Prognostic impact of CT severity score in childhood cancer with SARS-CoV-2

Abstract

Background CT chest severity score (CTSS) is a semi-quantitative measure done to correlate the severity of the pulmonary involvement on the CT with the severity of the disease. The objectives of this study are to describe chest CT criteria and CTSS of the COVID-19 infection in pediatric oncology patients, to find a cut-off value of CTSS that can differentiate mild COVID-19 cases that can be managed at home and moderate to severe cases that need hospital care. A retrospective cohort study was conducted on 64 pediatric oncology patients with confirmed COVID-19 infection between 1 April and 30 November 2020. They were classified clinically into mild, moderate, and severe groups. CT findings were evaluated for lung involvement and CTSS was calculated and range from 0 (clear lung) to 20 (all lung lobes were affected). Results Overall, 89% of patients had hematological malignancies and 92% were under active oncology treatment. The main CT findings were ground-glass opacity (70%) and consolidation patches (62.5%). In total, 85% of patients had bilateral lung involvement, ROC curve showed that the area under the curve of CTSS for diagnosing severe type was 0.842 (95% CI 0.737–0.948). The CTSS cut-off of 6.5 had 90.9% sensitivity and 69% specificity, with 41.7% positive predictive value (PPV) and 96.9% negative predictive value (NPV). According to the Kaplan–Meier analysis, mortality risk was higher in patients with CT score > 7 than in those with CTSS < 7. Conclusion Pediatric oncology patients, especially those with hematological malignancies, are more vulnerable to COVID-19 infection. Chest CT severity score > 6.5 (about 35% lung involvement) can be used as a predictor of the need for hospitalization.

Chest CT features of coronavirus disease 2019 (COVID-19) in pediatric patients and its correlation with the clinical condition

“…CT severity score is a semiquantitative measure used to assess the degree of lung involvement; it was significantly higher in severe patients. A severity score cutoff value of 4 (25%) lung involvement is used by CT-SS to identify severe cases; however, Romeih et al [ 20 ] stated that the cutoff point for severe cases was 6.5 (32%) but our CT-SS cutoff point has a higher sensitivity and specificity 100% compared to 90.9% and 78.12% compared to 69%, respectively.…”

Prognostic and discriminatory abilities of imaging scoring systems in predicting COVID‐19 adverse outcomes

“…We also used random model in the analysis of odds, and this widens the confidence interval and take the possibility of heterogeneity in its assumption. Nevertheless, CT has some downsides which are not encountered with lung ultrasound such as exposure to radiation, lack of assessment of hemodynamics, machine logistics and the presence of an expert reader, and moving the patients to the radiological setting for image acquisition, with a consequent increased risk of infection [64][65][66][67][68].…”

“…Nevertheless, CT has some downsides which are not encountered with lung ultrasound such as exposure to radiation, lack of assessment of hemodynamics, machine logistics and the presence of an expert reader, and moving the patients to the radiological setting for image acquisition, with a consequent increased risk of infection [64–68].…”

Covid-19 in pediatric hematology-oncology and stem cell transplant patients –The spectrum of illness, complications and comparison of first two waves

“…CT severity score is used as a semiquantitative imaging tool and studies show the cut-off of 6.5/20 (with about 32.5% lung involvement) had 90.9% sensitivity and 69% specificity for identification of severe cases [ 23 ]. The most widely used method is based on scoring of percentage of involvement of each lobe and total score of 0–25 [ 24 ]. The CT findings of COVID-19 ranged from consolidation patches with air bronchogram, pulmonary nodules and atelectatic fibrous bands to extrapulmonary findings in the form of pleural effusion and pericardial effusion.…”