Se presenta el caso del primer fallecido en el Perú. Varón de 78 años de edad, con antecedentes de hipertensión, el cual presentó un cuadro clínico característico de la enfermedad causada por el nuevo coronavirus (COVID-19), contacto epidemiológico, prueba confirmatoria positiva junto con algunos parámetros de laboratorio e imagen radiológica también característicos; que siguió una evolución fatal, pese a recibir la terapia recomendada en ese momento. Este caso puso en evidencia la necesidad de identificar rápidamente aquellos pacientes que podrían tener una evolución desfavorable, para poder brindar el tratamiento más temprano y adecuado.

Se presentan nueve casos de pacientes con COVID-19, que desarrollaron neumonía por el SARS-CoV-2, atendidos en el Hospital Central de la Fuerza Aérea del Perú, con diferentes manifestaciones clínicas, factores de riesgo y evolución; así como la descripción de los hallazgos en la tomografía computarizada de tórax (TCT), empleando un score de severidad tomográfico al ingreso hospitalario. La puntuación se basó en el porcentaje de afectación que tenía cada lóbulo pulmonar y permitió valorar el diagnóstico clínico de neumonía según su severidad, incluso antes que las pruebas moleculares y serológicas dieran positivo en algunos de los casos presentados.

Se presenta el caso de un paciente varón de 44 años, personal de salud con hipertensión arterial, que tuvo contacto con pacientes con neumonía por COVID-19. Presentó compromiso pulmonar severo de rápida progresión clínico-radiológica, recibió tratamiento según la evidencia en el momento de su admisión y un antagonista del receptor de interleucina 6 (tocilizumab) como uso compasivo, obteniendo una respuesta clínica favorable.

Objective: Determine whether the tomographic characteristics of patients with COVID-19 pneumonia at hospital admission and the initial tomographic severity score (TSS) as well as some laboratory tests or clinical characteristics predict mortality and length of hospital stay.Material and methods: Analytical, retrospective study that included 203 patients with a clinical diagnosis of SARSCoV2 Virus Infection, performed by reverse transcriptase polymerase chain reaction (RT-PCR), reactive serological test (IgM/IgG) and/or spiral computed tomography (CT) chest without contrast, admitted in the period from 6 April to 27 June 2020. Two radiologists (blind evaluators) described the tomographic findings. 15 patients with normal CT were excluded, 188 patients with clinical and laboratory parameters were admitted to the statistical analysis of TSS and mortality; data taken from epidemiological records and clinical histories, divided into two groups: recovered and deceased. Data analysis used the statistical package Stata version 14.2; hospital stay was analyzed by Kaplan – Meier curves and mortality prediction was made by Cox regression with 95% CI and a p value <0.05 as statistically significant.Results: Hypertension was the most frequent associated disease, the most common clinical presentation included cough, malaise, fever and dyspnea , there were no significant differences between studied groups   (Recovered  vs. death patients), 15 cases had normal CT, for this reason, they were excluded from the TSS score and mortality analysis. Mean age of the recovered patients was 53.6 ± 16.4 years and of the deceased 75.9 ± 13.9 years (p <0.0001). A moderate and high TSS (≥ 8) resulted in deaths (p <0.05), as well as a higher degree of lymphopenia and a history of asthma in the deceased (p <0.05). The variable arterial hypertension predicts the increase in days of hospital stay (p <0.05). The ground glass pattern was the most frequent, followed by the consolidation and distortion of the architecture; however, they were not associated with a type of outcome. The pattern of pleural effusion and bronchial dilation showed a significant difference with respect to the outcome, however, but it could be due to the infrequency of presentation of these patterns. Conclusions: TSS is useful in the initial and comprehensive diagnostic evaluation of COVID-19 pneumonia, in conjunction with markers such as lymphopenia and elevated CRP that can predict a poor short-term outcome. A high TSS score is a predictor of mortality. Hypertension predicts the increase in days of hospital stay.

Objective: Determine whether the tomographic characteristics of patients with COVID-19 pneumonia at the hospital admission and the initial tomographic severity score (TSS) as well as some laboratory tests or clinical characteristics predict mortality. Methods: Retrospective analytical study that included patients with a clinical diagnosis of SARSCoV2 virus infection, performed by reverse transcriptase polymerase chain reaction (RT-PCR), serologic reactive test (IgM/IgG) and/or thoracic computed tomography (CT). Patients were divided into two groups: recovered and deceased. Two radiologists (blind evaluators) described the tomographic findings. TSS, clinical and laboratory parameters in relation to mortality were analyzed. Mortality predictions were made by binary logistic regression. Results: Hypertension was the most frequent associated disease, the most common clinical presentation included cough, discomfort, fever, and dyspnea. The ground glass opacity pattern was the most frequent, followed by consolidation and distortion of the architecture; however, they were not associated with higher mortality. The pattern of pleural effusion and bronchial dilation showed a significant difference from mortality (p <0.05). The binary logistic regression model showed that a moderate and high TSS (≥ 8), as well as a higher degree of lymphopenia, history of asthma and age were associated with an increased risk of death (p< 0.05). Conclusions: TSS is useful in the initial and comprehensive diagnostic evaluation of COVID-19 pneumonia, in conjunction with markers such as lymphopenia that can predict a poor short-term outcome. A high TSS score is a predictor of mortality.