Respir Investig . Chest CT severity score and radiological patterns as predictors of disease severity, ICU admission, and viral positivity in COVID-19 patients

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Respir Investig


. 2021 Mar 19;S2212-5345(21)00040-X.
doi: 10.1016/j.resinv.2021.02.008. Online ahead of print.
Chest CT severity score and radiological patterns as predictors of disease severity, ICU admission, and viral positivity in COVID-19 patients


Ioannis Bellos ¹ , Kyriaki Tavernaraki ² , Konstantinos Stefanidis ³ , Olympia Michalopoulou ¹ , Giota Lourida ¹ , Eleni Korompoki ⁴ , Ioanna Thanou ⁵ , Loukas Thanos ⁵ , Angelos Pefanis ¹ , Aikaterini Argyraki ¹



Affiliations

• PMID: 33820751
• DOI: 10.1016/j.resinv.2021.02.008

Abstract

Background: Chest computed tomography (CT) is a useful tool for the diagnosis of coronavirus disease-2019 (COVID-19), although its exact value for predicting critical illness remains unclear. This study evaluated the efficacy of chest CT to predict disease progression, pulmonary complications, and viral positivity duration.
Methods: A single-center cohort study was conducted by consecutively including hospitalized patients with confirmed COVID-19. The chest CT patterns were described and a total severity score was calculated. The predictive accuracy of the severity score was evaluated using the receiver operating characteristic analysis, while a Cox proportional hazards regression model was implemented to identify the radiological features that are linked to prolonged duration of viral positivity.
Results: Overall, 42 patients were included with 10 of them requiring intensive care unit admission. The most common lesions were ground glass opacities (92.9%), consolidation (66.7%), and crazy-paving patterns (61.9%). The total severity score significantly correlated with inflammatory and respiratory distress markers, as well as with admission CURB-65 and PSI/PORT scores. It was estimated to predict critical illness with a sensitivity and specificity of 75% and 70%, respectively. Time-to-event analysis indicated that patients without ground-glass opacities presented significantly shorter median viral positivity (16 vs. 27 days).
Conclusions: Chest CT severity score positively correlates with markers of COVID-19 severity and presents promising efficacy in predicting critical illness. It is suggested that ground-glass opacities are linked to prolonged viral positivity. Further studies should confirm the efficacy of the severity score and elucidate the long-term pulmonary effects of COVID-19.

Keywords: COVID-19; Chest; Computed tomography; Critical illness; Predict.