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. 2021 Mar 23;16(3):e0248957.
doi: 10.1371/journal.pone.0248957. eCollection 2021.

The characteristics and evolution of pulmonary fibrosis in COVID-19 patients as assessed by AI-assisted chest HRCT

Jia-Ni Zou  1 , Liu Sun  2 , Bin-Ru Wang  3 , You Zou  4 , Shan Xu  4 , Yong-Jun Ding  4 , Li-Jun Shen  4 , Wen-Cai Huang  1 , Xiao-Jing Jiang  5 , Shi-Ming Chen  4   6
Affiliations

The characteristics and evolution of pulmonary fibrosis in COVID-19 patients as assessed by AI-assisted chest HRCT

Jia-Ni Zou et al. PLoS One. .

Abstract

The characteristics and evolution of pulmonary fibrosis in patients with coronavirus disease 2019 (COVID-19) have not been adequately studied. AI-assisted chest high-resolution computed tomography (HRCT) was used to investigate the proportion of COVID-19 patients with pulmonary fibrosis, the relationship between the degree of fibrosis and the clinical classification of COVID-19, the characteristics of and risk factors for pulmonary fibrosis, and the evolution of pulmonary fibrosis after discharge. The incidence of pulmonary fibrosis in patients with severe or critical COVID-19 was significantly higher than that in patients with moderate COVID-19. There were significant differences in the degree of pulmonary inflammation and the extent of the affected area among patients with mild, moderate and severe pulmonary fibrosis. The IL-6 level in the acute stage and albumin level were independent risk factors for pulmonary fibrosis. Ground-glass opacities, linear opacities, interlobular septal thickening, reticulation, honeycombing, bronchiectasis and the extent of the affected area were significantly improved 30, 60 and 90 days after discharge compared with at discharge. The more severe the clinical classification of COVID-19, the more severe the residual pulmonary fibrosis was; however, in most patients, pulmonary fibrosis was improved or even resolved within 90 days after discharge.

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Conflict of interest statement

No authors have competing interests

Figures

Fig 1
Fig 1
A. The AI inflammation scores of 239 COVID-19 patients with pulmonary fibrosis at discharge. *, P<0.05; **, P<0.01; B. Comparison of the AI inflammation score or pulmonary fibrosis score between patients at discharge and 30 days (n = 34 patients), 60 days (n = 11 patients) and 90 days (n = 7 patients) after discharge. C. Comparison of chest HRCT results between patients at discharge and 30 days after hospital discharge. a, b and c represent three separate patients: a represents a patient with mild pulmonary fibrosis, b represents a patient with moderate pulmonary fibrosis, and c represents a patient with severe pulmonary fibrosis. ① represents the chest HRCT at discharge; ② represents the extent of lesions marked by AI at discharge (red); ③ represents the chest HRCT 30 days after hospital discharge; ④ represents the extent of lesions marked by AI 30 days after hospital discharge (red).
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Publication types

Grants and funding

This study was supported by grant 81770981 and 82002863 from the National Natural Science Foundation of China and grant [2018]116 from Wuhan Municipality Young and Middle-aged Medical Talent Cultivation Program.
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