Residual Lung Abnormalities after COVID-19 Hospitalization: Interim Analysis of the UKILD Post-COVID-19 Study

PHOSP-COVID Collaborative Group; Iain Stewart; Joseph Jacob; Peter M George; Philip L Molyneaux; Joanna C Porter; Richard J Allen; Shahab Aslani; J Kenneth Baillie; Shaney L Barratt; Paul Beirne; Stephen M Bianchi; John F Blaikley; James D Chalmers; Rachel C Chambers; Nazia Chaudhuri; Christopher Coleman; Guilhem Collier; Emma K Denneny; Annemarie Docherty; Omer Elneima; Rachel A Evans; Laura Fabbri; Michael A Gibbons; Fergus V Gleeson; Bibek Gooptu; Neil J Greening; Beatriz Guillen Guio; Ian P Hall; Neil A Hanley; Victoria Harris; Ewen M Harrison; Melissa Heightman; Toby E Hillman; Alex Horsley; Linzy Houchen-Wolloff; Ian Jarrold; Simon R Johnson; Mark G Jones; Fasihul Khan; Rod Lawson; Olivia Leavy; Nazir Lone; Michael Marks; Hamish McAuley; Puja Mehta; Dhruv Parekh; Karen Piper Hanley; Manuela Platé; John Pearl; Mark Spears

doi:10.1164/rccm.202203-0564OC

Residual Lung Abnormalities after COVID-19 Hospitalization: Interim Analysis of the UKILD Post-COVID-19 Study

PHOSP-COVID Collaborative Group, Iain Stewart (Lead / Corresponding author), Joseph Jacob, Peter M George, Philip L Molyneaux, Joanna C Porter, Richard J Allen, Shahab Aslani, J Kenneth Baillie, Shaney L Barratt, Paul Beirne, Stephen M Bianchi, John F Blaikley, James D Chalmers, Rachel C Chambers, Nazia Chaudhuri, Christopher Coleman, Guilhem Collier, Emma K Denneny, Annemarie DochertyOmer Elneima, Rachel A Evans, Laura Fabbri, Michael A Gibbons, Fergus V Gleeson, Bibek Gooptu, Neil J Greening, Beatriz Guillen Guio, Ian P Hall, Neil A Hanley, Victoria Harris, Ewen M Harrison, Melissa Heightman, Toby E Hillman, Alex Horsley, Linzy Houchen-Wolloff, Ian Jarrold, Simon R Johnson, Mark G Jones, Fasihul Khan, Rod Lawson, Olivia Leavy, Nazir Lone, Michael Marks, Hamish McAuley, Puja Mehta, Dhruv Parekh, Karen Piper Hanley, Manuela Platé, John Pearl, Mark Spears

Undergraduate Medicine

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Abstract

Rationale: Shared symptoms and genetic architecture between coronavirus disease (COVID-19) and lung fibrosis suggest severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may lead to progressive lung damage.

Objectives: The UK Interstitial Lung Disease Consortium (UKILD) post-COVID-19 study interim analysis was planned to estimate the prevalence of residual lung abnormalities in people hospitalized with COVID-19 on the basis of risk strata.

Methods: The PHOSP-COVID-19 (Post-Hospitalization COVID-19) study was used to capture routine and research follow-up within 240 days from discharge. Thoracic computed tomography linked by PHOSP-COVID-19 identifiers was scored for the percentage of residual lung abnormalities (ground-glass opacities and reticulations). Risk factors in linked computed tomography were estimated with Bayesian binomial regression, and risk strata were generated. Numbers within strata were used to estimate posthospitalization prevalence using Bayesian binomial distributions. Sensitivity analysis was restricted to participants with protocol-driven research follow-up.

Measurements and Main Results: The interim cohort comprised 3,700 people. Of 209 subjects with linked computed tomography (median, 119 d; interquartile range, 83-155), 166 people (79.4%) had more than 10% involvement of residual lung abnormalities. Risk factors included abnormal chest X-ray (risk ratio [RR], 1.21; 95% credible interval [CrI], 1.05-1.40), percent predicted DlCO less than 80% (RR, 1.25; 95% CrI, 1.00-1.56), and severe admission requiring ventilation support (RR, 1.27; 95% CrI, 1.07-1.55). In the remaining 3,491 people, moderate to very high risk of residual lung abnormalities was classified at 7.8%, and posthospitalization prevalence was estimated at 8.5% (95% CrI, 7.6-9.5), rising to 11.7% (95% CrI, 10.3-13.1) in the sensitivity analysis.

Conclusions: Residual lung abnormalities were estimated in up to 11% of people discharged after COVID-19-related hospitalization. Health services should monitor at-risk individuals to elucidate long-term functional implications.

Original language	English
Pages (from-to)	693-703
Number of pages	11
Journal	American Journal of Respiratory and Critical Care Medicine
Volume	207
Issue number	6
Early online date	1 Dec 2022
DOIs	https://doi.org/10.1164/rccm.202203-0564OC
Publication status	Published - 15 Mar 2023

Keywords

COVID-19
HRCT
hospitalization
lung abnormalities
lung damage

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine
Pulmonary and Respiratory Medicine

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10.1164/rccm.202203-0564OCLicence: CC BY

Final Published VersionFinal published version, 0.99 MBLicence: CC BY

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PHOSP-COVID Collaborative Group, Stewart, I., Jacob, J., George, P. M., Molyneaux, P. L., Porter, J. C., Allen, R. J., Aslani, S., Baillie, J. K., Barratt, S. L., Beirne, P., Bianchi, S. M., Blaikley, J. F., Chalmers, J. D., Chambers, R. C., Chaudhuri, N., Coleman, C., Collier, G., Denneny, E. K., ... Spears, M. (2023). Residual Lung Abnormalities after COVID-19 Hospitalization: Interim Analysis of the UKILD Post-COVID-19 Study. American Journal of Respiratory and Critical Care Medicine, 207(6), 693-703. https://doi.org/10.1164/rccm.202203-0564OC

@article{d91338c0005a47febe1fdc20381384d0,

title = "Residual Lung Abnormalities after COVID-19 Hospitalization: Interim Analysis of the UKILD Post-COVID-19 Study",

abstract = "Rationale: Shared symptoms and genetic architecture between coronavirus disease (COVID-19) and lung fibrosis suggest severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may lead to progressive lung damage.Objectives: The UK Interstitial Lung Disease Consortium (UKILD) post-COVID-19 study interim analysis was planned to estimate the prevalence of residual lung abnormalities in people hospitalized with COVID-19 on the basis of risk strata.Methods: The PHOSP-COVID-19 (Post-Hospitalization COVID-19) study was used to capture routine and research follow-up within 240 days from discharge. Thoracic computed tomography linked by PHOSP-COVID-19 identifiers was scored for the percentage of residual lung abnormalities (ground-glass opacities and reticulations). Risk factors in linked computed tomography were estimated with Bayesian binomial regression, and risk strata were generated. Numbers within strata were used to estimate posthospitalization prevalence using Bayesian binomial distributions. Sensitivity analysis was restricted to participants with protocol-driven research follow-up.Measurements and Main Results: The interim cohort comprised 3,700 people. Of 209 subjects with linked computed tomography (median, 119 d; interquartile range, 83-155), 166 people (79.4%) had more than 10% involvement of residual lung abnormalities. Risk factors included abnormal chest X-ray (risk ratio [RR], 1.21; 95% credible interval [CrI], 1.05-1.40), percent predicted DlCO less than 80% (RR, 1.25; 95% CrI, 1.00-1.56), and severe admission requiring ventilation support (RR, 1.27; 95% CrI, 1.07-1.55). In the remaining 3,491 people, moderate to very high risk of residual lung abnormalities was classified at 7.8%, and posthospitalization prevalence was estimated at 8.5% (95% CrI, 7.6-9.5), rising to 11.7% (95% CrI, 10.3-13.1) in the sensitivity analysis.Conclusions: Residual lung abnormalities were estimated in up to 11% of people discharged after COVID-19-related hospitalization. Health services should monitor at-risk individuals to elucidate long-term functional implications.",

keywords = "COVID-19, HRCT, hospitalization, lung abnormalities, lung damage",

author = "{PHOSP-COVID Collaborative Group} and Iain Stewart and Joseph Jacob and George, {Peter M} and Molyneaux, {Philip L} and Porter, {Joanna C} and Allen, {Richard J} and Shahab Aslani and Baillie, {J Kenneth} and Barratt, {Shaney L} and Paul Beirne and Bianchi, {Stephen M} and Blaikley, {John F} and Chalmers, {James D} and Chambers, {Rachel C} and Nazia Chaudhuri and Christopher Coleman and Guilhem Collier and Denneny, {Emma K} and Annemarie Docherty and Omer Elneima and Evans, {Rachel A} and Laura Fabbri and Gibbons, {Michael A} and Gleeson, {Fergus V} and Bibek Gooptu and Greening, {Neil J} and {Guillen Guio}, Beatriz and Hall, {Ian P} and Hanley, {Neil A} and Victoria Harris and Harrison, {Ewen M} and Melissa Heightman and Hillman, {Toby E} and Alex Horsley and Linzy Houchen-Wolloff and Ian Jarrold and Johnson, {Simon R} and Jones, {Mark G} and Fasihul Khan and Rod Lawson and Olivia Leavy and Nazir Lone and Michael Marks and Hamish McAuley and Puja Mehta and Dhruv Parekh and {Piper Hanley}, Karen and Manuela Plat{\'e} and John Pearl and Mark Spears",

note = "Funding Information: Jointly funded by UK Research and Innovation and National Institute of Health Research (grant references: MR/V027859/1 and COV0319). Ethics Approval Ethics Ref: 20/YH/0225. JB acknowledges MRC Transition Fellowship (MR/T032529/1) and Manchester BRC funding. BG acknowledges UKRI-MRC Programme Grant and Confidence in Concept Grant, British Lung Foundation and the NIHR Leicester BRC funding. BGG acknowledges funding from Wellcome Trust grant 221680/Z/20/Z. NG is funded by an NIHR fellowship. IPH is in receipt of a NIHR Senior Investigator award. PLM and RJA are funded by the Action for Pulmonary Fibrosis Mike Bray Fellowships. DGW is funded by an NIHR Advanced Fellowship. RCC and MP acknowledge funds from the British Lung Foundation and the University College London Hospitals Biomedical Research Centre (UCLH BRC). JP is supported by UKRI PC-ILD grant, Breathing Matters Charity, and UCLH/UCL funding from the Department of Health{\textquoteright}s NIHR Biomedical Research Centres funding scheme. AART is Page 2 of 49funded by an Intermediate Clinical Fellowship from the British Heart Foundation (FS/18/13/33281). LVW is supported by GSK / Asthma + Lung UK Chair in Respiratory Research (C17-1). GJ acknowledges funding from a NIHR Research Professorship. IS fellowship is funded by the Rayne Foundation. Copyright: {\textcopyright}2023 by the American Thoracic Society",

year = "2023",

month = mar,

day = "15",

doi = "10.1164/rccm.202203-0564OC",

language = "English",

volume = "207",

pages = "693--703",

journal = "American Journal of Respiratory and Critical Care Medicine",

issn = "1073-449X",

publisher = "American Thoracic Society",

number = "6",

}

PHOSP-COVID Collaborative Group, Stewart, I, Jacob, J, George, PM, Molyneaux, PL, Porter, JC, Allen, RJ, Aslani, S, Baillie, JK, Barratt, SL, Beirne, P, Bianchi, SM, Blaikley, JF, Chalmers, JD, Chambers, RC, Chaudhuri, N, Coleman, C, Collier, G, Denneny, EK, Docherty, A, Elneima, O, Evans, RA, Fabbri, L, Gibbons, MA, Gleeson, FV, Gooptu, B, Greening, NJ, Guillen Guio, B, Hall, IP, Hanley, NA, Harris, V, Harrison, EM, Heightman, M, Hillman, TE, Horsley, A, Houchen-Wolloff, L, Jarrold, I, Johnson, SR, Jones, MG, Khan, F, Lawson, R, Leavy, O, Lone, N, Marks, M, McAuley, H, Mehta, P, Parekh, D, Piper Hanley, K, Platé, M, Pearl, J & Spears, M 2023, 'Residual Lung Abnormalities after COVID-19 Hospitalization: Interim Analysis of the UKILD Post-COVID-19 Study', American Journal of Respiratory and Critical Care Medicine, vol. 207, no. 6, pp. 693-703. https://doi.org/10.1164/rccm.202203-0564OC

Residual Lung Abnormalities after COVID-19 Hospitalization: Interim Analysis of the UKILD Post-COVID-19 Study. / PHOSP-COVID Collaborative Group; Stewart, Iain (Lead / Corresponding author); Jacob, Joseph et al.
In: American Journal of Respiratory and Critical Care Medicine, Vol. 207, No. 6, 15.03.2023, p. 693-703.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Residual Lung Abnormalities after COVID-19 Hospitalization

T2 - Interim Analysis of the UKILD Post-COVID-19 Study

AU - PHOSP-COVID Collaborative Group

AU - Stewart, Iain

AU - Jacob, Joseph

AU - George, Peter M

AU - Molyneaux, Philip L

AU - Porter, Joanna C

AU - Allen, Richard J

AU - Aslani, Shahab

AU - Baillie, J Kenneth

AU - Barratt, Shaney L

AU - Beirne, Paul

AU - Bianchi, Stephen M

AU - Blaikley, John F

AU - Chalmers, James D

AU - Chambers, Rachel C

AU - Chaudhuri, Nazia

AU - Coleman, Christopher

AU - Collier, Guilhem

AU - Denneny, Emma K

AU - Docherty, Annemarie

AU - Elneima, Omer

AU - Evans, Rachel A

AU - Fabbri, Laura

AU - Gibbons, Michael A

AU - Gleeson, Fergus V

AU - Gooptu, Bibek

AU - Greening, Neil J

AU - Guillen Guio, Beatriz

AU - Hall, Ian P

AU - Hanley, Neil A

AU - Harris, Victoria

AU - Harrison, Ewen M

AU - Heightman, Melissa

AU - Hillman, Toby E

AU - Horsley, Alex

AU - Houchen-Wolloff, Linzy

AU - Jarrold, Ian

AU - Johnson, Simon R

AU - Jones, Mark G

AU - Khan, Fasihul

AU - Lawson, Rod

AU - Leavy, Olivia

AU - Lone, Nazir

AU - Marks, Michael

AU - McAuley, Hamish

AU - Mehta, Puja

AU - Parekh, Dhruv

AU - Piper Hanley, Karen

AU - Platé, Manuela

AU - Pearl, John

AU - Spears, Mark

N1 - Funding Information: Jointly funded by UK Research and Innovation and National Institute of Health Research (grant references: MR/V027859/1 and COV0319). Ethics Approval Ethics Ref: 20/YH/0225. JB acknowledges MRC Transition Fellowship (MR/T032529/1) and Manchester BRC funding. BG acknowledges UKRI-MRC Programme Grant and Confidence in Concept Grant, British Lung Foundation and the NIHR Leicester BRC funding. BGG acknowledges funding from Wellcome Trust grant 221680/Z/20/Z. NG is funded by an NIHR fellowship. IPH is in receipt of a NIHR Senior Investigator award. PLM and RJA are funded by the Action for Pulmonary Fibrosis Mike Bray Fellowships. DGW is funded by an NIHR Advanced Fellowship. RCC and MP acknowledge funds from the British Lung Foundation and the University College London Hospitals Biomedical Research Centre (UCLH BRC). JP is supported by UKRI PC-ILD grant, Breathing Matters Charity, and UCLH/UCL funding from the Department of Health’s NIHR Biomedical Research Centres funding scheme. AART is Page 2 of 49funded by an Intermediate Clinical Fellowship from the British Heart Foundation (FS/18/13/33281). LVW is supported by GSK / Asthma + Lung UK Chair in Respiratory Research (C17-1). GJ acknowledges funding from a NIHR Research Professorship. IS fellowship is funded by the Rayne Foundation. Copyright: ©2023 by the American Thoracic Society

PY - 2023/3/15

Y1 - 2023/3/15

N2 - Rationale: Shared symptoms and genetic architecture between coronavirus disease (COVID-19) and lung fibrosis suggest severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may lead to progressive lung damage.Objectives: The UK Interstitial Lung Disease Consortium (UKILD) post-COVID-19 study interim analysis was planned to estimate the prevalence of residual lung abnormalities in people hospitalized with COVID-19 on the basis of risk strata.Methods: The PHOSP-COVID-19 (Post-Hospitalization COVID-19) study was used to capture routine and research follow-up within 240 days from discharge. Thoracic computed tomography linked by PHOSP-COVID-19 identifiers was scored for the percentage of residual lung abnormalities (ground-glass opacities and reticulations). Risk factors in linked computed tomography were estimated with Bayesian binomial regression, and risk strata were generated. Numbers within strata were used to estimate posthospitalization prevalence using Bayesian binomial distributions. Sensitivity analysis was restricted to participants with protocol-driven research follow-up.Measurements and Main Results: The interim cohort comprised 3,700 people. Of 209 subjects with linked computed tomography (median, 119 d; interquartile range, 83-155), 166 people (79.4%) had more than 10% involvement of residual lung abnormalities. Risk factors included abnormal chest X-ray (risk ratio [RR], 1.21; 95% credible interval [CrI], 1.05-1.40), percent predicted DlCO less than 80% (RR, 1.25; 95% CrI, 1.00-1.56), and severe admission requiring ventilation support (RR, 1.27; 95% CrI, 1.07-1.55). In the remaining 3,491 people, moderate to very high risk of residual lung abnormalities was classified at 7.8%, and posthospitalization prevalence was estimated at 8.5% (95% CrI, 7.6-9.5), rising to 11.7% (95% CrI, 10.3-13.1) in the sensitivity analysis.Conclusions: Residual lung abnormalities were estimated in up to 11% of people discharged after COVID-19-related hospitalization. Health services should monitor at-risk individuals to elucidate long-term functional implications.

AB - Rationale: Shared symptoms and genetic architecture between coronavirus disease (COVID-19) and lung fibrosis suggest severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection may lead to progressive lung damage.Objectives: The UK Interstitial Lung Disease Consortium (UKILD) post-COVID-19 study interim analysis was planned to estimate the prevalence of residual lung abnormalities in people hospitalized with COVID-19 on the basis of risk strata.Methods: The PHOSP-COVID-19 (Post-Hospitalization COVID-19) study was used to capture routine and research follow-up within 240 days from discharge. Thoracic computed tomography linked by PHOSP-COVID-19 identifiers was scored for the percentage of residual lung abnormalities (ground-glass opacities and reticulations). Risk factors in linked computed tomography were estimated with Bayesian binomial regression, and risk strata were generated. Numbers within strata were used to estimate posthospitalization prevalence using Bayesian binomial distributions. Sensitivity analysis was restricted to participants with protocol-driven research follow-up.Measurements and Main Results: The interim cohort comprised 3,700 people. Of 209 subjects with linked computed tomography (median, 119 d; interquartile range, 83-155), 166 people (79.4%) had more than 10% involvement of residual lung abnormalities. Risk factors included abnormal chest X-ray (risk ratio [RR], 1.21; 95% credible interval [CrI], 1.05-1.40), percent predicted DlCO less than 80% (RR, 1.25; 95% CrI, 1.00-1.56), and severe admission requiring ventilation support (RR, 1.27; 95% CrI, 1.07-1.55). In the remaining 3,491 people, moderate to very high risk of residual lung abnormalities was classified at 7.8%, and posthospitalization prevalence was estimated at 8.5% (95% CrI, 7.6-9.5), rising to 11.7% (95% CrI, 10.3-13.1) in the sensitivity analysis.Conclusions: Residual lung abnormalities were estimated in up to 11% of people discharged after COVID-19-related hospitalization. Health services should monitor at-risk individuals to elucidate long-term functional implications.

KW - COVID-19

KW - HRCT

KW - hospitalization

KW - lung abnormalities

KW - lung damage

UR - https://www.medrxiv.org/content/10.1101/2022.03.10.22272081v2

UR - http://www.scopus.com/inward/record.url?scp=85150397052&partnerID=8YFLogxK

U2 - 10.1164/rccm.202203-0564OC

DO - 10.1164/rccm.202203-0564OC

M3 - Article

C2 - 36457159

SN - 1073-449X

VL - 207

SP - 693

EP - 703

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

IS - 6

ER -

Residual Lung Abnormalities after COVID-19 Hospitalization: Interim Analysis of the UKILD Post-COVID-19 Study

Abstract

Keywords

ASJC Scopus subject areas

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PHOS-COVID (Joint with University of Leicester)

The British Lung Foundation/GSK Centre for Bronchiectasis Research

Cite this

Residual Lung Abnormalities after COVID-19 Hospitalization: Interim Analysis of the UKILD Post-COVID-19 Study

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Projects

PHOS-COVID (Joint with University of Leicester)

The British Lung Foundation/GSK Centre for Bronchiectasis Research

Cite this