnaires. Non-COVID-19 controls were retrospectively recruited for comparative analysis.Results728 COVID-19 survivors and 792 controls were included. From 6 months to 3 years, there was a gradual improvement in reduced diffusing capacity of the lung for carbon monoxide (DLCO<80% predicted: 49%versus38%; p=0.001), 6MWD (496versus510 m; p=0.002) and residual lung abnormalities (46%versus36%; p<0.001), regardless of disease severity. Patients with residual lung abnormalities at 3 years more commonly had respiratory symptoms (32%versus16%; p<0.001), lower 6MWD (494versus510 m; p=0.003) and abnormalDLCO(57%versus27%; p<0.001) compared with those with complete resolution. Compared with controls, the proportions ofDLCOimpairment (38%versus17%; p<0.001) and respiratory symptoms (23%versus2.2%; p<0.001) were significantly higher in the matched COVID-19 survivors at the 3-year follow-up.ConclusionsMost patients exhibited improvement in radiological abnormalities and pulmonary function over time following COVID-19. However, more than a third continued to have persistent lung abnormalities at the 3-year mark, which were associated with respiratory symptoms and reduced diffusion capacity.