Pulmonary Function Test and CT features during follow-up after SARS, MERS and COVID-19: A Systematic Review and Meta-Analysis

  1. Christopher C. Huntley1,2⇑,
  2. Ketan Patel2,3,
  3. Shahnoor-E-Salam Bil Bushra4,
  4. Farah Mobeen3,
  5. Michael N. Armitage5,
  6. Anita Pye2,
  7. Chloe B. Knight4,
  8. Alyaa Mostafa4,
  9. Marie Kershaw3,
  10. Aishah Z. Mughal4,
  11. Emily McKemey3,
  12. Alice M. Turner2,3,
  13. P. Sherwood Burge1 and
  14. Gareth I. Walters1,2
  1. 1Occupational and Interstitial Lung Disease Services, University Hospitals Birmingham (UHB) NHS Foundation Trust, Birmingham, United Kingdom
  2. 2Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
  3. 3UHB NHS Foundation Trust, Birmingham, United Kingdom
  4. 4University of Birmingham, Birmingham, United Kingdom
  5. 5University Hospitals Coventry and Warwickshire NHS Trust, Birmingham, United Kingdom
  1. Corresponding Author: Christopher C. Huntley (Christopher.huntley{at}nhs.net)

Abstract

Background The COVID-19 pandemic follows SARS and MERS coronavirus epidemics. Some survivors of COVID-19 infection experience persistent respiratory symptoms, yet their cause and natural history remains unclear. Follow-up after SARS and MERS may provide a model for predicting the long-term pulmonary consequences of COVID-19.

Methods This systematic review and meta-analysis aims to describe and compare the longitudinal pulmonary function test (PFT) and computed tomography (CT) features of patients recovering from SARS, MERS and COVID-19. Meta-analysis of PFT parameters (DerSimonian and Laird random effects model) and proportion of CT features (Freeman-Tukey transformation random effects model) were performed.

Findings Persistent reduction in the diffusing capacity for carbon monoxide (DLco) following SARS, and COVID-19 infection is seen at 6 months follow-up and 12 months after MERS. Other PFT parameters recover in this time. 6 months after SARS and COVID-19, ground-glass opacity (GGO), linear opacities and reticulation persist in over 30% of patients; honeycombing and traction dilatation reported less. Severe/ critical COVID-19 infection leads to greater CT and PFT abnormality compared to mild/ moderate infection.

Interpretation Persistent diffusion defects suggestive of parenchymal lung injury occur after SARS, MERS and COVID-19 infection, but improve over time. After COVID-19 infection, CT features are suggestive of persistent parenchymal lung injury, in keeping with a post-COVID-19 interstitial lung syndrome (PCOILS) – it is yet to be determined if this is a regressive or progressive disease.

Footnotes

This manuscript has recently been accepted for publication in the ERJ Open Research. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJOR online. Please open or download the PDF to view this article.

Chloe B Knight reports support for the present manuscript received from The Sir Arthur Thomson Trust Vacation Studentship.

Ketan Patel reports receiving support for attending meetings and/or travel from GSK, outside the submitted work.

Christopher C Huntley reports receiving support for attending meetings and/or travel from Boehringer-Ingelheim, outside the submitted work.

The remaining authors have nothing to disclose.

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  • Received February 1, 2022.
  • Accepted March 23, 2022.
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