The value of computed tomography in assessing the risk of death in COVID-19 patients presenting to the emergency room

Abstract

Objective The aims of this study were to develop a multiparametric prognostic model for death in COVID-19 patients and to assess the incremental value of CT disease extension over clinical parameters. Methods Consecutive patients who presented to all five of the emergency rooms of the Reggio Emilia province between February 27 and March 23, 2020, for suspected COVID-19, underwent chest CT, and had a positive swab within 10 days were included in this retrospective study. Age, sex, comorbidities, days from symptom onset, and laboratory data were retrieved from institutional information systems. CT disease extension was visually graded as < 20%, 20–39%, 40–59%, or ≥ 60%. The association between clinical and CT variables with death was estimated with univariable and multivariable Cox proportional hazards models; model performance was assessed using k -fold cross-validation for the area under the ROC curve (cvAUC). Results Of the 866 included patients (median age 59.8, women 39.2%), 93 (10.74%) died. Clinical variables significantly associated with death in multivariable model were age, male sex, HDL cholesterol, dementia, heart failure, vascular diseases, time from symptom onset, neutrophils, LDH, and oxygen saturation level. CT disease extension was also independently associated with death (HR = 7.56, 95% CI = 3.49; 16.38 for ≥ 60% extension). cvAUCs were 0.927 (bootstrap bias-corrected 95% CI = 0.899–0.947) for the clinical model and 0.936 (bootstrap bias-corrected 95% CI = 0.912–0.953) when adding CT extension. Conclusions A prognostic model based on clinical variables is highly accurate in predicting death in COVID-19 patients. Adding CT disease extension to the model scarcely improves its accuracy. Key Points • Early identification of COVID-19 patients at higher risk of disease progression and death is crucial; the role of CT scan in defining prognosis is unclear. • A clinical model based on age, sex, comorbidities, days from symptom onset, and laboratory results was highly accurate in predicting death in COVID-19 patients presenting to the emergency room. • Disease extension assessed with CT was independently associated with death when added to the model but did not produce a valuable increase in accuracy. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-07993-9.

Prognostic Role of the Pectoralis Musculature in Patients with COVID-19. A Multicenter Study

“…Computed tomography (CT) is the imaging modality of choice in COVID-19, especially for detection of pulmonary consolidations ( 5 , 6 , 7 ). Typical imaging findings in COVID-19 are bilateral, peripheral dominant ground-glass opacities with lower lobe and posterior predilection ( 5 , 6 , 7 ).…”

Lung Lesion Burden found on Chest CT as a Prognostic Marker in Hospitalized Patients with High Clinical Suspicion of COVID-19 Pneumonia: a Brazilian experience

“…Of note, a CT lung score of 15/24, which roughly translates a lung lesion burden (LLB) of 60% ( 8), was associated with a higher mortality rate, a rationale for a similar approach in COVID-19. It is intuitive to imagine the reversed linear correlation between lung lesion burden and the prognosis of COVID-19, there are some data supporting this correlation (10)(11)(12)(13)(14)(15); however, the available data regarding the dynamic changes of the CT during the disease's natural course are still limited in the current study (16).…”

“…Many investigators have shown the potential association between initial CT findings, primarily the extent of pulmonary involvement, and adverse outcomes in patients with COVID-19 pneumonia (10,11,13,15,(25)(26)(27)(28)(29). Clinical endpoints and magnitude of the association with CT findings varied greatly between these studies, as did the extent of involvement used as the cut-off point.…”

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“…Data of the included patients were partially used in previous studies to assess CT diagnostic accuracy and added prognostic value [ 8 , 16 ].…”

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