Interstitial lung abnormalities after hospitalization for COVID-19 in patients with cancer: A prospective cohort study

Abstract

Introduction: Survivors of SARS-CoV-2 pneumonia often develop persistent respiratory symptom and interstitial lung abnormalities (ILAs) after infection. Risk factors for ILA development and duration of ILA persistence after SARS-CoV-2 infection are not well described in immunocompromised hosts, such as cancer patients.

Methods: We conducted a prospective cohort study of 95 patients at a major cancer center and 45 patients at a tertiary referral center. We collected clinical and radiographic data during the index hospitalization for COVID-19 pneumonia and measured pneumonia severity using a semi-quantitative radiographic score, the Radiologic Severity Index (RSI). Patients were evaluated in post-COVID-19 clinics at 3 and 6 months after discharge and underwent comprehensive pulmonary evaluations (symptom assessment, chest computed tomography, pulmonary function tests, 6-min walk test). The association of clinical and radiological factors with ILAs at 3 and 6 months post-discharge was measured using univariable and multivariable logistic regression.

Results: Sixty-six (70%) patients of cancer cohort had ILAs at 3 months, of whom 39 had persistent respiratory symptoms. Twenty-four (26%) patients had persistent ILA at 6 months after hospital discharge. In adjusted models, higher peak RSI at admission was associated with ILAs at 3 (OR 1.5 per 5-point increase, 95% CI 1.1-1.9) and 6 months (OR 1.3 per 5-point increase, 95% CI 1.1-1.6) post-discharge. Fibrotic ILAs (reticulation, traction bronchiectasis, and architectural distortion) were more common at 6 months post-discharge.

Conclusions: Post-COVID-19 ILAs are common in cancer patients 3 months after hospital discharge, and peak RSI and older age are strong predictors of persistent ILAs.

Keywords: COVID-19; fibrosis; interstitial lung disease; pneumonia; post-infectious pulmonary complication.

FIGURE 1

Selection of the final study cohort (n = 94).

FIGURE 2

Schema for post‐COVID‐19 evaluations.

FIGURE 3

Representative images of a patient with mild (A, RSI 7), severe (B, RSI 41), and very severe (C, RSI 70) SARS‐CoV‐2 pneumonia.

FIGURE 4

Representative images of interstitial lung abnormalities (ILAs). Arrows illustrate representative abnormalities, while the inset figure shows the abnormalities with 50% magnification. (A–C) ILAs seen at 3 months. (A) Ground‐glass opacities (GGOs). (B) Reticular opacities. (C) Reticular opacities and non‐emphysematous cysts. (D–H) Examples of ILAs seen at 6 months. (D) Reticular opacities and bronchiectasis. (E) Air trapping. (F) Lower lobe consolidation. (G) Honeycombing and traction bronchiectasis. (H) Architectural distortion and GGOs.

FIGURE 5

Representative images of two separate patients with transient (A, B) and persistent (C, D) ILAs. (A) Imaging from the initial SARS‐CoV‐2 pneumonia with complete resolution (B) 6 months after hospital discharge. (C) Imaging from the initial SARS‐CoV‐2 pneumonia in a patient with persistent ILAs (D) 6 months after hospital discharge, including reticular and ground‐glass opacities and architectural distortion, highlighted by the white arrows.