Residual lung abnormality following COVID-19 hospitalisation is characterised by biomarkers of epithelial injury
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background Long term respiratory symptoms are reported following recovery of acute COVID-19 infection and residual lung abnormalities (RLA) on follow-up thoracic computed tomography (CT) after COVID-19 hospitalisation have been observed. It is unknown whether RLA are associated with epithelial lung injury. Methods Plasma was sampled from the observational Post HOSPitalisation-COVID cohort at five months post-hospitalisation. Epithelial injury biomarkers Krebs von den Lungen-6 (KL-6), matrix metalloproteinase 7 (MMP-7), surfactant protein-D (SP-D) and surfactant protein-A (SP-A) were assayed. In those without follow-up CT, RLA at-risk was defined by percent predicted DL CO <80% and/or abnormal chest X-ray, otherwise they were considered low-risk. Follow-up CT RLA was defined as combined involvement of ground glass opacity and reticulation ≥10%. Findings A total of 957 people were included, 846 people with no CT (at-risk n=103; 12.2%), 111 people with follow-up CT (RLA ≥10% n=85; 76.6%). All epithelial injury biomarkers were significantly elevated in people at-risk of RLA compared with low-risk. KL-6 and MMP-7 were significantly higher in people with ≥10% RLA than those with <10%, SP-D and SP-A did not reach significance. SP-D and SP-A were associated with percent involvement of reticulation (3.22%, 95% CI 1.19–5.24; 3.03%, 95% CI 0.76–5.30, respectively). Interpretation RLA after acute COVID-19 infection were consistent with elevated epithelial injury biomarkers and pro-fibrotic signalling. Future studies should address the temporal association between fibrotic biomarkers and resolution or progression of radiological involvement. Funding MRC-UK Research and Innovation and National Institute for Health Research (NIHR) rapid response panel to tackle COVID-19 (MR/V027859/1; COV0319; MR/W006111/1).
Source: EBioMedicine
Authors: Iain Stewart, Iain Stewart, Joseph Jacob, Joanna C. Porter, Bin Liu, Amanda L. Tatler, Nancy Gomez, Matthew R. Pugh, Alison E. John, Richard J. Allen, John F. Blaikley, Nazia Chaudhuri, Emma Denneny, Laura Fabbri, Peter M. George, Beatriz Guillen-Guio, Bibek Gooptu, Ian P. Hall, Ling Pei Ho, Ian Jarrold, Simon Johnson, Mark G. Jones, Fasihul Khan, Puja Mehta, Jane Mitchell, Philip L. Molyneaux, John E. Pearl, Karen Piper Hanley, Manuela Platé, Valerie Quinn, Pilar Rivera-Ortega, Laura C. Saunders, David J.F. Smith, Mark Spears, Lisa G. Spencer, Stefan C. Stanel, A.A. Roger Thompson, Simon Walsh, Jim M. Wild, Dan G. Wootton, Annemarie B. Docherty, Fergus Gleeson, William Greenhalf, Ewen M. Harrison, Nazir Lone, Jennifer Quint, Anastasia Maslova, Moritz Pohl, Adam Stephens, Simon Young, Amisha Singapuri, Aarti Shikotra, Marco Sereno, Ruth M. Saunders, Matthew Richardson, Betty Raman, Krisnah Poinasamy, Hamish J.C. McAuley, Michael Marks, Olivia C. Leavy, Linzy Houchen-Wolloff, Alex Horsley, Victoria C. Harris, Neil Greening, Rachael A. Evans, Omer Elneima, James D. Chalmers, Christopher E. Brightling, Rachel C. Chambers, Louise V. Wain, R. Gisli Jenkins, K. Abel, H. Adamali, D. Adeloye, O. Adeyemi, R. Adrego, L.A. Aguilar Jimenez, S. Ahmad, N. Ahmad Haider, R. Ahmed, N. Ahwireng, M. Ainsworth, B. Al-Sheklly, A. Alamoudi, M. Ali, M. Aljaroof, A.M. All, L. Allan, R.J. Allen, L. Allerton, L. Allsop, P. Almeida, D. Altmann, M. Alvarez Corral, S. Amoils, D. Anderson, C. Antoniades, G. Arbane, A. Arias, C. Armour, L. Armstrong, N. Armstrong, D. Arnold, H. Arnold, A. Ashish, A. Ashworth, M. Ashworth, S. Aslani, H. Assefa-Kebede, C. Atkin, P. Atkin, R. Aul, H. Aung, L. Austin, C. Avram, A. Ayoub, M. Babores, R. Baggott, J. Bagshaw, D. Baguley, L. Bailey, J.K. Baillie, S. Bain, M. Bakali, M. Bakau, E. Baldry, D. Baldwin, M. Baldwin, C. Ballard, A. Banerjee, B. Bang, R.E. Barker, L. Barman, S. Barratt, F. Barrett, D. Basire, N. Basu, M. 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Charalambou, N. Chaudhuri, A. Checkley, J. Chen, Y. Cheng, L. Chetham, C. Childs, E.R. Chilvers, H. Chinoy, A. Chiribiri, K. Chong-James, G. Choudhury, N. Choudhury, P. Chowienczyk, C. Christie, M. Chrystal, D. Clark, C. Clark, J. Clarke, S. Clohisey, G. Coakley, Z. Coburn, S. Coetzee, J. Cole, C. Coleman, F. Conneh, D. Connell, B. Connolly, L. Connor, A. Cook, B. Cooper, J. Cooper, S. Cooper, D. Copeland, T. Cosier, M. Coulding, C. Coupland, E. Cox, T. Craig, P. Crisp, D. Cristiano, M.G. Crooks, A. Cross, I. Cruz, P. Cullinan, D. Cuthbertson, L. Daines, M. Dalton, P. Daly, A. Daniels, P. Dark, J. Dasgin, A. David, C. David, E. Davies, F. Davies, G. Davies, G.A. Davies, K. Davies, M.J. Davies, J. Dawson, E. Daynes, A. De Soyza, B. Deakin, A. Deans, C. Deas, J. Deery, S. Defres, A. Dell, K. Dempsey, E. Denneny, J. Dennis, A. Dewar, R. Dharmagunawardena, N. Diar-Bakerly, C. Dickens, A. Dipper, S. Diver, S.N. Diwanji, M. Dixon, R. Djukanovic, H. Dobson, S.L. Dobson, A.B. Docherty, A. 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Wolf-Roberts, C. Wood, F. Woodhead, J. Woods, D.G. Wootton, J. Wormleighton, J. Worsley, D. Wraith, C. Wrey Brown, C. Wright, L. Wright, S. Wright, J. Wyles, I. Wynter, M. Xu, N. Yasmin, S. Yasmin, T. Yates, K.P. Yip, B. Young, S. Young, A. Young, A.J. Yousuf, A. Zawia, L. Zeidan, B. Zhao, B. Zheng, O. Zongo
Institutions: NIHR Imperial Biomedical Research Centre, Imperial College London, University College London Hospitals NHS Foundation Trust, University College London, University of Nottingham, Nottingham Biomedical Research Centre, University of Birmingham, University of Leicester, NIHR Leicester Biomedical Research Centre, University of Manchester, Manchester University NHS Foundation Trust, University of Ulster, Guy's and St Thomas' NHS Foundation Trust, University of Oxford, Oxford University Hospitals NHS Trust, Asthma + Lung UK, University Hospital Southampton NHS Foundation Trust, University Hospitals of Leicester NHS Trust, University of Sheffield, University of Dundee, NHS Tayside, Liverpool University Hospitals NHS Foundation Trust, NIHR Sheffield Biomedical Research Centre, University of Edinburgh, University of Liverpool, London School of Hygiene & Tropical Medicine
Language: English
Subfield: Neurology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $5,780
Funders: GlaxoSmithKline, Muscular Dystrophy UK, UK Research and Innovation, Galecto, National Institute for Health and Care Research, British Heart Foundation, Department of Health and Social Care, Kidney Research UK, Cystic Fibrosis Trust, Heart Research UK, Diabetes UK, Stroke Association, Universitas Hasanuddin, Versus Arthritis, Manchester Biomedical Research Centre, Medical Research Council, NIHR Leicester Biomedical Research Centre, Cilag
Awards: PHOSP-COVID Post-hospitalisation COVID-19 study: a national consortium to understand and improve long-term health outcomes, The UK Interstitial Lung Disease Long-COVID19 study (UKILD-Long COVID): understanding the burden of Interstitial Lung Disease in Long COVID., G3662074923, G4411034795, G4976874386, G611400891, G699656635, G8067524069, G8415457339
OpenAlex ID: W7125584307