Chest CT Scan Features to Predict COVID-19 Patients’ Outcome and Survival

Abstract

Background. Providing efficient care for infectious coronavirus disease 2019 (COVID-19) patients requires an accurate and accessible tool to medically optimize medical resource allocation to high-risk patients. Purpose. To assess the predictive value of on-admission chest CT characteristics to estimate COVID-19 patients’ outcome and survival time. Materials and Methods. Using a case-control design, we included all laboratory-confirmed COVID-19 patients who were deceased, from June to September 2020, in a tertiary-referral-collegiate hospital and had on-admission chest CT as the case group. The patients who did not die and were equivalent in terms of demographics and other clinical features to cases were considered as the control (survivors) group. The equivalency evaluation was performed by a fellowship-trained radiologist and an expert radiologist. Pulmonary involvement (PI) was scored (0–25) using a semiquantitative scoring tool. The PI density index was calculated by dividing the total PI score by the number of involved lung lobes. All imaging parameters were compared between case and control group members. Survival time was recorded for the case group. All demographic, clinical, and imaging variables were included in the survival analyses. Results. After evaluating 384 cases, a total of 186 patients (93 in each group) were admitted to the studied setting, consisting of 126 (67.7%) male patients with a mean age of 60.4 ± 13.6 years. The PI score and PI density index in the case vs. the control group were on average 8.9 ± 4.5 vs. 10.7 ± 4.4 ( p value: 0.001) and 2.0 ± 0.7 vs. 2.6 ± 0.8 ( p value: 0.01), respectively. Axial distribution (p value: 0.01), cardiomegaly ( p value: 0.005), pleural effusion (p value: 0.001), and pericardial effusion ( p value: 0.04) were mostly observed in deceased patients. Our survival analyses demonstrated that PI score ≥ 10 ( p value: 0.02) and PI density index ≥ 2.2 ( p value: 0.03) were significantly associated with a lower survival rate. Conclusion. On-admission chest CT features, particularly PI score and PI density index, are potential great tools to predict the patient’s clinical outcome.

Association of chest computed tomography severity score at ICU admission and respiratory outcomes in critically ill COVID-19 patients

“…The evaluation of tomographic patterns in COVID-19 was also essential to predict clinical outcomes to optimizing the allocation of resources during the pandemic, a metanalysis have shown that its application in this context, using diverse methods of semi-quantitative evaluation, leads to good values of sensitivity and specificity with correlation with disease severity and mortality in COVID-19 patients [ 30 ]. However, most of this score’s systems were not validated and were not further study in a large cohort or in critically ill patients, mostly studies were involving patients on the ward [ 11 , 12 , 18 , 31 ].…”

“…Some points may explain the divergent results. First, there was no standardization of the scores used in the studies [ 11 , 12 , 31 , 34 ], generating high variance in the definitions of severity in Chest-CT. Second, the studies have mostly evaluated patients outside intensive care [ 11 , 12 , 31 , 34 ], which makes comparison with the collective of critically ill patients difficult. Moreover, the collective of critically ill patients in our study is represented by patients with severe disease representing a higher chance of death from the disease compared to patients with mild or moderate disease, which represents more than 80% of the patients in the ward [ 35 ].…”

Risk of flare or relapse in patients with immune-mediated diseases following SARS-CoV-2 vaccination: a systematic review and meta-analysis

“…Besides, the risk of flares after COVID-19 and vaccination in patients with MS was 12.8% and 7.7%, respectively, confirming the lower risk of flare after vaccination compared to COVID-19. Of note, COVID-19-related morbidity and mortality are significantly higher in unvaccinated AI-IMD patients [ 95 , 96 ]. Putting all together, vaccination against SARS-CoV-2 in AI-IMD patients not only minimizes post-COVID-19 morbidity and mortality but also has a lower risk of flare compared to infection.…”

Value of CT in COVID-19-pandemia: A systematic analysis of CT-findings and outcomes in patients with COVID-19 pneumonia

“…In line with our data, previous studies have demonstrated the overall prognostic value of Chest-CT depending on pulmonary involvement. [ 16 ] In addition, our study included the first prognostic assessment using the RSNA-template.…”