CT-Based Risk Stratification for Intensive Care Need and Survival in COVID-19 Patients—A Simple Solution

Abstract

We evaluated a simple semi-quantitative (SSQ) method for determining pulmonary involvement in computed tomography (CT) scans of COVID-19 patients. The extent of lung involvement in the first available CT was assessed with the SSQ method and subjectively. We identified risk factors for the need of invasive ventilation, intensive care unit (ICU) admission and for time to death after infection. Additionally, the diagnostic performance of both methods was evaluated. With the SSQ method, a 10% increase in the affected lung area was found to significantly increase the risk for need of ICU treatment with an odds ratio (OR) of 1.68 and for invasive ventilation with an OR of 1.35. Male sex, age, and pre-existing chronic lung disease were also associated with higher risks. A larger affected lung area was associated with a higher instantaneous risk of dying (hazard ratio (HR) of 1.11) independently of other risk factors. SSQ measurement was slightly superior to the subjective approach with an AUC of 73.5% for need of ICU treatment and 72.7% for invasive ventilation. SSQ assessment of the affected lung in the first available CT scans of COVID-19 patients may support early identification of those with higher risks for need of ICU treatment, invasive ventilation, or death.

Analysis of Deaths and Favorable Developments of Patients with SARS-CoV-2 Hospitalized in the Largest Hospital for Infectious Diseases and Pneumo-Phthisiology in the West of the Country

“…The CT imaging characteristics of COVID-19 pneumonia showed 74.3% of patients exhibited peripherally accentuated bilateral consolidations -and this was more extensive in patients intubated or hospitalized at ICUs and opacities in “matte glass” at 89.1%, who rarely showed pleural effusions and lymphadenopathy. 45 The analysis of 23 studies, with a total of 4631 Chinese patients, showed that elevated levels of CK, CK-MB, troponin T/L, LDH and IL-6 and emerging arrhythmia were associated with the development of severe forms of the disease, hospitalization at the ICU or death. 46 …”

Prognostic findings for ICU admission in patients with COVID-19 pneumonia: baseline and follow-up chest CT and the added value of artificial intelligence

“…Using the same method for the semi-quantitative analysis, Hosse et al confirmed that a 10% increase in the affected parenchyma increased the risk for ICU admission (OR 1.68) and for invasive ventilation (OR 1.58), improving early detection of patients at risk for poor outcome compared to subjective assessment [ 49 ]. In their analysis of serial CT features of COVID-19 patients, Li et al stated that critical patients had higher CT scores from the second to the fourth week after onset of symptoms with a peak value of all the features in the third week.…”