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Pulmonary fibrosis 4 months after COVID-19 is associated with severity of illness and blood leucocyte telomere length
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  • Published on:
    Response to Hursoy and colleagues
    • Claire F. McGroder, Physician, Pulmonary and Critical Care Medicine Columbia University Irving Medical Center
    • Other Contributors:
      • Matthew R. Baldwin, Physician, Pulmonary and Critical Care Medicine
      • Mary M. Salvatore, Radiologist
      • Eric A. Hoffman, Radiology and Biomedical Imaging Investigator
      • Christine Kim Garcia, Physician, Pulmonary and Critical Care Medicine

    To the editor,

    We thank N. Hürsoy and colleagues for their interest in our study of patients four months after severe COVID-19 [1]. We agree that there needs to be continued development of terms describing the radiographic appearance of post-COVID fibrotic-like patterns. We acknowledge that without the benefit of histopathology or serial imaging, our ability to define pulmonary fibrosis is limited.

    The authors posit that parenchymal bands, irregular densities, and ground glass opacities, may be considered fibrotic-like patterns. We have included irregular densities, characterized as reticulations or traction bronchiectasis, as fibrotic-like changes. We did not include parenchymal bands [2], as these can be associated with atelectasis, which is common in COVID and can disappear over time [3]. Similarly, we did not include isolated ground glass opacities as fibrotic-like changes, as these have been found to decrease over time in CT lung cancer screening cohorts [4] and in other post COVID-19 cohorts [5, 6].

    A priori, we evaluated for both previously established interstitial lung abnormality categories [7], as well as categories of radiographic abnormalities reported in Acute Respiratory Distress Syndrome (ARDS) survivors using an established scoring system [8]. This inclusive approach should facilitate meta-analyses and comparisons with future studies of COVID-19 survivors, interstitial lung disease studies, and studies of non-COVID ARDS survivors. Fu...

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    Conflict of Interest:
    None declared.
  • Published on:
    Different Views About Post-Covid Fibrotic-Like Patterns
    • Nur Hürsoy, Radiologist Recep Tayyip Erdogan University, Faculty of Medicine
    • Other Contributors:
      • Dilek Karadogan, Pulmonologist
      • Aycan Yüksel, Pulmonologist
      • Metin Akgün, Pulmonologist

    Dear Editor,

    We have read with great interest the article investigating the relationship between computed tomography (CT) findings of the patients with fibrotic-like patterns and telomere length after four months of acute COVID-19 infection. According to the literature and our experience, post-COVID interstitial lung disease is a potential public health problem. Thus, we aimed to share our concerns about the fibrotic-like patterns in this group of patients.

    Post-COVID fibrosis is not as the same as the other interstitial lung diseases. In the article, the authors describe CT findings of fibrotic-like patterns as limited to reticulation, honeycomb cysts, and traction bronchiectasis. However, post-COVID fibrosis CT findings were shown to be more varied and may include parenchymal bands, irregular densities, and ground-glass areas (1–3). As we move towards the future, all of us need to create a common language, a lingua franca in the definition of post-COVID fibrosis. To achieve this, we need brainstorming and close cooperation.

    It will also be helpful to elaborate the characteristics of the non-fibrotic pattern in the table. The clinical importance of the ground glass areas, which persist four months after active infection but not defined as fibrotic, is unknown. We consider that these patterns cannot be separated from fibrotic-like patterns precisely. Additionally, we can also classify parenchymal bands as fibrosis-like appearance. In our experience...

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    Conflict of Interest:
    None declared.