Relationship of chest CT score with clinical characteristics of 108 patients hospitalized with COVID-19 in Wuhan, China

Abstract

Background: In December 2019, the outbreak of a disease subsequently termed COVID-19 occurred in Wuhan, China. The number of cases increased rapidly and spread to six continents. However, there is limited information on the chest computed tomography (CT) results of affected patients. Chest CT can assess the severity of COVID-19 and has sufficient sensitivity to assess changes in response to glucocorticoid therapy. Objective: Analyze COVID-19 patients to determine the relationships of clinical characteristics, chest CT score, and levels of inflammatory mediators. Methods: This retrospective, single-center case series of 108 consecutive hospitalized patients with confirmed COVID-19 at Tongji Hospital, Tongji Medical College of HUST (Wuhan, China) examined patients admitted from January 28 to February 20, 2020. Patient demographics, comorbidities, clinical findings, chest CT results, and CT scores of affected lung parenchyma were recorded. The relationships between chest CT score with levels of systemic inflammatory mediators were determined. Results: All patients exhibited signs of significant systemic inflammation, including increased levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin, chest CT score, and a decreased lymphocyte (LY) count. Chest CT score had positive associations with white blood cell (WBC) count, CRP, ESR, procalcitonin, and abnormal coagulation function, and a negative association with LY count. Treatment with a glucocorticoid increased the LY count, reduced the CT score and CRP level, and improved coagulation function. Conclusions: COVID-19 infection is characterized by a systemic inflammatory response that affects the lungs, blood, digestive system, and circulatory systems. The chest CT score is a good indicator of the extent of systemic inflammation. Glucocorticoid treatment appears to reduce systemic inflammation in these patients.

Correlation of Computerized Tomography (CT) Severity Score for COVID-19 pneumonia with Clinical Outcomes

“…The serum D-Dimer levels were also increased in severe cases (5.3 +/-5.8) versus in mild cases (4 +/-3.5), however not statically signification with p-value of 0.44. These findings have been reported previously and also are confirmed by our study (13,14) Various CT severity scores have already been described in literature since the start of this pandemic (15)(16)(17) . But one pertinent problem in all of the previously described scores is relatively challenging calculation and variance in inter-observer agreement.…”

“…Study performed by Zhang J et al on 108 patients revealed positive association of CT severity score with CRP, erythrocyte sedimentation rate (ESR), D-Dimer and procalcitonin and negative association with lymphocyte count (17) .…”

“…Various CT severity scores have already been described in literature since the start of this pandemic (15)(16)(17) . One pertinent issue with all of the previously described severity scores is their relative challenging calculation and variance in inter-observer agreement.…”

Diabetes is most important cause for mortality in COVID-19 hospitalized patients: Systematic review and meta-analysis

“…In line with the latter findings, a multicenter randomized controlled trial, comparing efficacy and safety of high- versus low-molecular weight heparin dosages in hospitalized patients with severe COVID-19 pneumonia and coagulopathy, is ongoing [ 150 ]. Reduced platelet count and lymphopenia, along with eosinopenia, have all been associated in these patients with more severe pneumonia and with higher inflammatory response [ 111 ]; hence, their association with higher mortality is not surprising. Similarly, symptoms such as myalgia and fatigue can be considered the expression of a more severe systemic inflammatory involvement, explaining their association with higher mortality risk.…”

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“…Despite these limitations, some previous studies suggested that CT score was highly correlated with laboratory findings and disease severity, which could serve as a biomarker of predicting the outcome of COVID-19 patients (41,(43)(44)(45)(46)(47)(48)(49)(50)(51). However, our study might suggest that admission CT score is not a significant predictor for longer-term prognosis.…”