Clinical and radiological imaging as prognostic predictors in COVID-19 patients

Abstract

Background Since the announcement of COVID-19 as a pandemic infection, several studies have been performed to discuss the clinical picture, laboratory finding, and imaging features of this disease. The aim of this study is to demarcate the imaging features of novel coronavirus infected pneumonia (NCIP) in different age groups and outline the relation between radiological aspect, including CT severity, and clinical aspect, including age, oxygen saturation, and fatal outcome. We implemented a prospective observational study enrolled 299 laboratory-confirmed COVID-19 patients (169 males and 130 females; age range = 2–91 years; mean age = 38.4 ± 17.2). All patients were submitted to chest CT with multi-planar reconstruction. The imaging features of NCIP in different age groups were described. The relations between CT severity and age, oxygen saturation, and fatal outcome were evaluated. Results The most predominant CT features were bilateral (75.4%), posterior (66.3%), pleural-based (93.5%), lower lobe involvement (89.8%), and ground-glass opacity (94.7%). ROC curve analysis revealed that the optimal cutoff age that was highly exposed to moderate and severe stages of NCIP was 38 years old (AUC = 0.77, p < 0.001). NCIP was noted in 42.6% below 40-year-old age group compared to 84% above 40-year-old age group. The CT severity was significantly related to age and fatal outcome (p < 0.001). Anterior, centrilobular, hilar, apical, and middle lobe involvements had a significant relation to below 90% oxygen saturation. A significant negative correlation was found between CT severity and oxygen saturation (r = − 0.49, p < 0.001). Crazy-paving pattern, anterior aspect, hilar, centrilobular involvement, and moderate and severe stages had a statistically significant relation to higher mortality. Conclusion The current study confirmed the value of CT as a prognostic predictor in NCIP through demonstration of the strong relation between CT severity and age, oxygen saturation, and the fatal outcome. In the era of COVID-19 pandemic, this study is considered to be an extension to other studies discussing chest CT features of COVID-19 in different age groups with demarcation of the relation of chest CT severity to different pattern and distribution of NCIP, age, oxygen saturation, and mortality rate.

SARS-CoV-2 Spike Protein Induces Hemagglutination: Implications for COVID-19 Morbidities and Therapeutics and for Vaccine Adverse Effects

“…This HA-reversal effect could account for sharp increases observed within 24 h after administration of IVM of pre-treatment depressed SpO2 levels in severe COVID-19 patients, as summarized in Figure 6 below, which reproduces a figure from the most recent of three clinical studies reporting this effect [ 64 ]. In contrast to the sharp, rapid increases in SpO2 levels observed in these studies, moderate and severe COVID-19 patients under standard care typically manifest decreasing SpO2 values in tandem with increasing pulmonary CT abnormalities from the day of onset of disease symptoms through the second week following, as established in several studies that tracked SpO2 values, pulmonary abnormalities, or both [ 65 , 66 , 67 , 68 , 69 , 70 , 71 ].…”

Changes in SpO2 on Room Air for 34 Severe COVID-19 Patients after Ivermectin-Based Combination Treatment: 62% Normalization within 24 Hours

“…These highly significant p-values are based on the well-grounded assumption of expected change in SpO2 values of ≤0 during this time period. Moderate and severe COVID-19 patients under standard care typically manifest decreasing SpO2 values in tandem with increasing pulmonary CT abnormalities from the day of onset of disease symptoms through the second week following, as established in several studies that tracked SpO2 values, pulmonary abnormalities, or both [31][32][33][34][35][36][37]. For example, Figure 5 shows SpO2 values recorded over three weeks for COVID-19 patients under standard care [31], with decreasing SpO2 values through Stage 3, 8-14 days after the onset of symptoms.…”

Sialylated Glycan Bindings from SARS-CoV-2 Spike Protein to Blood and Endothelial Cells Govern the Severe Morbidities of COVID-19

“…For cases of moderate and severe COVID-19 in patients on room air, there is a consistent baseline of null effect in a 1-2 week timeframe: the magnitude of reductions in SpO2 levels correlate with the extent of pulmonary damage, and neither of these normalize in that timeframe [311][312][313][314][315][316][317]. With that backdrop of null effect, as shown in Figure 5, three studies of severe COVID-19 patients on room air treated with IVM-based regimens observed sharp increases in SpO2 after 1 day of treatment [318][319][320][321] while SpO2 decreased during the same 1-day period in a fourth group of such patients under standard care.…”