Two years after hospitalization for COVID-19, 58% of patients still show lung abnormalities such as ground-glass opacities and reticulations, with 33% developing fibrotic-like lesions including traction bronchiectasis and architectural distortion, according to a recent study.

Researchers investigated the long-term respiratory sequelae in COVID-19 patients 2 years post-hospitalization. The study cohort was comprised of 237 patients who underwent follow-up assessments 18 to 24 months after hospital discharge, building on initial evaluations conducted 6 to 12 months post-discharge.

Average age was 56.3 years; 47% of enrolled patients were male and 53% were female. Among the cohort, 68% of patients required intensive care during their hospitalizations for COVID-19 infection, with 38% needing vasoactive drugs, 68% requiring invasive mechanical ventilation, and 9% undergoing tracheostomy, according to research published in The Lancet Regional Health – Americas.

Key findings indicated that 20 of 80 patients with fibrotic-like lesions (25%) experienced a worsening of lung abnormalities compared to their initial post-discharge assessment. Serial computed tomography scans revealed an increase in patients with architectural distortion, from 43 out of 204 (21%) at the initial follow-up to 57 out of 204 (28%) at the 18-to-24-month follow-up (P = 0.0093), and an increase in patients with traction bronchiectasis from 55 out of 204 (27%) to 69 out of 204 (34%) over the same period (P = 0.0043).

Pulmonary function tests consistently demonstrated a restrictive pattern in 44% of patients (91 of 207) at the 18-to-24-month follow-up, compared to 42% (87 of 207) at the 6-to-12-month follow-up (P = 0.76). Reduced lung diffusion capacity was noted in 42% of patients (87 of 208) at both follow-ups (P = 1.0), indicating persistent functional impairment.

Predictive analysis identified prolonged hospitalization (odds ratio [OR] = 1.04, 95% confidence interval [CI] = 1.01–1.07, P = 0.0040), the need for invasive mechanical ventilation (OR = 3.11, 95% CI = 1.30–7.58, P = 0.011), and older age (OR = 1.03, 95% CI = 1.01–1.06, P = 0.0074) as significant predictors for the development of fibrotic-like lesions. 

"Post–COVID-19 lung sequelae can persist and progress after hospital discharge, suggesting airways involvement and formation of new fibrotic-like lesions, mainly in patients who were in [the] intensive care unit," noted the study authors.

Full disclosures can be found in the published study.