COVID-19 follow-up: Chest X-ray findings with clinical and radiological relationship three months after recovery

Abstract

Introduction: To evaluate the radiological sequelae of coronavirus disease (COVID-19) in a mid-term follow-up and investigate their relationship with clinical-radiological findings.

Methods: This prospective study included COVID-19 patients who underwent a CXR three months after discharge. The relationship between CXR score at three months after discharge and clinical findings and previous CXR scores, at admission and before the discharge, were evaluated. Then, based on mid-term follow-up CXR score, patients were divided in Group A (score = 0) and Group B (score≥1), and clinical-radiological findings were compared between two Groups. Finally, we calculated the CXR scores at admission and before the discharge with the highest sensitivity and specificity to predict normal and abnormal CXR score at mid-term follow-up.

Results: The study included 119 patients, mean age 65.9 ± 14.6 years. The oxygen saturation (Sa_O2) (p = 0.0006), the days of hospitalization (p < 0.0001) and the CXR score before the discharge (p = 0.0091) were independent factors to predict the mid-term follow-up CXR score. The Group A, 59 (49.6%) patients, had CXR scores at admission and before the discharge lower than Group B. The CXR scores at admission and before the discharge with the highest sensitivity and specificity to predict normal and abnormal CXR score at mid-term follow-up were, respectively, 3 and 2 (p < 0.0001).

Conclusions: The radiological abnormalities were present in about half patients three months after discharge, which had higher age, previous CXR scores and longer hospitalization. The S_O2, days of hospitalization and previous CXR scores were independent factors for predicting the CXR at three months.

Implications for practice: The radiologist with CXR could play a central role in mid to long-term follow-up of COVID-19, assessing the radiological sequelae of patients and identifying those who might require a closer follow-up.

Keywords: COVID-19; Chest X-ray; Follow up; Radiological sequelae.