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P9 Do persistent chest radiograph changes correlate with ongoing respiratory symptoms in patients recovering from COVID-19 pneumonia?

Jain, NG ; Saigal, A ; Naidu, SB ; Shah, AJ ; Brill, SE ; Jarvis, H ; Barnett, J ; Hare, S ; Hurst, JR ; Lipman, M ; Mandal, S

Thorax, 2021-02, Vol.76 (Suppl 1), p.A89-A90 [Periódico revisado por pares]

London: BMJ Publishing Group LTD

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  • Título:
    P9 Do persistent chest radiograph changes correlate with ongoing respiratory symptoms in patients recovering from COVID-19 pneumonia?
  • Autor: Jain, NG ; Saigal, A ; Naidu, SB ; Shah, AJ ; Brill, SE ; Jarvis, H ; Barnett, J ; Hare, S ; Hurst, JR ; Lipman, M ; Mandal, S
  • Assuntos: Coronaviruses ; COVID-19 ; Pneumonia
  • É parte de: Thorax, 2021-02, Vol.76 (Suppl 1), p.A89-A90
  • Descrição: Introduction and ObjectivesIn May 2020, BTS published guidelines on radiological follow-up for patients with COVID-19 pneumonia, advising an initial repeat chest radiograph at 12 weeks to assess resolution.1 It is unclear whether persistent chest radiograph changes are clinically significant. Our aim was to assess whether there is a correlation between post-COVID chest radiograph appearances and ongoing respiratory symptoms.MethodsInpatients at two trust hospital sites diagnosed with COVID-19, either clinically or from a positive nasopharyngeal swab, were followed-up via telephone approximately 6–8 weeks post-discharge. Patients were offered a chest radiograph and blood tests if abnormal and a symptomatic assessment via a proforma. Patients subjectively rated their degree of breathlessness, cough and fatigue using a numerical rating scale. Chest radiograph reports were coded by consultant radiologists as per BSTI guidelines2 and grouped into ‘improvers’ (PCVCX0/1) and ‘non-improvers’ (PCVCX2/3 i.e. static or worsening appearances). Patients who had both an initial and follow-up chest radiograph, and who completed a proforma were included for retrospective analysis.Results382 patients were included, with a median (IQR) time to follow-up of 56 days (44 – 68). Baseline characteristics are shown in table 1. 93% of patients had significantly improved radiographs. Patients with radiographs that were classified as ‘non-improvers’ were significantly more breathless subjectively compared to improvers [NRS 2 (0 – 4) vs. 1 (0 – 3), p= 0.01], [MRC scale 1 (1 – 3) vs. 1 (1 – 2), p= 0.021]. They were also more likely to have been admitted to ITU [10/26 (38.5%) vs. 41/356 (11.5%), p< 0.001].Abstract P9 Table 1Differences in symptom burden in patients with improved vs. non-improved chest radiographs Demographic Chest radiograph appearance p-value Improvers n= 356 (93%) Non-improvers n= 26 (7%) Age (years)58.9 ± 14.763.23 ± 12.70.103BMI (kg/m2)27.7 ± 5.4326.7 ± 4.500.331Male sex (n,%)224 (62.9)21 (80.8)0.154BAME (n,%)165 (46.3)10 (38.5)0.268Current or ex-smoker (n,%)112 (31.4)9 (34.6) 0.008 Underlying respiratory disease (n,%)62 (17.4)3 (11.5)0.737ITU admission (n,%)41 (11.5)10 (38.5) < 0.001 Symptoms Breathlessness*1 (0 – 3)2 (0 – 4) 0.010 Cough*0 (0 –1)0 (0 – 2.5)0.090Fatigue*2 (0 – 5)2 (0.5 – 4.5)0.773How close back to 100% of usual do you feel?*90 (80 – 100)85 (75 – 97.5)0.500MRC dyspnoea scale*1 (1 – 2)1 (1 – 3) 0.021 *non-parametric data presented as median and IQR, all other data are presented as mean ± standard deviationConclusionsIn our cohort, patients recovering from COVID-19 pneumonia with a ‘non-improver’ chest radiograph are more likely to have been admitted to ITU and remain breathless at follow-up. We conclude that ‘non-improver’ chest radiographs at follow-up are an indicator of who may have ongoing respiratory pathology. These patients can thus be prioritised for further respiratory investigation.ReferencesBritish Thoracic Society (2020). Guidance on Respiratory Follow Up of Patients with a Clinico-Radiological Diagnosis of COVID-19 Pneumonia. https://www.brit-thoracic.org.uk/document-library/quality-improvement/covid-19/resp-follow-up-guidance-post-covid-pneumonia/British Society of Thoracic Imaging (2020). Post-COVID-19 CXR Report Codes. https://www.bsti.org.uk/media/resources/files/BSTI_PostCOVIDCXRtemplatefinal.28.05.201.pdf
  • Editor: London: BMJ Publishing Group LTD
  • Idioma: Inglês
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  • Realização: ABCD-USP USP   Logos de Redes Sociais: Freepik

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