Parenchymal lung abnormalities, clinical severity and outcomes in patients with COVID 19 pneumonia: a prospective longitudinal observational study

Abstract

Background: Clinical outcome and parenchymal lung abnormalities (PLA) data from hospitalized patients with COVID 19 pneumonia are limited.

Objectives: (1) Understand and compare the patterns of PLA on high resolution computed tomographic (HRCT) at admission, 4-8 weeks post-admission in all patients and 10-12 weeks post-admission in a subgroup of patients (2) follow up their general health status on phone 6 months post admissionMethods: Prospective, observational study of consecutive adult patients hospitalized with RT-PCR confirmed COVID-19 pneumonia in a tertiary centre, India. Clinical data and HRCT image patterns and distribution of PLA at admission, 4-8 weeks in all patients and at 10-12 weeks in a subgroup of patients were analysed using a novel, composite radiological score (CRS). Surviving patients were followed up telephonically 6 months later. Findings: Of 179 patients, HRCT features were ground glass opacity (144, 80.4%), consolidation (23, 12.8%) and reticulation (7, 4%) at admission. 74% demonstrated resolving PLA with 14% showing complete resolution at 4-8 weeks. Fine reticulations were seen in 12% at 8 weeks and 20% in a subgroup of 44 patients who had persisting symptoms at 10-12 weeks. CRS correlated well with clinical severity and recovery (p=0.003). At 6 months, 144 responded to the phone follow up, reported no functional impairment and had returned to their pre-COVID health status. Conclusion: PLA resolved in 88% at 8 weeks and all the 144 patients who were followed up at 6 months reported return to pre-COVID 19 health status. This is quite reassuring amidst concerns of ‘long COVID’