P129 Getting it right in a digital age – robust patient selection to an early supported discharge service

Abstract

P130 Figure 1 Features of COVID-19 on the CT were very common in hospitalised patients and were related to all-cause mortality one year following hospitalisation Poster sessions A136 Thorax 2021;76(Suppl 2):A1–A205 on N ovem er 9, 2021 by gest. P rocted by coright. httphorax.bm jcom / T hrax: frst pulished as 10.113orax-2021-B T S abscts.239 on 8 N ovem er 221. D ow nladed fom CTT; 78 (25%) had consolidation and 274 (88%) had PE (figure 1). Patients from Asian, Black and Other ethnic minority groups had a higher prevalence and severity of multifocal ground glass changes on CTT compared to those from White groups (severe ground glass changes for White: 15 [6%]. Asian: 6 [14%], Black 2 [11%], Other 8 [47%], p<0.001). After one year, 104 (33%) patients died. On univariable analysis, multifocal ground glass changes and consolidation were related to all-cause mortality at one year. In a model consisting of age; ethnicity; gender; number of comorbidities; admission National Early Warning Score-2; admission lymphocyte count; C-reactive protein and urea, the addition of worsening ground glass changes on CTT were related to all-cause mortality at one year (aHR: 1.29, 95% CI 1.08–1.55, p=0.005 and Figure) and boosted the model’s cumulative discrimination (Harrell’s c statistic 0.75 from 0.69, p<0.001). Conclusion Evidence of COVID-19 pneumonia on CTT is more common and severe in patients from ethnic minority groups and is independently associated with worse prognosis following hospitalisation. P131 THE DEGREE OF ACUTE RESPIRATORY SUPPORT WITH COVID-19 PNEUMONIA, SMOKING STATUS ON ADMISSION AND NON-RESOLVING CT FEATURES AT THREE MONTHSARE THERE LINKS? H Karimzadeh, R Penfold, U Nnajiuba, A Wight.Wirral Lung Unit, Wirral University Teaching Hospital NHS Foundation Trust, Birkenhead, UK 10.1136/thorax-2021-BTSabstracts.240 Introduction and Objectives BTS guidelines suggest radiological follow up at 12 weeks for patients with COVID-19 associated pneumonia. It is suggested development of post-covid fibrotic changes is more prevalent with severity of illness. We compared illness severity based on maximal respiratory support with non-resolving changes on CT imaging at >12 weeks. Smoking status at time of admission was also collected. Methods Retrospective analysis of COVID-19 patients surviving to follow up identified either by CVCX1 coded CXR or CVCX2 coded CXR and positive PCR between March 2020January 2021. This identified 912 patients reviewed at 12 weeks with CXR ± CT imaging. 50/912 patients (5.5%) had evidence of either established fibrotic change or ongoing pneumonitis on CT. Imaging was reviewed by radiologist using suggested scoring system for Covid-19 follow-up 2 based on sum of 0–5 severity in 5 lobes (total 0–25) for markers of fibrosis/pneumonitis. Results Comparison is shown in table 1. All patients requiring more than 60% oxygen therapy received advanced respiratory support. 10/50 patients (20%) required no supplementary oxygen and 6/10 were not admitted to hospital. Comparison mean fibrosis score; IPPV-18.6, CPAP/HFNO-9.23, RA8.5. There were no current smokers in the follow-up cohort, 24 ex-smokers. Conclusions We noted significant risk for developing postCovid pneumonic fibrotic changes even in clinically mild cases. With SpO2 at times of peak incidence being main indicator for CXR and/or admission we surmise there may be a significant unrecognized population without an initial CXR to prompt follow-up. It is not clear whether these patients will develop significant symptoms to prompt future investigations and what impact this might have. No patients developing ongoing CT changes were current smokersa topic we suggest for further study and correlation. REFERENCES 1. McGroder CF, et al. Pulmonary fibrosis 4 months after COVID-19 is associated with severity of illness and blood leucocyte telomere length. Thorax 29 April 2021. doi:10.1136/thoraxjnl-2021-217031 2. Xiaoyu Han, et al. Six-month follow-up chest CT findings after severe COVID-19 pneumonia. Radiology 2021;299:1, E177–E186. P132 INTERMEDIATE FOLLOW UP OF RADIOLOGICAL INTERSTITIAL CHANGES FOR COVID-19 PATIENTS OVER THE FIRST YEAR POST DISCHARGE: A LONGITUDINAL STUDY JC Gates, A Draper, J Moser, J Arberry, D Jajbhay, J Panaguiton, E Yarham, YE Ong, R Aul. St George’s Hospital, London, UK 10.1136/thorax-2021-BTSabstracts.24