Pulmonary Fibrosis in Patients Surviving Ards Pneumonia of Covid-19 and Non-Covid-19 Etiologies

ABSTRACT

INTRODUCTION: To examine the patient-centered outcomes and the occurrence of lung fibrotic changes on Chest computed tomography (CT) imaging following pneumonia-related acute respiratory distress syndrome (ARDS). We sought to investigate outpatient clinic chest CT imaging in survivors of COVID19-related ARDS and non-COVID-related ARDS, to determine group differences and explore relationships between lung fibrotic changes and functional outcomes. METHOD(S) Retrospective practice analysis of electronic health records at an ICU Recovery Clinic in tertiary academic medical center. RESULT(S) One-hundred four patients with mean age 54 +/- 13 and 52% male were included (n=74 COVID-19 and n=30 non-COVID groups). There were no differences for age, sex, mechanical ventilation duration, tracheotomy, or sequential organ failure assessment (SOFA) scores between two groups. Six-weeks after hospital discharge, fibrotic changes visualized on CT imaging occurred in a higher proportion of COVID-19 survivors (69%) compared to non-COVID (43%, chi2 = 5.6, p = 0.018). In general, across both groups, patients with fibrotic changes (n=64) were older, had a lower BMI, and had longer duration of mechanical ventilation. Overall, patients performed poorly on six-minute walk test (44 +/- 27% of predictive distance), had poor respiratory function (FEV1% = 66 +/- 27% and FVC% = 65 +/- 20%), and had high occurrences of anxiety, depression, emotional distress, and mild cognitive impairment regardless of presence of fibrotic changes. CONCLUSION(S) Patients surviving pneumonia-ARDS are at high risk of impairments in physical, emotional, and cognitive health related to Post-Intensive Care Syndrome. Of clinical importance, pulmonary fibrotic changes on chest CT occurred in a higher proportion in COVID-ARDS group;however, no differences were measured in spirometry or functional assessments at six weeks post hospital discharge. Whether COVID infection imparts a unique recovery is not evident from these data but suggest that long-term follow up is necessary for all survivors of ARDS.