Early prediction of disease progression in COVID-19 pneumonia patients with chest CT and clinical characteristics

Abstract

The outbreak of coronavirus disease 2019 (COVID-19) has rapidly spread to become a worldwide emergency. Early identification of patients at risk of progression may facilitate more individually aligned treatment plans and optimized utilization of medical resource. Here we conducted a multicenter retrospective study involving patients with moderate COVID-19 pneumonia to investigate the utility of chest computed tomography (CT) and clinical characteristics to risk-stratify the patients. Our results show that CT severity score is associated with inflammatory levels and that older age, higher neutrophil-to-lymphocyte ratio (NLR), and CT severity score on admission are independent risk factors for short-term progression. The nomogram based on these risk factors shows good calibration and discrimination in the derivation and validation cohorts. These findings have implications for predicting the progression risk of COVID-19 pneumonia patients at the time of admission. CT examination may help risk-stratification and guide the timing of admission.

Inter-reader agreement of high-resolution computed tomography findings in patients with COVID-19 pneumonia: A multi-reader study

“…First, this is a monocentric work, suggesting that our findings should be validated by multi-institutional trials. However, our results are overall in line with previous works performed both in Western [ 12 ] and in Eastern [ 10 , 11 ] scenarios of the pandemic, suggesting they are reasonably generalizable. Second, we limited our models to imaging findings, excluding patients’ comorbidities and other clinical factors.…”

“…When considering experienced readers only, severe disease was independently predicted also by OP pattern (in the case of R1), and consolidation > 2 (in the case of R2), in accordance with higher pairwise agreement on those two features ( k = 0.59 and 0.64, respectively). Our findings are in line with previous studies showing substantial-to-almost perfect inter-reader agreement for most CT features [ 14 , 16 ], and the capability of semi-quantitative or quantitative evaluation of lung involvement [ 10 , 12 ] to predict disease worsening. Overall, our results provide reliable potential markers for disease progression.…”

“…Another target of research is as to whether HRCT can predict unfavorable clinical outcome, which has been variably defined as progression to severe disease, Intensive Care Unit (ICU) admission, or death [ 10 – 13 ]. Previous Authors [ 10 – 13 ] found that qualitative and semi-quantitative indexes expressing the amount of lung involvement are associated to disease worsening.…”

The Efficacy and Safety of Hydroxychloroquine in Patients with COVID-19: A Multicenter National Retrospective Cohort

“…Analysis of the demographics of our studied sample showed that patients who received HCQ were significantly of older age, which could be associated with a more severe HCQ-requiring presentation. Although this is an extrapolation from our data, age has reportedly been associated with a more severe progression of the disease [ 25 – 28 ]. However, a recent study quantifying the isolated effect of age on severity of COVID-19 outcomes concluded a minimal influence of age after adjusting for important age-dependent risk factors (e.g., diabetes, hypertension, cardiovascular disease (CVD) etc.)…”

Serological Surveillance of COVID-19 Hospitalized Patients in Réunion Island (France) Revealed that Specific Immunoglobulin G Are Rapidly Vanishing in Severe Cases

“…Non-severe cases display symptoms such as fever, dry cough, and fatigue, but have a good prognosis. By contrast, up to 10-15% of hospitalized patients progress to a severe form of the disease and may develop pneumonia, acute respiratory distress syndrome, and multiple organ failure, requiring long stays in intensive care units (ICU) [1][2][3].…”