ABSTRACT
Background and Aim: COPD Assessment Tool (CAT) is used to access symptoms in COPD. We have shown that CAT>=10 is a useful predictor for post covid pulmonary fibrosis (Aul et al ERJ 2021;58:Suppl.65, OA4193). In this study we assessed the correlation between CAT score and lung function at post COVID follow up. Method(s): We collected data from post Covid clinic in our hospital. CAT score and Lung function were assessed at 2- 3 and 6-8-months post discharge after COVID-19 (visit 1 and 2). Data is presented as median (IQ range), association between CAT score and lung function parameters is assessed using Pearson's correlation coefficient. Result(s): Median age of the patients was 63 (55-76) and 56.6% were men (n=387). Lung function was available for 114 and 82 patients at visit 1 and 2 respectively. Median CAT scores, FVC% and DCO% are shown in the table. CAT negatively correlated with both FVC% [r= -0.35 (p< 0.01), r= -0.25 (p=0.049)] and DCO% [r= -0.23 (p= 0.018), r=-0.26 (p=0.049)] at Visit 1 and 2. Change in FVC% and DCO% between the two visits had a further negative View inline correlation with change in CAT score (Figure). Discussion(s): Our study shows that CAT score correlates with FVC% and gas transfer at multiple time points in post Covid assessment and it may be used as a surrogate tool for assessing patients with post COVID pulmonary disease.
ABSTRACT
P132 Table 1Follow up symptoms and radiological findings at first and second assessment post discharge. Analysed by Wilcoxon Rank Sum, median (range) First timepoint Second timepoint P value Clinic assessment (months post discharge) 1.5 (1–3) 9 (6–12) CT scan (months post discharge) 2.5 (1–4) 8 (6–12) MRC score 3 (2–4) 1 (1–3) <0.0001 CAT score 12 (7–18) 6 (4–14) 0.002 Numbers of CT performed 81 35 Numbers of CTs performed for isolated ground glass abnormalities (PCVCT1+2) 47 13 Numbers of CTs performed for fibrosis plus ground glass changes (PCVCT3) 34 22 ConclusionThose patients found to have PCVCT3 changes on initial CT should receive long term follow up as a proportion (approximately 9%) of them may develop progressive fibrotic changes. However this is likely to only represent less than 1% of all COVID-19 patients discharged from hospital. Longer term follow up is needed to determine the ongoing trajectory of these interstitial changes. These patients may potentially benefit from clinical trials in the future for the use of antifibrotics.ReferencesHuang C, et al. 6-month consequences of COVID-19 in patients discharged from hospital: a cohort study. Lancet 2021;397:220–32.BSTI. BSTI Post-COVID-19 CT Report Codes. BSTI 22-May-2020.
ABSTRACT
Introduction Current guidelines for follow up of COVID-19 patients are based on experience with outbreaks with Middle East Respiratory Syndrome (MERS) and Severe Acute Respiratory Syndrome (SARS), with the aim to identify patients likely to develop post infectious fibrosis. The COVID-19 pandemic is on a much larger scale and requires investigation regarding the most effective way to follow up these patients. Methods We set up a pathway to allow us to screen selected discharged patients to identify those who required further investigations. Discharged patients were identified following admission between March and June 2020 using electronic hospital records. Patients who were not suitable to be called were excluded, and a letter was written to their GP explaining this. All other patients were called approximately 6 weeks after discharge. Information was collected including ongoing symptoms, admission radiological changes, and selected questionnaires. Patients with ongoing symptoms were invited back for investigations and face-to-face appointment, and anyone without symptoms but x-ray changes was invited for repeat X-ray at 10 weeks. Results Of the 828 admissions, 281 died, and a further 182 were unsuitable to call. Of those called, 88% (321) answered, and 65 remained symptomatic and were seen in clinic. 154 people required a repeat chest x-ray, 8 subsequently had a CT thorax and clinic review. 56 people did not attend for follow-up x-ray and were discharged. Of the 73 people seen, 59 had interstitial changes based on radiological criteria;29 of these were resolving inflammation which did not require further follow up as the patients were also clinically improving. 30 patients, 11 with fibrotic changes, required observation or treatment. Four patients received oral prednisolone and 7 had received intravenous methylprednisolone earlier. In the symptomatic group, PEs, pulmonary hypertension, adenocarcinoma in situ and breathing pattern disorders were also diagnosed. Conclusion Less than 10% of patients required treatment with steroids after admission with COVID-19 infection. This is lower than previous estimates following MERS/SARS infection. Interestingly, severe radiology changes did not predict the likelihood of developing fibrosis. The screening telephone clinic was a useful way of identifying those with ongoing symptoms who required further investigation.