The Differences and Changes of Semi-Quantitative and Quantitative CT Features of Coronavirus Disease 2019 Pneumonia in Patients With or Without Smoking History

Abstract

Objective: To assess CT features of COVID-19 patients with different smoking status using quantitative and semi-quantitative technologies and to investigate changes of CT features in different disease states between the two groups.Methods: 30 COVID-19 patients with current smoking status (29 men, 1 woman) admitted in our database were enrolled as smoking group and 56 COVID-19 patients without smoking history (24 men, 32 women) admitted during the same period were enrolled as a control group. Twenty-seven smoking cases and 55 control cases reached recovery standard and were discharged. Initial and follow-up CT during hospitalization and follow-up CT after discharge were acquired. Thirty quantitative features, including the ratio of infection volume and visual-assessed interstitial changes score including total score, score of ground glass opacity, consolidation, septal thickening, reticulation and honeycombing sign, were analyzed.Results: Initial CT images of the smoking group showed higher scores of septal thickening [4.5 (0–5) vs. 0 (0–4), p = 0.001] and reticulation [0 (0–5.25) vs 0 (0–0), p = 0.001] as well as higher total score [7 (5–12.25) vs. 6 (5–7), p = 0.008] with statistical significance than in the control group. The score of reticulation was higher in the smoking group than in the control group when discharged [0.89 (0–0) vs. 0.09 (0–0), p = 0.02]. The score of septal thickening tended to be higher in the smoking group than the control group [4 (0–4) vs. 0 (0–4), p = 0.007] after being discharged. Quantitative CT features including infection ratio of whole lung and left lung as well as infection ratio within HU (−750, −300) and within HU (−300, 49) were higher in the control group of initial CT with statistical differences. The infection ratio of whole lung and left lung, infection ratio within HU (−750), and within HU (−750, −300) were higher in the control group with statistical differences when discharged. This trend turned adverse after discharge and the values of quantitative features were generally higher in the smoking group than in the control group without statistical differences.Conclusions: Patients with a history of smoking presented more severe interstitial manifestations and more residual lesion after being discharged. More support should be given for COVID-19 patients with a smoking history during hospitalization and after discharge.

A Discriminant Analysis of the Factors Affecting Abnormalities in Chest Computed Tomographies of 608-Group Patients with COVID-19 Pneumonia

“…The correlation between the factors and abnormalities in chest CTs of the 608-group patients with COVID-19 pneumonia showed that age, body weight, smoking history, duration from onset of the symptoms to perform chest CTs and CT severity score were statistically significantly associated with abnormalities in the chest CTs of 608-group patients with COVID-19 pneumonia, which is in line with previous studies which found that age, body weight, smoking history, duration from onset of the symptoms to perform chest CTs and CT severity score were independent variables or risk factors that could predict the prognosis or progression of COVID-19 19,20 . Old age, increased body weight, smoking history, greater duration from onset of the symptoms to perform chest CTs and higher CT severity score were associated with abnormalities in chest CTs, and greater severity and mortality rates, as well [21][22][23][24] .…”

Radiological Differences in COVID-19 Related Lung Manifestations Between Smokers and Non-smokers: A Single-Center Retrospective Study in Jordan

“…Contrary to that, a study of 86 patients in Hunan, China, conducted by Xie et al found that patients with a history of smoking exhibited more severe interstitial features and that these patients may have less easily differentiated margins and more residual lesions on follow-up CT scans. In the same study, however, it was shown that non-smokers demonstrated larger lung involvement on chest CT images, but with well-defined margins of ground-glass opacities (GGOs), indicating that the lesions were continuously being resorbed, as was shown in follow-up CT scans [ 9 ].…”

“…Radiological imaging techniques, such as computed tomography (CT) scans, have been instrumental in identifying and monitoring the evolution of COVID-19-related lung damage [ 2 ]. Radiological differences between smokers and non-smokers with COVID-19-related lung damage have been the subject of recent research [ 8 , 9 ]. This is because smoking can cause a loss of lung elastic recoil pressure, leading to reduced lung function and increased amenability to respiratory infections, including COVID-19 [ 10 ].…”

“…A “case-control study” by Xie et al conducted in China showed that patients with a history of smoking are more likely to have severe and widespread lung damage on radiological imaging than non-smokers [ 9 ]. This includes the presence of ground-glass opacities (GGOs), consolidations, and air bronchograms on chest CT scans, which are indicative of COVID-19-related lung damage.…”