The role of a chest computed tomography severity score in coronavirus disease 2019 pneumonia

Abstract

The chest computed tomography (CT) characteristics of coronavirus disease 2019 (COVID-19) are important for diagnostic and prognostic purposes. The aim of this study was to investigate chest CT findings in COVID-19 patients in order to determine the optimal cut-off value of a CT severity score that can be considered a potential prognostic indicator of a severe/critical outcome. The CT findings were evaluated by means of a severity score that included the extent (0–4 grading scale) and nature (0–4 grading scale) of CT abnormalities. The images were evaluated at 3 levels bilaterally. A receiver operating characteristics (ROC) curve was used to identify the optimal score (Youden's index) predicting severe/critical COVID-19. The study involved 165 COVID-19 patients (131 men [79.4%] and 34 women [20.6%] with a mean age of 61.5 ± 12.5 years), of whom 30 (18.2%) had severe/critical disease and 135 (81.8%) mild/typical disease. The most frequent CT finding was bilateral predominantly subpleural and basilar airspace changes, with more extensive ground-glass opacities than consolidation. CT findings of consolidation, a crazy-paving pattern, linear opacities, air bronchogram, and extrapulmonary lesions correlated with severe/critical COVID-19. The mean CT severity score was 63.95 in the severe/critical group, and 35.62 in the mild/typical group ( P < .001). ROC curve analysis showed that a CT severity score of 38 predicted the development of severe/critical symptoms. A CT severity score can help the risk stratification of COVID-19 patients.

Analysis of endogenous oxidative damage markers and association with pulmonary involvement severity in patients with SARS-CoV-2 pneumonia

“…All patients underwent chest tomography evaluated with thin-sliced, high-resolution computed tomography. Severe and non-severe pulmonary involvement was evaluated with a prevalence score described by Fausto et al [16] . Findings included ground-glass opacities, consolidation and nodular opacities in all lobes and segments of the lungs.…”

Imaging in the COVID-19 era: Lessons learned during a pandemic

“…Indications: Chest CT is a valuable imaging modality that can provide an accurate assessment of the severity and extent of disease, detect complications, evaluate treatment efficacy and rule out alternative diagnoses[ 34 ].…”

“…A final score is created by summing the scores for each individual segment. Higher CT severity scores are seen in patients with critical disease compared to those with milder disease[ 34 ] and have been associated with worse long-term outcomes[ 55 ]. No association has been found between the extent of CT findings and infectivity[ 56 ].…”

Predicting Severe/Critical Outcomes in Patients With SARS-CoV2 Pneumonia: Development of the prediCtion seveRe/crItical ouTcome in COVID-19 (CRITIC) Model

“…The present study is an extension of the data collected in a previous study aimed at realizing a prognostic lung CT score for worse outcomes in COVID-19 pneumonia (18). In that study, between February 20th, 2020 and April 15th, 2020, data concerning a cohort of patients diagnosed as having COVID-19 pneumonia were retrospectively collected from four hospitals in the Italian regions of Marche, Lombardy and Emilia-Romagna.…”