Pulmonary Fibrosis in Critically Ill Patients With COVID-19: A Multi-Center Retrospective Cohort Study in Korea.

ABSTRACT:

Background

Pulmonary fibrosis can persist long after recovery from coronavirus disease 2019 (COVID-19) infection, thereby reducing quality of life and lung function. We aimed to evaluate the frequency and risk factors for pulmonary fibrosis in patients with severe COVID-19 pneumonia requiring mechanical ventilation (MV), a high-risk group for developing pulmonary fibrosis.

Methods

Clinical data and chest computed tomography (CT) scans of patients with severe COVID-19 pneumonia requiring MV were retrospectively collected from nine hospitals in South Korea. Fibrotic-like changes on chest CT were visually assessed.

Results

We included 125 patients with a mean age of 68.5 years, 60.8% men and 7.2% having underlying lung disease. Based on follow-up chest CT (the median interval, 38.0 days; interquartile range, 24.0-68.0 days), 94 (75.2%) patients exhibited fibrotic-like changes, with traction bronchiectasis and/or bronchiolectasis being the most common change (60.8%). Among all patients, 17.6% died during hospitalization and 71.2% experienced complications, including intubation-related airway injury (12.8%), ventilator-associated pneumonia (44.8%), lung injury (11.2%), and hemodynamic disturbance (33.4%). In-hospital mortality (16.1% vs. 18.1%) and complications (67.7% vs. 72.3%) were similar between patients with and without fibrotic-like changes. In multivariable logistic regression analysis, a higher daily steroid dose (odds ratio, 0.961; 95% confidence interval, 0.849-0.993; P = 0.018) was associated with a reduced risk of pulmonary fibrosis, along with a higher heart rate on intensive care unit admission.

Conclusion

Our study demonstrated that in patients with severe COVID-19 pneumonia requiring MV, chest CT revealed fibrotic-like changes in approximately three-quarters of patients. In addition, our results suggest that higher daily doses of steroids may be associated with a reduced risk of pulmonary fibrosis. Further research is needed to determine the appropriate steroid dose that may reduce the progression of pulmonary fibrosis and improve clinical outcomes.

Trial registration

Clinical Research Information Service Identifier: KCT0006312.

SUBMITTER: Cho D 

PROVIDER: S-EPMC12480960 | biostudies-literature | 2025 Sep

REPOSITORIES: biostudies-literature