Pulmonary Sequelae of COVID-19 in Patients With Lung Damage Over 75% (CT-4)

Introduction: A number of studies uses severity of lung damage as a predictor of lung changes in the long-term period. Objective: To evaluate computed tomography (CT) findings in the long-term period after extremely severe lung damage (CT-4) caused by COVID-19 during different pandemic waves and compare those with clinical data. Materials and methods: The study included 51 patients (51.0% of them were women; age, 57 ± 12 years 95% CI, 53-60) that were treated for COVID-19 with lung damage (CT-4) in O.M. Filatov City Clinical Hospital No. 15 (Moscow, Russian Federation) and gave their consent for examination after discharge. The patients underwent chest CT and dyspnea assessment (Medical Research Council MRC dyspnea scale) in the long-term period and were grouped based on the pandemic wave and dyspnea grade. Twelve patients from the first pandemic wave were examined 12.5 months after discharge; 13 patients from the second pandemic wave were examined in 6.5 months, and 26 patients from the third pandemic wave were examined in 8 months. The group with MRC dyspnea grade 0 included 19 patients, whereas 32 patients comprised the group with MRC dyspnea grades 1 and 2. Results: CT revealed changes in 50 (98.0%) of the examined patients, with fibrotic-like changes (88.2%), areas of consolidation (47.1%), and ground-glass opacity (13.7%) being the most common findings. All 3 patterns were equally common, regardless of the pandemic wave. No dyspnea higher than MRC grade 2 was observed. Fibrotic-like changes were found in 100.0% of the patients with MRC dyspnea grades 1 and 2, whereas they were detected only in 68.4% of the patients with MRC dyspnea grade 0, P = .002. The multivariate analysis showed that fibrotic-like changes were the only factor associated with dyspnea higher than grade 0. Conclusions: After extremely severe lung damage (CT-4) CT changes were present in almost all the patients. The study results highlight clinical significance of these changes and demonstrate the rehabilitation potential of this group.