Visual lung damage CT score at hospital admission of COVID-19 patients and 30-day mortality

Abstract

Objectives Chest CT has been widely used to screen and to evaluate the severity of COVID-19 disease in the early stages of infection without severe acute respiratory syndrome, but no prospective data are available to study the relationship between extent of lung damage and short-term mortality. The objective was to evaluate association between standardized simple visual lung damage CT score (vldCTs) at admission, which does not require any software, and 30-day mortality. Methods In a single-center prospective cohort of COVID-19 patients included during 4 weeks, the presence and extent of ground glass opacities(GGO), consolidation opacities, or both of them were visually assessed in each of the 5 lung lobes (score from 0 to 4 per lobe depending on the percentage and out of 20 per patient = vldCTs) after the first chest CT performed to detect COVID-19 pneumonia. Results Among 210 confirmed COVID-19 patients, the number of survivors and non-survivors was 162 (77%) and 48 (23%), respectively at 30 days. vldCTs was significantly higher in non-survivors, and the AUC of vldCTs to distinguish survivors and non-survivors was 0.72 (95%CI 0.628-0.807, p < 0.001); the best cut-off vldCTs value was 7. During follow-up, significant differences in discharges and 30-day mortality were observed between patients with vldCTs ≥ 7 versus vldCTs < 7: (98 [85.2%] vs 49 [51.6%]; p < 0.001 and 36 [37.9%] vs 12 [12.4%]; p < 0.001, respectively. The 30-day mortality increased if vldCTs ≥ 7 (HR, 3.16 (1.50-6.43); p = 0.001), independent of age, respiratory rate and oxygen saturation levels, and comorbidities at admission. Conclusions By using chest CT in COVID-19 patients, extensive lung damage can be visually assessed with a score related to 30day mortality independent of conventional risk factors of the disease. Key Points • In non-selected COVID-19 patients included prospectively during 4 weeks, the extent of ground glass opacities(GGO) and consolidation opacities evaluated by a simple visual score was related to 30-day mortality independent of age, respiratory rate, oxygen saturation levels, comorbidities, and hs-troponin I level at admission. • This severity score should be incorporated into risk stratification algorithms and in structured chest CT reports requiring a standardized reading by radiologists in case of COVID-19.

Lung Lesion Burden found on Chest CT as a Prognostic Marker in Hospitalized Patients with High Clinical Suspicion of COVID-19 Pneumonia: a Brazilian experience

“…Of note, a CT lung score of 15/24, which roughly translates a lung lesion burden (LLB) of 60% ( 8), was associated with a higher mortality rate, a rationale for a similar approach in COVID-19. It is intuitive to imagine the reversed linear correlation between lung lesion burden and the prognosis of COVID-19, there are some data supporting this correlation (10)(11)(12)(13)(14)(15); however, the available data regarding the dynamic changes of the CT during the disease's natural course are still limited in the current study (16).…”

“…Many investigators have shown the potential association between initial CT findings, primarily the extent of pulmonary involvement, and adverse outcomes in patients with COVID-19 pneumonia (10,11,13,15,(25)(26)(27)(28)(29). Clinical endpoints and magnitude of the association with CT findings varied greatly between these studies, as did the extent of involvement used as the cut-off point.…”

Visual classification of three computed tomography lung patterns to predict prognosis of COVID-19: a retrospective study

“…COVID-19 pneumonia has an extremely variable prognosis [ 17 – 21 ]. While 80% of patients are either asymptomatic or have mild symptoms, 20% develop severe or profound disease and eventually die [ 22 – 25 ]. CT imaging of the lungs plays an important role in the care of patients infected with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), with the prognostic value of CT evaluated in several studies [ 9 – 14 , 18 – 21 ].…”

“…However, most of these studies are from China, Europe, and the United States, with no information available for patient cohorts in Japan [ 22 – 26 ]. In addition, several researchers have used image analysis software to quantify CT findings, making these impractical in daily clinical practice [ 25 – 27 ]. Practicality in clinical practice was our motivation to develop and evaluate the prognostic value of our visually-based assessment of CT lung findings (peripheral, multifocal, and diffuse) in a hospital patient cohort in Tokyo, Japan, a city with a particularly high SARS-CoV-2 prevalence.…”

“…These results suggest that the more extensive the abnormal findings in the lungs, the more severe the systemic over-inflammatory response in COVID-19. The laboratory features presented by this study could be attributed to respiratory failure, septic shock, and/or multiple organ dysfunction or failure compatible with the acute respiratory distress syndrome course of severe and critical COVID-19 types [ 17 , 25 – 29 ]. Our simple visual assessment of CT images revealed the possibility of predicting systemic cytokine storm in COVID-19 patients.…”