Development of prognostic models to estimate the probability of lung injury one year after COVID-19-related hospitalization-a prospective study

Ana Casal-Mouriño; José Manuel Álvarez-Dobaño; María Jesús Domínguez; Francisco Gude; María E Toubes; Óscar Lado-Baleato; Anxo Martínez de Alegría; Manuel Taboada; Vanessa Riveiro; Nuria Rodríguez-Núñez; Adriana Lama; Lucía Ferreiro; Borja Otero; Juan Suárez-Antelo; Antonio Pose; Luis Valdés

doi:10.21037/jtd-22-1565

Development of prognostic models to estimate the probability of lung injury one year after COVID-19-related hospitalization-a prospective study

J Thorac Dis. 2023 Jun 30;15(6):2971-2983. doi: 10.21037/jtd-22-1565. Epub 2023 Apr 26.

Authors

Ana Casal-Mouriño¹, José Manuel Álvarez-Dobaño¹, María Jesús Domínguez², Francisco Gude³, María E Toubes¹, Óscar Lado-Baleato^{4

5}, Anxo Martínez de Alegría⁶, Manuel Taboada⁷, Vanessa Riveiro¹, Nuria Rodríguez-Núñez¹, Adriana Lama¹, Lucía Ferreiro¹, Borja Otero⁸, Juan Suárez-Antelo¹, Antonio Pose^#^{2

4

8}, Luis Valdés^#^{1

4

9}

Affiliations

¹ Pulmonology Department, Clinical University Hospital of Santiago, Santiago de Compostela, Spain.
² Internal Medicine Department, Clinical University Hospital of Santiago, Santiago de Compostela, Spain.
³ Clinical Epidemiology Department, Clinical University Hospital of Santiago, Santiago de Compostela, Spain.
⁴ Research Methods Group (RESMET), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
⁵ ISCIII Support Platforms for Clinical Research, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
⁶ Radiology Department, Clinical University Hospital of Santiago, Santiago de Compostela, Spain.
⁷ Anesthesia and Resuscitation Department, Clinical University Hospital of Santiago, Santiago de Compostela, Spain.
⁸ Esteve Teijin Company, Clinical University Hospital of Santiago, Santiago de Compostela, Spain.
⁹ Medicine Department, University of Santiago, Santiago de Compostela, Spain.

^# Contributed equally.

Abstract

Background: Long-term effects of severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) infection still under study. The objectives of this study were to identify persistent pulmonary lesions 1 year after coronavirus disease 2019 (COVID-19) hospitalization and assess whether it is possible to estimate the probability that a patient develops these complications in the future.

Methods: A prospective study of ≥18 years old patients hospitalized for SARS-COV-2 infection who develop persistent respiratory symptoms, lung function abnormalities or have radiological findings 6-8 weeks after hospital discharge. Logistic regression models were used to identify prognostic factors associated with a higher risk of developing respiratory problems. Models performance was assessed in terms of calibration and discrimination.

Results: A total of 233 patients [median age 66 years [interquartile range (IQR): 56, 74]; 138 (59.2%) male] were categorized into two groups based on whether they stayed in the critical care unit (79 cases) or not (154). At the end of follow-up, 179 patients (76.8%) developed persistent respiratory symptoms, and 22 patients (9.4%) showed radiological fibrotic lesions with pulmonary function abnormalities (post-COVID-19 fibrotic pulmonary lesions). Our prognostic models created to predict persistent respiratory symptoms [post-COVID-19 functional status at initial visit (the higher the score, the higher the risk), and history of bronchial asthma] and post-COVID-19 fibrotic pulmonary lesions [female; FVC% (the higher the FVC%, the lower the probability); and critical care unit stay] one year after infection showed good (AUC 0.857; 95% CI: 0.799-0.915) and excellent performance (AUC 0.901; 95% CI: 0.837-0.964), respectively.

Conclusions: Constructed models show good performance in identifying patients at risk of developing lung injury one year after COVID-19-related hospitalization.

Keywords: Post-acute coronavirus disease 2019 syndrome (post-acute COVID-19 syndrome); clinical prediction models; fibrotic pulmonary lesions; radiological findings; respiratory functional test; respiratory symptoms.