Background This study aims to review chest computed tomography (CT) scanning parameters which are utilized to evaluate patients for COVID-19-induced pneumonia. Also, some of radiation dose reduction techniques in CT would be mentioned, because using these techniques or low-dose protocol can decrease the radiation burden on the population. Main body Chest CT scan can play a key diagnostic role in COVID-19 patients. Additionally, it can be useful to monitor imaging changes during treatment. However, CT scan overuse during the COVID-19 pandemic raises concerns about radiation-induced adverse effects, both in patients and healthcare workers. Conclusion By evaluating the CT scanning parameters used in several studies, one can find the necessity for optimizing these parameters. It has been found that chest CT scan taken using low-dose CT protocol is a reliable diagnostic tool to detect COVID-19 pneumonia in daily practice. Moreover, the low-dose chest CT protocol results in a remarkable reduction (up to 89%) in the radiation dose compared to the standard-dose protocol, not lowering diagnostic accuracy of COVID-19-induced pneumonia in CT images. Therefore, its employment in the era of the COVID-19 pandemic is highly recommended.
Objective: With every new strain of the SARS-CoV-2 spreading on a fast pace across the borders, an easy-to-calculate and reliable scoring system seems invaluable to identify high-risk patients. This study aims to investigate the relationship between CT severity score (CTSS) and CURB-65 score with mortality in COVID-19 patients. Methods: This study was conducted on RT-PCR confirmed COVID-19 patients admitted to a tertiary teaching center during fifth national wave of disease in one of the early disease epicenters in the country. All enrolled patients underwent chest CT scan within first day of admission. CTSS and CURB-65 scores were calculated and assigned to patients, while radiologist was blinded to clinical and laboratory findings, and they were evaluated for their correlation with in-hospital mortality, additively and separately. Results: Total number of 216 patients (140 males) with a mean age of 56.02 ± 17.34 years (ranging from 4 to 95) were enrolled. We found no significant relationship between CURB-65 score and CTSS (correlation coefficient: 0.065; P: 0.338). CURB-65 scores above 1 was predictive of in-hospital mortality with sensitivity of 56.4% and specificity of 81.9% (P: 0), those for CTSS above 11 were 79.5% and 4 51.5%, respectively (P: 0.001). CURB-65 score >1 and CTSS >11 predicted in-hospital mortality with sensitivity and specificity of 61.5% and 79.7% (P: 0.000). CURB-65 score and CTSS had a higher sensitivity and specificity to predict mortality comparing to each of those separately, but these enhanced statistics were not significant. Conclusion: CURB-65 score is meaningfully stronger than CTSS to prognosticate in-hospital mortality in patients with COVID-19, and it is not significantly correlated with CTSS.
Objectives: The aim of this study was to identify the clinical and laboratory features and CT scan (CT intensity score and pleural effusion) associated with COVID-19 pneumonia to evaluate the relationship between CT scan findings and mortality by comparing deceased patients with normal patients. Methods: In this retrospective case-control study, 290 ICU admitted patients with RT-PCR confirmed COVID-19 pneumonia were investigated. Totally, 150 deceased patients (with confirmed COVID-19 related death) were extracted from the COVID-19 registry of the affiliated university hospital belonging to mentioned period of time (in-hospital mortality subgroup, case), and 150 patients who survived the admission course were randomly selected from the same data set (surviving subgroup, control). Available electronic records for each patient were enlisted, including laboratory and clinical information, and their on-admission computed tomography (CT) images were reviewed. Mortality-related risk factors were compared between case and control subgroups. Results: The mean age of deceased patients (68.20±16.07) was significantly higher than that of the surviving patients (54.72± 19.50) (p <0.001). Diabetes, hypertension, and chronic kidney disease (CKD) were significantly related with higher mortality rates (62.2%, 58.7%, and 80.4% mortality in diabetic, hypertensive, and CKD patients versus 41.7%, 42.1%, and 35.9% in non-diabetics, normotensives, and patients without CKD). Additionally, the mean on-admission air-room SPO2 level in deceased patients (90%) was significantly lower than that of the survivors (93%) (p = 0.001). Lymphocyte count, neutrophil to lymphocyte ratio (NLR), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), lactate dehydrogenase (LDH), fasting blood sugar (BS), blood urea nitrogen (BUN), and Creatinine (Cr), mean CT severity score (CT-ss), and O2 supportive therapy requirement were significantly higher in the mortality subgroup (p <0.05). Pleural effusion showed no significant correlation with short-term mortality. CT-ss of >11, in isolation or in combination with above-mentioned prognosticators, was 64% or 81.4% sensitive, and 60% or of 78.6% specific, to predict mortality. Conclusions: Factors such as advanced age, underlying diseases such as diabetes, hypertension, and CKD, decreased air-room SPO2, and increased lymphocyte count, higher NLR, ESR, CRP, LDH, BS, BUN, and Cr level, as well as higher CT-ss and O2 supportive therapy, are all significantly correlated with higher mortality in ICU-admitted COVID-19 patients.
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