Prognostic value of initial chest CT findings for clinical outcomes in patients with COVID-19

Abstract

Rationale: To identify whether the initial chest computed tomography (CT) findings of patients with coronavirus disease 2019 (COVID-19) are helpful for predicting the clinical outcome. Methods: A total of 224 patients with laboratory-confirmed COVID-19 who underwent chest CT examination within the first day of admission were enrolled. CT findings, including the pattern and distribution of opacities, the number of lung lobes involved and the chest CT scores of lung involvement, were assessed. Independent predictors of adverse clinical outcomes were determined by multivariate regression analysis. Adverse outcome were defined as the need for mechanical ventilation or death. Results: Of 224 patients, 74 (33%) had adverse outcomes and 150 (67%) had good outcomes. There were higher frequencies of more than four lung zones involved (73% vs 32%), both central and peripheral distribution (57% vs 42%), consolidation (27% vs 17%), and air bronchogram (24% vs 13%) and higher initial chest CT scores (8.6±3.4 vs 5.4±2.1) ( P < 0.05 for all) in the patients with poor outcomes. Multivariate analysis demonstrated that more than four lung zones (odds ratio [OR] 3.93; 95% confidence interval [CI]: 1.44 to 12.89), age above 65 (OR 3.65; 95% CI: 1.11 to 10.59), the presence of comorbidity (OR 5.21; 95% CI: 1.64 to 19.22) and dyspnea on admission (OR 3.19; 95% CI: 1.35 to 8.46) were independent predictors of poor outcome. Conclusions: Involvement of more than four lung zones and a higher CT score on the initial chest CT were significantly associated with adverse clinical outcome. Initial chest CT findings may be helpful for predicting clinical outcome in patients with COVID-19.

Predicting Severe/Critical Outcomes in Patients With SARS-CoV2 Pneumonia: Development of the prediCtion seveRe/crItical ouTcome in COVID-19 (CRITIC) Model

“…Identifying admission CT predictors of adverse outcome in patients without underlying medical issues would help to identify the most vulnerable patients in this age range and, as a result, change their therapy. Several recent studies reported imaging CT findings of patients with adverse outcomes (12)(13)(14)(15). However, data on the outcomes of consecutive patients, factors influencing hospital admission vs. outpatient management, and risk factors for COVID-19 adverse effects is still lacking in Italy.…”

Can initial chest CT scan predict status and clinical outcomes of COVID-19 infection? A retrospective cohort study

“…In the study by Liu et al [ 8 ], which used the same criteria as the present study used for the disease severity (WHO), number of lung lobes involved and total CT score were directly correlated to disease severity. In other study, it was stated that the odds of adverse outcome (need for mechanical ventilation or mortality) is four times higher in patients with more than four lung zones involved than in those without [ 15 ]. Auger et al [ 16 ] reported that ground glass, crazy paving, and consolidation did not have a significant association either with invasive endotracheal ventilation or mortality.…”

Associations between CT pulmonary opacity score on admission and clinical characteristics and outcomes in patients with COVID-19

“…More studies showed the CT score calculated by their scoring systems was significantly higher in critical and severe than in mild and common category [ 18 , 19 , 22 ]. Other studies found that the overall lung involvement score had predictive value for clinical severity and ICU admission, and higher chest CT score was significantly associated with an increase in requirement of oxygen and even mechanical ventilation [ 16 , 25 – 27 , 36 , 37 ]. CT involvement score can help early diagnosis, severity assessment and treatment of COVID-19 [ 9 , 38 , 39 ] and may indicate the progression and recovery of the disease [ 6 , 40 ].…”