Background: Chest radiography (CXR) has not been validated for its prognostic utility in evaluating patients with coronavirus disease 2019 .Purpose: The purpose of this study was to analyze the prognostic value of a CXR severity scoring system for younger (non-elderly) patients with COVID-19 upon initial presentation to the emergency department (ED). Outcomes of interest included hospitalization, intubation, prolonged stay, sepsis, and death. Materials & Methods:In this retrospective study, patients between the ages of 21 and 50 years who presented to EDs of an urban multicenter health system from March 10 -26, 2020 with COVID-19 confirmation on real-time reverse transcriptase polymerase chain reaction (RT-PCR) were identified.Each patient's ED CXR was divided into 6 zones and examined for opacities by two cardiothoracic radiologists with scores collated into a total concordant lung zone severity score. Clinical and laboratory variables were collected. Multivariable logistic regression was utilized to evaluate the relationship between clinical parameters, CXR scores, and patient outcomes. Results:The study included 338 patients: 210 males (62%), median age 39 [31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]. After adjustment for demographics and co-morbidities, independent predictors of hospital admission (n=145, 43%) were CXR severity score ≥ 2 (OR: 6.2, 95% CI 3.5-11, p<0.001) and obesity (OR 2.4 (1.1-5.4) or morbid obesity. Of patients who were admitted, a CXR score ≥3 was an independent predictor of intubation (n=28) (OR: 4.7, 95% CI 1.8-13, p=0.002) as was hospital site. We found no significant difference in primary outcomes across race/ethnicity, those with a history of tobacco use, asthma or diabetes mellitus type II. Conclusion:For patients aged 21-50 with COVID-19 presenting to the emergency department, a chest xray severity score was predictive of risk for hospital admission and intubation.

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Purpose We describe the presenting characteristics and hospital course of 11 novel coronavirus (COVID-19) patients who developed spontaneous subcutaneous emphysema (SE) with or without pneumomediastinum (SPM) in the absence of prior mechanical ventilation. Materials and methods A total of 11 non-intubated COVID-19 patients (8 male and 3 female, median age 61 years) developed SE and SPM between March 15 and April 30, 2020 at a multi-center urban health system in New York City. Demographics (age, gender, smoking status, comorbid conditions, and body-mass index), clinical variables (temperature, oxygen saturation, and symptoms), and laboratory values (white blood cell count, C-reactive protein, D-dimer, and peak interleukin-6) were collected. Chest radiography (CXR) and computed tomography (CT) were analyzed for SE, SPM, and pneumothorax by a board-certified cardiothoracic-fellowship trained radiologist. Results Eleven non-intubated patients developed SE, 36% (4/11) of whom had SE on their initial CXR. Concomitant SPM was apparent in 91% (10/11) of patients, and 45% (5/11) also developed pneumothorax. Patients developed SE on average 13.3 days (SD: 6.3) following symptom onset. No patients reported a history of smoking. The most common comorbidities included hypertension (6/11), diabetes mellitus (5/11), asthma (3/11), dyslipidemia (3/11), and renal disease (2/11). Four (36%) patients expired during hospitalization. Conclusion SE and SPM were observed in a cohort of 11 non-intubated COVID-19 patients without any known cause or history of invasive ventilation. Further investigation is required to elucidate the underlying mechanism in this patient population.

“Just Accepted” papers have undergone full peer review and have been accepted for publication in Radiology: Artificial Intelligence . This article will undergo copyediting, layout, and proof review before it is published in its final version. Please note that during production of the final copyedited article, errors may be discovered which could affect the content. Purpose To train a deep learning classification algorithm to predict chest radiography severity scores and clinical outcomes in patients with coronavirus disease 2019 (COVID-19). Materials and Methods In this retrospective cohort study, we identified patients of ages of 21 to 50 who presented to the emergency department (ED) of a multicenter urban health system from March 10–26, 2020 with COVID-19 confirmation on real-time reverse transcription polymerase chain reaction. We collected the initial chest radiographs (CXRs), clinical variables, and outcomes including admission, intubation, and survival within 30 days ( n = 338; median age 39; 210 men). Two fellowship-trained cardiothoracic radiologists examined CXRs for opacities and assigned a clinically validated severity score. We trained a deep learning algorithm to predict outcomes on a holdout test set composed of confirmed COVID-19 patients who presented from March 27–29, 2020 ( n = 161; median age 60; 98 men) for both younger (ages 21–50; n = 51) and older (ages > 50; n = 110) populations. Bootstrapping methods computed confidence intervals. Results The model trained on the CXR severity score produced the following areas under the receiver operating characteristic (AUCs): 0.80 (0.73,0.88) for the CXR severity score, 0.76 (0.68,0.84) for admission, 0.66 (0.56,0.75) for intubation, and 0.59 (0.49,0.69) for death. The model trained on clinical variables produced the following AUCs 0.64 (0.55,0.73) for intubation and 0.59 (0.50,0.68) for death. Combining CXR and clinical variables increased AUC of intubation and death to 0.86 (0.79,0.96) and 0.82 (0.72,0.91), respectively. Conclusion The combination of imaging and clinical information improves outcome predictions.

Background: Recent studies have demonstrated a complex interplay between comorbid cardiovascular disease, COVID-19 pathophysiology, and poor clinical outcomes. Coronary artery calcification (CAC) may therefore aid in risk stratification of COVID-19 patients. Methods: Non-contrast chest CT studies on 180 COVID-19 patients ≥ age 21 admitted from March 1, 2020 to April 27, 2020 were retrospectively reviewed by two radiologists to determine CAC scores. Following feature selection, multivariable logistic regression was utilized to evaluate the relationship between CAC scores and patient outcomes. Results: The presence of any identified CAC was associated with intubation (AOR: 3.6, CI: 1.4-9.6) and mortality (AOR: 3.2, CI: 1.4-7.9). Severe CAC was independently associated with intubation (AOR: 4.0, CI: 1.3-13) and mortality (AOR: 5.1, CI: 1.9-15). A greater CAC score (UOR: 1.2, CI: 1.02-1.3) and number of vessels with calcium (UOR: 1.3, CI: 1.02-1.6) was associated with mortality. Visualized coronary stent or coronary artery bypass graft surgery (CABG) had no statistically significant association with intubation (AOR: 1.9, CI: 0.4-7.7) or death (AOR: 3.4, CI: 1.0-12). Conclusion: COVID-19 patients with any CAC were more likely to require intubation and die than those without CAC. Increasing CAC and number of affected arteries was associated with mortality. Severe CAC was associated with higher intubation risk. Prior CABG or stenting had no association with elevated intubation or death.

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Post-acute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are debilitating, clinically heterogeneous and of unknown molecular etiology. A transcriptome-wide investigation was performed in 165 acutely infected hospitalized individuals who were followed clinically into the post-acute period. Distinct gene expression signatures of post-acute sequelae were already present in whole blood during acute infection, with innate and adaptive immune cells implicated in different symptoms. Two clusters of sequelae exhibited divergent plasma-cell-associated gene expression patterns. In one cluster, sequelae associated with higher expression of immunoglobulin-related genes in an anti-spike antibody titer-dependent manner. In the other, sequelae associated independently of these titers with lower expression of immunoglobulin-related genes, indicating lower non-specific antibody production in individuals with these sequelae. This relationship between lower total immunoglobulins and sequelae was validated in an external cohort. Altogether, multiple etiologies of post-acute sequelae were already detectable during SARS-CoV-2 infection, directly linking these sequelae with the acute host response to the virus and providing early insights into their development.

Materials and Methods: A single-center retrospective review included 29 patients undergoing 41 LRTs-transarterial chemoembolization or yttrium-90 transarterial radioembolization-60 days before or concurrently with nivolumab. Demographic, clinical, and laboratory values and adverse events were reviewed before and after nivolumab initiation and after each LRT. Treatment response and time to progression were assessed using Modified Response Evaluation Criteria in Solid Tumors. Clinical events, including nivolumab termination, death, and time of last follow-up, were assessed.Results: Over a median nivolumab course of 8.1 months (range, 1.0-30) with a median of 14.2 2-week cycles (range, 1-53), predominantly Child-Pugh A (22/29) patients-12 Barcelona Clinic Liver Cancer (BCLC) B and 17 BCLC C-underwent 20 transarterial chemoembolization and 21 transarterial radioembolization LRTs at a median of 67 days (range, 48-609) after nivolumab initiation. Ten patients underwent multiple LRTs. During a median follow-up of 11.5 months (range, 1.8-35.1), no grade III/IV adverse events attributable to nivolumab were observed. There were five instances of grade III/IV hypoalbuminemia or hyperbilirubinemia within 3 months after LRT. There were no nivolumab-related deaths, and 30-day mortality after LRT was 0%.