Quantitative Burden of COVID-19 Pneumonia at Chest CT Predicts Adverse Outcomes: A Post Hoc Analysis of a Prospective International Registry

Abstract

C oronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is an unprecedented global health crisis with over 29.7 million confirmed cases worldwide as of September 17, 2020 (1). The most critical complication is acute respiratory failure requiring invasive mechanical ventilation, occurring in up to 17% of patients (2,3) which is associated with a high rate of in-hospital mortality (4,5). While the reversetranscription polymerase chain reaction (RT-PCR) assay is considered the reference standard for diagnosing COV-ID-19 infection (6), chest CT has greater sensitivity for early disease detection (7). This is particularly useful in patients in whom initial RT-PCR testing is negative and a high clinical suspicion remains (8). Furthermore, chest CT findings can indicate disease stage (9-11) and predict adverse outcomes (12,13) in COVID-19 pneumonia.Characteristic CT abnormalities are bilateral patchy ground-glass opacities (GGO) with or without consolidation in a peripheral, posterior, and diffuse or lower lung zone distribution (9-11). Increasing lung consolidation is typically observed later in the disease course (10,11) and is associated with critical illness (13,14). Studies have demonstrated that the extent of diseased lungs in COVID-19 pneumonia assessed by visual scoring correlates with

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“…Also, Tharakan et al reported that a significant increase was observed in mortality for every 0.5 °C increase in body temperature (34). In consistent with our study, Grodecki et al showed that consolidation in chest CT was associated with 3.4-fold increased risk for clinical deterioration (35).…”

Pulmonary Vascular Thrombosis in COVID-19 Pneumonia

“… 10 , 11 Furthermore, chest CT (irrespective of contrast medium administration) has been used to quantify disease burden. 12 , 13 …”

Quantitative analysis based on chest CT classifies common and severe patients with coronavirus disease 2019 pneumonia in Wuhan, China

“…Most of these studies focused on the radiological features of this novel disease [12][13][14][15][16][17], and the data are sparse with regard to the quantitative CT analysis. Several studies investigated the association between quantitative CT data and adverse clinical outcomes [18][19][20], but few related the dynamic change of these data with patients' clinical course.…”