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

Abstract

To investigate the relationship between lung lesion burden (LLB) found on chest computed tomography (CT) and 30-day mortality in hospitalized patients with high clinical suspicion of coronavirus disease 2019 (COVID-19), accounting for tomographic dynamic changes. METHODS: Patients hospitalized with high clinical suspicion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a dedicated and reference hospital for COVID-19, having undergone at least one RT-PCR test, regardless of the result, and with one CT compatible with COVID-19, were retrospectively studied. Clinical and laboratory data upon admission were assessed, and LLB found on CT was semi-quantitatively evaluated through visual analysis. The primary outcome was 30-day mortality after admission. Secondary outcomes, including the intensive care unit (ICU) admission, mechanical ventilation used, and length of stay (LOS), were assessed. RESULTS: A total of 457 patients with a mean age of 57±15 years were included. Among these, 58% presented with positive RT-PCR result for COVID-19. The median time from symptom onset to RT-PCR was 8 days [interquartile range 6-11 days]. An initial LLB of X50% using CT was found in 201 patients (44%), which was associated with an increased crude at 30-day mortality (31% vs. 15% in patients with LLB of o50%, po0.001). An LLB of X50% was also associated with an increase in the ICU admission, the need for mechanical ventilation, and a prolonged LOS after adjusting for baseline covariates and accounting for the CT findings as a time-varying covariate; hence, patients with an LLB of X50% remained at a higher risk at 30-day mortality (adjusted hazard ratio 2.17, 95% confidence interval 1.47-3.18, po0.001). CONCLUSION: Even after accounting for dynamic CT changes in patients with both clinical and imaging findings consistent with COVID-19, an LLB of X50% might be associated with a higher risk of mortality.

Pulmonary Embolism and COVID-19: A Diagnostic Dilemma – A German Single Centre Experience

“…We choose to distribute the patients in four categories depending on the estimated percentage of the affected lung volume (Table 9). Our cut-off value to define severe infect was 50%, as advocated by Ran, et al and Fonseca,et al [16,17]. However, without the help of AI remains our estimation unprecise.…”

“…Many scores were described in the literature to assess the severity of the infect burden in the CT-Scan, with different cut-off values [16][17][18][19].…”

Autópsia minimamente invasiva na COVID-19: análise dos achados da tomografia computadorizada post mortem do tórax e da histopatologia dos pulmões

“…Por fim, a Sociedade Norte-Americana de Radiologia, o Colégio Americano de Radiologia e a Sociedade de Radiologia da América do Norte elegeram a TC de Tórax como o método de escolha para avaliação do envolvimento pulmonar na COVID-19, podendo estimar seguramente a porcentagem de acometimento pulmonar (28). Esta última informação, por sua vez, foi bastante correlacionada com o prognóstico da doença e utilizada até como critério de internação (29).…”