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

IF 2.3 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

Journal of Korean Medical Science Pub Date : 2025-09-29 DOI:10.3346/jkms.2025.40.e249

Daehong Cho, Ganghee Chae, Joon-Sung Joh, Junghyun Kim, Tae Yun Park, Ae-Rin Baek, Won-Young Kim, Yangjin Jegal, Chi Ryang Chung, Jinwoo Lee, Joo Hun Park, Jae Wook Lee, Soyeoun Lim, Jin Woo Song

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引用次数: 0

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.

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COVID-19危重患者肺纤维化：韩国一项多中心回顾性队列研究

背景：2019冠状病毒病（COVID-19）感染康复后，肺纤维化可持续很长时间，从而降低生活质量和肺功能。我们的目的是评估需要机械通气（MV）的严重COVID-19肺炎患者发生肺纤维化的频率和危险因素，这是发生肺纤维化的高危人群。方法：回顾性收集韩国9家医院新冠肺炎重症患者的临床资料和胸部CT扫描结果。在胸部CT上观察纤维样改变。结果：我们纳入125例患者，平均年龄68.5岁，60.8%为男性，7.2%患有潜在肺部疾病。根据随访胸部CT（中位间隔38.0天，四分位数间距24.0-68.0天），94例（75.2%）患者表现为纤维样改变，其中牵引性支气管扩张和/或细支气管扩张是最常见的变化（60.8%）。在所有患者中，17.6%在住院期间死亡，71.2%出现并发症，包括插管相关气道损伤（12.8%）、呼吸机相关肺炎（44.8%）、肺损伤（11.2%）和血流动力学障碍（33.4%）。住院死亡率（16.1% vs. 18.1%）和并发症（67.7% vs. 72.3%）在有和没有纤维样改变的患者之间相似。在多变量logistic回归分析中，较高的每日类固醇剂量（优势比，0.961；95%可信区间，0.849-0.993;P = 0.018）与肺纤维化风险降低以及重症监护病房入院时较高的心率相关。结论：我们的研究表明，在需要MV的重症COVID-19肺炎患者中，约四分之三的患者胸部CT显示纤维化样改变。此外，我们的研究结果表明，较高的每日类固醇剂量可能与肺纤维化风险降低有关。需要进一步的研究来确定合适的类固醇剂量，以减少肺纤维化的进展并改善临床结果。试验注册：临床研究信息服务标识：KCT0006312。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Korean Medical Science 医学-医学：内科

CiteScore

7.80

自引率

8.90%

发文量

320

审稿时长

3-6 weeks

期刊介绍： The Journal of Korean Medical Science (JKMS) is an international, peer-reviewed Open Access journal of medicine published weekly in English. The Journal’s publisher is the Korean Academy of Medical Sciences (KAMS), Korean Medical Association (KMA). JKMS aims to publish evidence-based, scientific research articles from various disciplines of the medical sciences. The Journal welcomes articles of general interest to medical researchers especially when they contain original information. Articles on the clinical evaluation of drugs and other therapies, epidemiologic studies of the general population, studies on pathogenic organisms and toxic materials, and the toxicities and adverse effects of therapeutics are welcome.