Correlations between chest-CT and laboratory parameters in SARS-CoV-2 pneumonia

Abstract

To investigate the relationship between damaged lung assessed by chest computed tomography (CT) scan and laboratory biochemical parameters with the aim of finding other diagnostic tools. Patients who underwent chest CT for suspected Corona Virus Disease-2019 (COVID-19) pneumonia at the emergency department admission in the first phase of COVID-19 epidemic in Italy were retrospectively analyzed. Patients with both negative chest CT and absence of the novel coronavirus in nasopharyngeal or oropharyngeal real-time reverse transcriptase polymerase chain reaction (RT-PCR) swabs were excluded from the study. A total of 462 patients with positive CT scans for interstitial pneumonia were included in the study (250 males and 212 females, mean age 57 ± 17 years, range 18–89). Of these, 344 were positive to RT-PCR test, 118 were negative to double RT-PCR tests. CTs were analyzed for quantification of affected lung volume visually and by dedicated software. Statistical analysis to evaluate the relationship between laboratory analyses and CT patterns and amount of damaged lung related with COVID-19 pneumonia was performed in 2 groups of patients: positive RT-PCR COVID-19 group and negative RT-PCR COVID-19 group, but both with positive CT scans for interstitial pneumonia. Lymphocytopenia, C-reactive protein (CRP), lactate dehydrogenase (LDH), d -dimer, and fibrinogen increased levels occurred in most patients without statistically significant differences between the 2 groups with CT scans suggestive for COVID-19. In fact, in both groups the volume of lung damage was strongly associated with altered laboratory test results, even for patients with negative RT-PCR test. The decreased number of lymphocytes, and the increased levels of CRP, LDH, d -dimer, and fibrinogen levels are associated with SARS-CoV 2 related pneumonia. This may be useful as an additional diagnostic tool in patients with double negative RT-PCR assay and with highly suspected clinic and chest CT features for COVID-19 to isolate patients in a pandemic period.

The relationship between CRP at admission and thorax CT findings in patients diagnosed with COVID‐19

“… 26 , 27 Lymphopenia, CRP, LDH, D‐dimer and fibrinogen elevation can be used as an auxiliary diagnostic tool in suspected patients with high clinical and thorax CT scanning features, despite a double negative RT‐PCR test. 28 In addition, systemic inflammation as measured by CRP is strongly associated with VTE, AKI, critical illness and mortality in COVID‐19. Evaluating the associations between CRP concentrations and respiratory failure requiring mechanical ventilation, patients with a recent CRP > 5 mg/dL had an approximately five‐fold greater reported risk for acute respiratory distress syndrome (ARDS).…”

“…In some studies, it has been shown that there are more frequent changes in some laboratory parameters in COVID‐19 patients (such as lymphocyte count, CRP, LDH, D‐dimer and fibrinogen) 26,27 . Lymphopenia, CRP, LDH, D‐dimer and fibrinogen elevation can be used as an auxiliary diagnostic tool in suspected patients with high clinical and thorax CT scanning features, despite a double negative RT‐PCR test 28 . In addition, systemic inflammation as measured by CRP is strongly associated with VTE, AKI, critical illness and mortality in COVID‐19.…”

Patient with false negative RT-PCR for COVID-19 referred to cancer hospital for lung cancer screening: A case report

“…This can be an added investigative tool in patients with highly suspicious double-tested and highly questionable clinics. Patients with SARS-COV-2 symptoms should be isolated [5]. Our case study showed COVID-19 features in the HRCT chest (ground-glass opacity (GGO) with crazy paving).…”

Predicting of poor outcomes in COVID-19 patients: Experience from an Argentinean hospital

“…Surprisingly, sex, comorbidities and urea did not show a better performance when 4C-score was excluded, which probably reflects a type-2 error, or the small effect of these variables, whose influence is presumably, additive. It highlights the additive value of LDH to 4C-score, in all likelihood as a reflection of the severity of pulmonary involvement [20][21][22][23][24]. This paper, on its own, cannot clarify whether the lack of predictive value of other variables, in particular, the lymphocyte count, depends on the multicollinearity with other variables, on its role only as a marker of underlying phenomena or on a lesser predictive role that requires a higher inclusion of patients to be detected.…”