Chest Computed Tomography Scoring in Patients With Novel Coronavirus-infected Pneumonia: Correlation With Clinical and Laboratory Features and Disease Outcome

Abstract

Background/Aim: This study investigated the correlation of chest computed tomography (CT), findings, graded using two different scoring methods, with clinical and laboratory features and disease outcome, including a novel clinical predictive score, in patients with novel coronavirusinfected pneumonia (NCIP). Patients and Methods: In this retrospective, observational study, CT scan of 92 NCIP patients admitted to Policlinico Tor Vergata, were analyzed using a quantitative, computed-based and a semiquantitative, radiologist-assessed scoring system. Correlations of the two radiological scores with clinical and laboratory features, the CALL score, and their association with a composite adverse outcome were assessed. Results: The two scores correlated significantly with each other (ρ=0.637, p<0.0001) and were independently associated with age, LDH, estimated glomerular filtration rate, diabetes, and with the composite outcome, which occurred in 24 patients. Conclusion: In NCIP patients, two different radiological scores correlated with each other and with several clinical, laboratory features, and the CALL score. The quantitative score was a better independent predictor of the composite adverse outcome than the semiquantitative score.A novel coronavirus termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified as the cause of the pneumonia outbreak that started in the city of Wuhan, the capital of the Hubei province in China, in December 2019 (1), and rapidly spread throughout China and to many other countries all over the world, including Italy (2). On March 11, 2020, the World Health Organization declared the disease, called COronaVirus Disease 19 , as a pandemic (3).COVID-19 is a multiorgan, potentially lethal disease, whose main manifestation is an interstitial pneumonia, called novel coronavirus-infected pneumonia (NCIP) (4), which can be diagnosed by chest X-rays and particularly computed tomography (CT) (5). It has been suggested that chest CT could be used as a primary tool for the screening and diagnosis of COVID-19. A meta-analysis of 68 studies showed that pooled sensitivity and specificity of chest CT were 94% and 37%, respectively, whereas sensitivity of RT-PCR was 89%; however, in low prevalence countries, the positive predictive value of CT was ten times lower than that of RT-PCR, which remains the gold standard (6). Nevertheless, positive CT scans were observed prior to (or concurrently with) the initial positivity of RT-PCR from swab samples in 60% to 93% of 1,014 Chinese patients ( 7)This article is freely accessible online.

Metabolic characteristics in patients with COVID-19 and no-COVID-19 interstitial pneumonia with mild-to-moderate symptoms and similar radiological severity

“…Notably, they were also blinded to COVID-19 tests results. Scans were scored on the axial images according to literature [20,21]. Each of the six zones was scored separately on two scales: a three-point scale for the presence of CT features (1 for normal attenuation, 2 for ground-glass opacity, and 3 for consolidation) and a four-point scale for the extent of the parenchymal distribution of ground-glass opacities or consolidation (0 for none, 1 for <25%, 2 for 25e50%, 3 for 50e75%, and 4 for >75%).…”