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

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; Krisnah Poinasamy; Jennifer K Quint; Betty Raman; Matthew Richardson; Pilar Rivera-Ortega; Laura Saunders; Ruth Saunders; Malcolm G Semple; Marco Sereno; Aarti Shikotra; A John Simpson; Amisha Singapuri; David Jf Smith; Mark Spears; Lisa G Spencer; Stefan Stanel; David Thickett; A A Roger Thompson; Mathew Thorpe; Simon Lf Walsh; Samantha Walker; Nicholas David Weatherley; Mark Weeks; Jim M Wild; Dan G Wootton; Chris E Brightling; Ling-Pei Ho; Louise V Wain; R Gisli Jenkins

doi:10.1164/rccm.202203-0564OC

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

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 ElneimaRachel 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, Krisnah Poinasamy, Jennifer K Quint, Betty Raman, Matthew Richardson, Pilar Rivera-Ortega, Laura Saunders, Ruth Saunders, Malcolm G Semple, Marco Sereno, Aarti Shikotra, A John Simpson, Amisha Singapuri, David Jf Smith, Mark Spears, Lisa G Spencer, Stefan Stanel, David Thickett, A A Roger Thompson, Mathew Thorpe, Simon Lf Walsh, Samantha Walker, Nicholas David Weatherley, Mark Weeks, Jim M Wild, Dan G Wootton, Chris E Brightling, Ling-Pei Ho, Louise V Wain, R Gisli Jenkins

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Abstract / Description of output

RATIONALE: Shared symptoms and genetic architecture between COVID-19 and lung fibrosis suggests SARS-CoV-2 infection may lead to progressive lung damage.

OBJECTIVES: The UKILD Post-COVID study interim analysis was planned to estimate the prevalence of residual lung abnormalities in people hospitalized with COVID-19 based on risk strata.

METHODS: The Post-HOSPitalisation COVID Study (PHOSP-COVID) was used for capture of routine and research follow-up within 240 days from discharge. Thoracic CTs linked by PHOSP-COVID identifiers were scored for percentage of residual lung abnormalities (ground glass opacities and reticulations). Risk factors in linked CT were estimated with Bayesian binomial regression and risk strata were generated. Numbers within strata were used to estimate post-hospitalization 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 3700 people. Of 209 subjects with linked CTs (median 119 days, interquartile range 83-155), 166 people (79.4%) had >10% involvement of residual lung abnormalities. Risk factors included abnormal chest X-ray (RR 1·21 95%CrI 1·05; 1·40), percent predicted DLco<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 3491 people, moderate to very-high risk of residual lung abnormalities was classified in 7·8%, post-hospitalization prevalence was estimated at 8.5% (95%CrI 7.6%; 9.5%) rising to 11.7% (95%CrI 10.3%; 13.1%) in sensitivity analysis.

CONCLUSIONS: Residual lung abnormalities were estimated in up to 11% of people discharged following COVID-19 related hospitalization. Health services should monitor at-risk individuals to elucidate long-term functional implications. This article is open access and distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).

Original language	English
Journal	American Journal of Respiratory and Critical Care Medicine
Early online date	1 Dec 2022
DOIs	https://doi.org/10.1164/rccm.202203-0564OC
Publication status	E-pub ahead of print - 1 Dec 2022

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rccm.202203-0564ocFinal published version, 1.37 MBLicence: Creative Commons: Attribution (CC-BY)

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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., Docherty, A., ... Jenkins, R. G. (2022). Residual Lung Abnormalities Following COVID-19 Hospitalization: Interim Analysis of the UKILD Post-COVID Study. American Journal of Respiratory and Critical Care Medicine. Advance online publication. https://doi.org/10.1164/rccm.202203-0564OC

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

abstract = "RATIONALE: Shared symptoms and genetic architecture between COVID-19 and lung fibrosis suggests SARS-CoV-2 infection may lead to progressive lung damage.OBJECTIVES: The UKILD Post-COVID study interim analysis was planned to estimate the prevalence of residual lung abnormalities in people hospitalized with COVID-19 based on risk strata.METHODS: The Post-HOSPitalisation COVID Study (PHOSP-COVID) was used for capture of routine and research follow-up within 240 days from discharge. Thoracic CTs linked by PHOSP-COVID identifiers were scored for percentage of residual lung abnormalities (ground glass opacities and reticulations). Risk factors in linked CT were estimated with Bayesian binomial regression and risk strata were generated. Numbers within strata were used to estimate post-hospitalization 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 3700 people. Of 209 subjects with linked CTs (median 119 days, interquartile range 83-155), 166 people (79.4%) had >10% involvement of residual lung abnormalities. Risk factors included abnormal chest X-ray (RR 1·21 95%CrI 1·05; 1·40), percent predicted DLco<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 3491 people, moderate to very-high risk of residual lung abnormalities was classified in 7·8%, post-hospitalization prevalence was estimated at 8.5% (95%CrI 7.6%; 9.5%) rising to 11.7% (95%CrI 10.3%; 13.1%) in sensitivity analysis.CONCLUSIONS: Residual lung abnormalities were estimated in up to 11% of people discharged following COVID-19 related hospitalization. Health services should monitor at-risk individuals to elucidate long-term functional implications. This article is open access and distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).",

author = "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 Krisnah Poinasamy and Quint, {Jennifer K} and Betty Raman and Matthew Richardson and Pilar Rivera-Ortega and Laura Saunders and Ruth Saunders and Semple, {Malcolm G} and Marco Sereno and Aarti Shikotra and Simpson, {A John} and Amisha Singapuri and Smith, {David Jf} and Mark Spears and Spencer, {Lisa G} and Stefan Stanel and David Thickett and Thompson, {A A Roger} and Mathew Thorpe and Walsh, {Simon Lf} and Samantha Walker and Weatherley, {Nicholas David} and Mark Weeks and Wild, {Jim M} and Wootton, {Dan G} and Brightling, {Chris E} and Ling-Pei Ho and Wain, {Louise V} and Jenkins, {R Gisli}",

year = "2022",

month = dec,

day = "1",

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

language = "English",

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

issn = "1073-449X",

publisher = "American Thoracic Society",

}

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, Poinasamy, K, Quint, JK, Raman, B, Richardson, M, Rivera-Ortega, P, Saunders, L, Saunders, R, Semple, MG, Sereno, M, Shikotra, A, Simpson, AJ, Singapuri, A, Smith, DJ, Spears, M, Spencer, LG, Stanel, S, Thickett, D, Thompson, AAR, Thorpe, M, Walsh, SL, Walker, S, Weatherley, ND, Weeks, M, Wild, JM, Wootton, DG, Brightling, CE, Ho, L-P, Wain, LV & Jenkins, RG 2022, 'Residual Lung Abnormalities Following COVID-19 Hospitalization: Interim Analysis of the UKILD Post-COVID Study', American Journal of Respiratory and Critical Care Medicine. https://doi.org/10.1164/rccm.202203-0564OC

TY - JOUR

T1 - Residual Lung Abnormalities Following COVID-19 Hospitalization

T2 - Interim Analysis of the UKILD Post-COVID Study

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 - Poinasamy, Krisnah

AU - Quint, Jennifer K

AU - Raman, Betty

AU - Richardson, Matthew

AU - Rivera-Ortega, Pilar

AU - Saunders, Laura

AU - Saunders, Ruth

AU - Semple, Malcolm G

AU - Sereno, Marco

AU - Shikotra, Aarti

AU - Simpson, A John

AU - Singapuri, Amisha

AU - Smith, David Jf

AU - Spears, Mark

AU - Spencer, Lisa G

AU - Stanel, Stefan

AU - Thickett, David

AU - Thompson, A A Roger

AU - Thorpe, Mathew

AU - Walsh, Simon Lf

AU - Walker, Samantha

AU - Weatherley, Nicholas David

AU - Weeks, Mark

AU - Wild, Jim M

AU - Wootton, Dan G

AU - Brightling, Chris E

AU - Ho, Ling-Pei

AU - Wain, Louise V

AU - Jenkins, R Gisli

PY - 2022/12/1

Y1 - 2022/12/1

N2 - RATIONALE: Shared symptoms and genetic architecture between COVID-19 and lung fibrosis suggests SARS-CoV-2 infection may lead to progressive lung damage.OBJECTIVES: The UKILD Post-COVID study interim analysis was planned to estimate the prevalence of residual lung abnormalities in people hospitalized with COVID-19 based on risk strata.METHODS: The Post-HOSPitalisation COVID Study (PHOSP-COVID) was used for capture of routine and research follow-up within 240 days from discharge. Thoracic CTs linked by PHOSP-COVID identifiers were scored for percentage of residual lung abnormalities (ground glass opacities and reticulations). Risk factors in linked CT were estimated with Bayesian binomial regression and risk strata were generated. Numbers within strata were used to estimate post-hospitalization 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 3700 people. Of 209 subjects with linked CTs (median 119 days, interquartile range 83-155), 166 people (79.4%) had >10% involvement of residual lung abnormalities. Risk factors included abnormal chest X-ray (RR 1·21 95%CrI 1·05; 1·40), percent predicted DLco<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 3491 people, moderate to very-high risk of residual lung abnormalities was classified in 7·8%, post-hospitalization prevalence was estimated at 8.5% (95%CrI 7.6%; 9.5%) rising to 11.7% (95%CrI 10.3%; 13.1%) in sensitivity analysis.CONCLUSIONS: Residual lung abnormalities were estimated in up to 11% of people discharged following COVID-19 related hospitalization. Health services should monitor at-risk individuals to elucidate long-term functional implications. This article is open access and distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).

AB - RATIONALE: Shared symptoms and genetic architecture between COVID-19 and lung fibrosis suggests SARS-CoV-2 infection may lead to progressive lung damage.OBJECTIVES: The UKILD Post-COVID study interim analysis was planned to estimate the prevalence of residual lung abnormalities in people hospitalized with COVID-19 based on risk strata.METHODS: The Post-HOSPitalisation COVID Study (PHOSP-COVID) was used for capture of routine and research follow-up within 240 days from discharge. Thoracic CTs linked by PHOSP-COVID identifiers were scored for percentage of residual lung abnormalities (ground glass opacities and reticulations). Risk factors in linked CT were estimated with Bayesian binomial regression and risk strata were generated. Numbers within strata were used to estimate post-hospitalization 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 3700 people. Of 209 subjects with linked CTs (median 119 days, interquartile range 83-155), 166 people (79.4%) had >10% involvement of residual lung abnormalities. Risk factors included abnormal chest X-ray (RR 1·21 95%CrI 1·05; 1·40), percent predicted DLco<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 3491 people, moderate to very-high risk of residual lung abnormalities was classified in 7·8%, post-hospitalization prevalence was estimated at 8.5% (95%CrI 7.6%; 9.5%) rising to 11.7% (95%CrI 10.3%; 13.1%) in sensitivity analysis.CONCLUSIONS: Residual lung abnormalities were estimated in up to 11% of people discharged following COVID-19 related hospitalization. Health services should monitor at-risk individuals to elucidate long-term functional implications. This article is open access and distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).

U2 - 10.1164/rccm.202203-0564OC

DO - 10.1164/rccm.202203-0564OC

M3 - Article

C2 - 36457159

SN - 1073-449X

JO - American Journal of Respiratory and Critical Care Medicine

JF - American Journal of Respiratory and Critical Care Medicine

ER -

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

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