Publication date: Jun 22, 2026
Long-term pulmonary sequelae following hospitalization for COVID-19 remain incompletely characterized, and few studies have reported radiological outcomes beyond 2 years. This study investigated the persistence of chest CT abnormalities up to 4. 5 years after hospitalization for COVID-19 and their association with current dyspnea and fatigue. This longitudinal cohort study included patients hospitalized for COVID-19 in 2020. Chest CT was performed 3 months after hospital admission, with follow-up imaging after 12 months and 4. 5 years in patients with persisting abnormalities. CT images were evaluated using a CT severity score (CSS) on a 0-12 scale, which was subsequently recoded to an abbreviated CSS (aCSS) on a 0-3 scale. Trends in CT abnormalities and their determinants were analyzed using multivariable mixed effects ordinal regression. In total, 187 patients underwent chest CT at 3 months. Among patients with persistent abnormalities, 99 completed follow-up CT at 12 months and 54 at 4. 5 years. Dyspnea (33%) and fatigue (61%) remained common at 4. 5 years; however, correlations between current symptoms and aCSS were weak. Greater severity of the initial disease and older age were strong predictors of CT abnormalities. Regression analysis showed a gradual reduction in ground glass opacities (GGO) severity over time, whereas parenchymal bands increased and were associated with initial severity as assessed by the WHO 8-point ordinal scale for clinical improvement. Mosaic attenuation decreased during follow-up, but remained associated with the severity of the initial COVID-19 episode. From 3 months to 4. 5 years after hospitalization, GGO and mosaic attenuation decreased, whereas parenchymal bands increased, with minimal change beyond 12 months. CT abnormalities were associated with initial disease severity and age but showed little association with dyspnea or fatigue.
Open Access PDF
| Concepts | Keywords |
|---|---|
| 3months | Cohort study |
| 5years | COVID-19 |
| Dyspnea | Dyspnea |
| Hospitalization | Ground glass opacities |
| Pulmonary | Long-term |
| Pulmonary fibrosis | |
| Radiology |
Semantics
| Type | Source | Name |
|---|---|---|
| disease | MESH | COVID-19 |
| disease | MESH | dyspnea |
| disease | MESH | fatigue |
| disease | MESH | included |
| disease | MESH | CSS |
| pathway | REACTOME | Reproduction |
| disease | MESH | pulmonary fibrosis |
| disease | MESH | long COVID |
| disease | MESH | cognitive impairment |
| drug | DRUGBANK | Oxygen |
| disease | MESH | image |
| disease | MESH | bronchiectasis |
| disease | MESH | fibrosis |
| disease | MESH | cysts |
| drug | DRUGBANK | Medical air |
| drug | DRUGBANK | Aspartame |