First report on clinical and radiological features of COVID-19 pneumonitis in a Caucasian population: Factors predicting fibrotic evolution. (October 2020)

• Record Type: Journal Article
• Authors: Marvisi, Maurizio; Ferrozzi, Francesco; Balzarini, Laura; Mancini, Chiara; Ramponi, Sara; Uccelli, Mario
• Is Part Of: International journal of infectious diseases. Volume 99(2020)
• Page Start: 485
• Page End: 488
• Publication Date: 2020-10
• Subjects: Covid-19 -- Pneumonitis -- Pulmonary fibrosis -- Reversed halo sign; Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2020.08.054
• Languages: English
• ISSNs: 1201-9712

Abstract

Highlights: Pulmonary fibrosis is frequent in patients with COVID 19 pneumonia. Risk factors are: male sex, smoking habit, and comorbidities. The reversed halo sign associated with diffuse ground-glass opacities is the peculiar HRCT pattern. Abstract: Background: At the end of February, the Lombardy region (Northern Italy) was involved in the pandemic spread of the new COVID-19. We here summarize the clinical and radiological characteristics of 90 confirmed cases and analyze their role in predicting the evolution of fibrosis. Methods: We retrospectively analyzed the clinical and radiological data of 90 patients with COVID-19 pneumonitis. All subjects underwent an HRCT study on the day of admission and eight weeks later, and were treated with lopinavir + ritonavir (Kaletra) 400/100 mg two times a day or darunavir + ritonavir two times a day, and Hydroxychloroquine 200 mg two times a day. Pulmonary fibrosis was defined according to the Fleischner Society glossary of terms for thoracic imaging. Results: Twenty-three patients developed pulmonary fibrosis (25.5%): 15 were males, whose mean age was 75 ± 15. The majority were active smokers (60.8%) and had comorbidities (78.2%), above all, hypertension (47.8%), and diabetes (34.7%). Interestingly, in our series of cases, the "reversed halo sign" is frequent (63%) and seems to be a typical COVID-19 pneumonitis pattern. The patients showing fibrosis had a higher grade of systemic inflammation (ESR and PCR) and appeared to have bone marrow inhibition with a significant reduction in platelets, leukocytes, and hemoglobin. Conclusions: To conclude, our data showed that the reversed halo sign associated with a ground-glass pattern may be a typical HRCT pattern of COVID-19 pneumonitis. The evolution to pulmonary fibrosis is frequent in older males and patients with comorbidities and bone marrow involvement.