Semiquantitative Chest CT Severity Score Predicts Failure of Noninvasive Positive-Pressure Ventilation in Patients Hospitalized for COVID-19 Pneumonia

Abstract

Objective Non-invasive positive pressure ventilation (NPPV) emerged as an efficient tool for treatment of Coronavirus disease-19 (COVID-19) pneumonia. The factors influencing NPPV failure are still elusive. The aim of the study was to investigate the relationships between semiquantitative chest computed tomography (CT) scoring and NPPV failure and mortality in patients with COVID-19 Design Observational study Setting Non-intensive setting of care Participants N=112 patients consecutively admitted for COVID-19 pneumonia. Interventions Usual care including various degrees of respiratory support Measurements and Main Results The semi-quantitative CT-score was calculated at hospital admission. Subgroups were identified according to the ventilation strategy used (oxygen delivered by Venturi mask n=53; NPPV-responder n=38; NPPV-failure n=21). The study's primary endpoint was the use of NPPV. The secondary endpoints were NPPV failure and in-hospital death, respectively. CT-score progressively increased among groups (6 vs 9 vs 14, p<0.05 between all). CT-score was an independent predictor of all study endpoints (primary endpoint: 1.25 [95% CI 1.1-1.4], p=0.001; NPPV failure: 1.41 [95% CI 1.18-1.69], p<0.001; in-hospital mortality: 1.21 [95% CI 1.07-1.38], p=0.003). According to receiver operator characteristics curve analysis, CT-score was the most accurate variable for prediction of NPPV failure (area under the curve 0.862 with p<0.001; p<0.05 vs other variables). Conclusions We reported the common and effective use of NPPV in patients with COVID-19 pneumonia. In our population, a semi-quantitative chest CT analysis at hospital admission accurately identified those people poorly responding to NPPV.

A Systematic Review of the Relationship between Chest CT Severity Score and Laboratory Findings and Clinical Parameters in COVID-19 Pneumonia

“…Two studies [ 21 , 22 ] were conducted in Italy. Six studies [ 19 , 23 , 24 , 25 , 26 , 27 ] were conducted in India. Furthermore, two studies [ 18 , 28 ] were carried out in Pakistan.…”

“…Several studies showed a significant association between the CT severity score and clinical outcomes. Studies [ 22 , 23 , 24 , 25 , 26 , 28 , 33 , 34 , 38 , 40 , 41 , 42 ], found that the CT severity score is positively associated with mortality and morbidity rates (increased risk of mortality and morbidity), the need for mechanical ventilation and for emergency medical treatment, patient survival, inflammatory markers, endotracheal intubation, oxygen saturation and demand, respiratory rate, length of hospital stays (prolonged hospitalization, >21 days), increased risk of noninvasive positive-pressure ventilation (NIPPV) failure, ICU admission, vaccination status, age, gender, co-morbidities, and stage of disease in the cohort of COVID-19 patients. It has also been found that CT severity score is higher in patients with severe COVID-19 pneumonia compared to those with mild or moderate disease.…”

Reply letter to: Correspondence on ‘Coronavirus disease 2019 in patients with cardiovascular disease’ (J Cardiovasc Med (Hagerstown). 2022 Jan 1;23(1):e42. doi: 10.2459/JCM.0000000000001276. PMID: 34874340.)

“…We are glad to provide answers to the stimulating comments made by Mungmunpuntipantipa and Wiwanitkit 1 to our article recently published in the Journal 2 . Regarding concomitant drug therapy, antibiotics, steroids, remdesivir and tocilizumab prescription rates in our population have been recently reported 3 . Hydroxychloroquine was used for a short period of time during the first wave only (March–April 2020).…”

“…2 Regarding concomitant drug therapy, antibiotics, steroids, remdesivir and tocilizumab prescription rates in our population have been recently reported. 3 Hydroxychloroquine was used for a short period of time during the first wave only (March-April 2020). Pertaining to the population of the present study, 2 we reanalyzed prescription rates of the aforementioned drugs according to the presence of underlying cardiovascular disease as well as cardiac biomarkers status and outcome, albeit finding no significant difference between groups.…”

Threshold of increase in oxygen demand to predict mechanical ventilation use in novel coronavirus disease 2019: A retrospective cohort study incorporating restricted cubic spline regression

“…While several studies have attempted to develop a prediction model for the need of MV or ICU admission, there is no well-accepted method that captures rapidly changing respiratory status in patients with COVID-19 [ 7 – 12 ]. Although some clinical scoring systems showed promising results with high discrimination, most use daily clinical data or those on admission and only predict deterioration within 24–48 h or thereafter [ 8 , 9 , 11 , 12 ]. Since candidates for MV are usually on oxygen therapy and changes in respiratory status are frequently assessed within a day, estimation with such a long-term interval using a score is not practical.…”