• Purnema Madahar, Kathleen M Capaccione, Mary M Salvatore, Briana Short, Romina Wahab, Darryl Abrams, Madhavi Parekh, Joshua D Geleris, David Furfaro, Michaela R Anderson, Jason Zucker, Daniel Brodie, Matthew J Cummings, Max O'Donnell, Claire F McGroder, Ying Wei, Christine K Garcia, and Matthew R Baldwin.
• Division of Pulmonary, Allergy, and Critical Care, Columbia University Vagelos College of Physicians and Surgeons/New York Presbyterian, New York, NY.
• Crit. Care Med. 2023 Nov 1; 51 (11): e209e220e209-e220.

ObjectivesPulmonary fibrosis is a feared complication of COVID-19. To characterize the risks and outcomes associated with fibrotic-like radiographic abnormalities in patients with COVID-19-related acute respiratory distress syndrome (ARDS) and chronic critical illness.DesignSingle-center prospective cohort study.SettingWe examined chest CT scans performed between ICU discharge and 30 days after hospital discharge using established methods to quantify nonfibrotic and fibrotic-like patterns.PatientsAdults hospitalized with COVID-19-related ARDS and chronic critical illness (> 21 d of mechanical ventilation, tracheostomy, and survival to ICU discharge) between March 2020 and May 2020.InterventionsNone.Measurements And Main ResultsWe tested associations of fibrotic-like patterns with clinical characteristics and biomarkers, and with time to mechanical ventilator liberation and 6-month survival, controlling for demographics, comorbidities, and COVID-19 therapies. A total of 141 of 616 adults (23%) with COVID-19-related ARDS developed chronic critical illness, and 64 of 141 (46%) had a chest CT a median (interquartile range) 66 days (42-82 d) after intubation. Fifty-five percent had fibrotic-like patterns characterized by reticulations and/or traction bronchiectasis. In adjusted analyses, interleukin-6 level on the day of intubation was associated with fibrotic-like patterns (odds ratio, 4.40 per quartile change; 95% CI, 1.90-10.1 per quartile change). Other inflammatory biomarkers, Sequential Organ Failure Assessment score, age, tidal volume, driving pressure, and ventilator days were not. Fibrotic-like patterns were not associated with longer time to mechanical ventilator liberation or worse 6-month survival.ConclusionsApproximately half of adults with COVID-19-associated chronic critical illness have fibrotic-like patterns that are associated with higher interleukin-6 levels at intubation. Fibrotic-like patterns are not associated with longer time to liberation from mechanical ventilation or worse 6-month survival.Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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