Post-Discharge Prediction of Lung Fibrosis in COVID-19 Survivors: A Follow-Up HRCT-Based Assessment

Abstract

Background: COVID-19 primarily affects the lungs and may lead to long-term pulmonary complications in recovered patients. Emerging evidence suggests a significant number of survivors develop fibrotic lung changes after recovery. Early identification of high-risk individuals is essential to prevent irreversible post-COVID fibrosis. Objective: This study aimed to assess the clinical, radiographic, and laboratory findings of COVID-19 with HRCT follow-up in discharged patients to predict lung fibrosis after COVID-19 infection. Methodology: This retrospective observational study included 160 COVID-19 patients who underwent follow-up high-resolution CT (HRCT) between 20- and 65-days post-discharge. Clinical, laboratory, and radiological data were collected and analyzed. Patients were categorized into fibrotic and non-fibrotic groups based on HRCT findings. Logistic regression and ROC analysis were performed to identify independent predictors of fibrosis. Results: Out of 160 patients, 76 (47.5%) showed fibrotic changes in follow-up HRCT. Fibrosis was significantly associated with older age, ICU admission, higher CT severity scores, and crazy-paving patterns. Multivariate analysis identified age >51.5 years, CT score >10.5, and ICU admission as independent predictors. CT severity score showed the highest predictive accuracy with an AUC of 0.93. Conclusion: A substantial proportion of post-COVID-19 patients develop fibrotic lung changes detectable on follow-up HRCT. Older age, severe initial CT involvement, and ICU admission are key predictors of fibrosis. Early identification of high-risk individuals can guide targeted follow-up and intervention. HRCT-based scoring systems offer valuable tools for post-discharge risk stratification.