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Parenchymal lung abnormalities following hospitalisation for COVID-19 and viral pneumonitis: a systematic review and meta-analysis

Fabbri, Laura; Moss, Samuel; Khan, Fasihul A.; Chi, Wenjie; Xia, Jun; Robinson, Karen; Smyth, Alan Robert; Jenkins, Gisli; Stewart, Iain

Parenchymal lung abnormalities following hospitalisation for COVID-19 and viral pneumonitis: a systematic review and meta-analysis Thumbnail


Authors

Laura Fabbri

Samuel Moss

Fasihul A. Khan

Wenjie Chi

Jun Xia

Karen Robinson

Alan Robert Smyth

Gisli Jenkins

Iain Stewart



Abstract

Introduction Persisting respiratory symptoms in COVID-19 survivors may be related to development of pulmonary fibrosis. We assessed the proportion of chest CT scans and pulmonary function tests consistent with parenchymal lung disease in the follow-up of people hospitalised with COVID-19 and viral pneumonitis.

Methods Systematic review and random effects meta-analysis of proportions using studies of adults hospitalised with SARS-CoV-2, SARS-CoV, MERS-CoV or influenza pneumonia and followed up within 12 months. Searches performed in MEDLINE and Embase. Primary outcomes were proportion of radiological sequelae on CT scans; restrictive impairment; impaired gas transfer. Heterogeneity was explored in meta-regression.

Results Ninety-five studies (98.9% observational) were included in qualitative synthesis, 70 were suitable for meta-analysis including 60 SARS-CoV-2 studies with a median follow-up of 3 months. In SARS-CoV-2, the overall estimated proportion of inflammatory sequelae was 50% during follow-up (0.50; 95% CI 0.41 to 0.58; I2=95%), fibrotic sequelae were estimated in 29% (0.29; 95% CI 0.22 to 0.37; I2=94.1%). Follow-up time was significantly associated with estimates of inflammatory sequelae (−0.036; 95% CI −0.068 to –0.004; p=0.029), associations with fibrotic sequelae did not reach significance (−0.021; 95% CI −0.051 to 0.009; p=0.176). Impaired gas transfer was estimated at 38% of lung function tests (0.38 95% CI 0.32 to 0.44; I2=92.1%), which was greater than restrictive impairment (0.17; 95% CI 0.13 to 0.23; I2=92.5%), neither were associated with follow-up time (p=0.207; p=0.864).

Discussion Sequelae consistent with parenchymal lung disease were observed following COVID-19 and other viral pneumonitis. Estimates should be interpreted with caution due to high heterogeneity, differences in study casemix and initial severity.

Citation

Fabbri, L., Moss, S., Khan, F. A., Chi, W., Xia, J., Robinson, K., …Stewart, I. (2023). Parenchymal lung abnormalities following hospitalisation for COVID-19 and viral pneumonitis: a systematic review and meta-analysis. Thorax, 78(2), 191-201. https://doi.org/10.1136/thoraxjnl-2021-218275

Journal Article Type Article
Acceptance Date Feb 3, 2022
Online Publication Date Mar 25, 2022
Publication Date 2023-02
Deposit Date Mar 27, 2022
Publicly Available Date Mar 29, 2024
Journal Thorax
Print ISSN 0040-6376
Electronic ISSN 1468-3296
Publisher BMJ
Peer Reviewed Peer Reviewed
Volume 78
Issue 2
Pages 191-201
DOI https://doi.org/10.1136/thoraxjnl-2021-218275
Keywords Pulmonary and Respiratory Medicine
Public URL https://nottingham-repository.worktribe.com/output/7655441
Publisher URL https://thorax.bmj.com/content/78/2/191