Risk Factors for Potential Persistent Lung Abnormality on Chest Radiographs in Post COVID-19 Patients

Abstract

Background: Most COVID-19 pneumonia survivors develop abnormal chest radiographs (CXR) that progress to interstitial lung disease. This study aimed to identify potential risk factors for persistent CXR abnormalities in post COVID-19 patients. Methods: The study included hospitalized COVID-19 pneumonia patients at Phramongkutklao Hospital between July 2021 and June 2022. At 12 weeks after discharge, CXR were evaluated based on the extent of abnormal infiltration, using a scoring system. The primary objective was to determine risk factors during COVID-19 infection associated with persistent CXR abnormalities at 12 weeks. Results:120 patients included (56% male; mean age 58 years), 76 (63%) exhibited persistently abnormal CXR at 12 weeks after discharge. The group with persistent CXR abnormalities had significantly higher mean age (62 vs. 52 years, p < 0.001), longer hospital stays (21 vs. 14 days, p < 0.001), higher rates of hypertension (61.8 vs. 27.3%, p < 0.001), dyslipidemia (44.7 vs. 27.4%, p = 0.04), use of oxygen support (85.5 vs. 45.5%, p < 0.001), and use of HFNC or NIV (44.7 vs. 15.9%, p < 0.001) compared to the group with complete resolution. Laboratory revealed significantly elevated levels of serum LDH (p < 0.001), CRP (p = 0.002), and peak CRP (p = 0.001) in the group with persistent CXR abnormalities. Multivariable analysis identified a longer hospital stay (>14 days), hypertension, use of oxygen therapy (HFNC, NIV, or ETT), and serum LDH levels >250 U/L as significant factors associated with CXR abnormality. Conclusion: A longer hospital stays > 14 days, hypertension, use of oxygen therapy, and serum LDH > 250 U/L were identified as risk factors for persistent CXR abnormality from COVID-19 at 12 weeks.