Visual lung damage CT score at hospital admission of COVID-19 patients and 30-day mortality

COVID-19 환자의 입원 시 시각적 폐 손상 CT 점수 및 30일 사망률

Published on
Journal: European Radiology
[키워드]
[저자] Etienne Charpentier, Gilles Soulat, Antoine Fayol, Anne Hernigou, Marine Livrozet, Teodor Grand, Guillaume Reverdito, Jad Al Haddad, Kim Diep Dang Tran, Anne Charpentier, Olivier Clement, Jean-Sebastien Hulot, Elie Mousseaux
[Category] SARS, 치료기술,
PMC URL    [DOI] 10.1007/s00330-021-07938-2    
[Article Type] Article
[Source] PMC

Abstract
Objectives: Chest CT has been widely used to screen and to evaluate the severity of COVID-19 disease in the early stages of infection without severe acute respiratory syndrome, but no prospective data are available to study the relationship between extent of lung damage and short-term mortality. The objective was to evaluate association between standardized simple visual lung damage CT score (vldCTs) at admission, which does not require any software, and 30-day mortality.
Methods: In a single-center prospective cohort of COVID-19 patients included during 4 weeks, the presence and extent of ground glass opacities(GGO), consolidation opacities, or both of them were visually assessed in each of the 5 lung lobes (score from 0 to 4 per lobe depending on the percentage and out of 20 per patient = vldCTs) after the first chest CT performed to detect COVID-19 pneumonia.
Results: Among 210 confirmed COVID-19 patients, the number of survivors and non-survivors was 162 (77%) and 48 (23%), respectively at 30 days. vldCTs was significantly higher in non-survivors, and the AUC of vldCTs to distinguish survivors and non-survivors was 0.72 (95%CI 0.628-0.807, p < 0.001); the best cut-off vldCTs value was 7. During follow-up, significant differences in discharges and 30-day mortality were observed between patients with vldCTs ≥ 7 versus vldCTs < 7: (98 [85.2%] vs 49 [51.6%]; p < 0.001 and 36 [37.9%] vs 12 [12.4%]; p < 0.001, respectively. The 30-day mortality increased if vldCTs ≥ 7 (HR, 3.16 (1.50-6.43); p = 0.001), independent of age, respiratory rate and oxygen saturation levels, and comorbidities at admission.
Conclusions: By using chest CT in COVID-19 patients, extensive lung damage can be visually assessed with a score related to 30-day mortality independent of conventional risk factors of the disease.
Key points: • In non-selected COVID-19 patients included prospectively during 4 weeks, the extent of ground glass opacities(GGO) and consolidation opacities evaluated by a simple visual score was related to 30-day mortality independent of age, respiratory rate, oxygen saturation levels, comorbidities, and hs-troponin I level at admission. • This severity score should be incorporated into risk stratification algorithms and in structured chest CT reports requiring a standardized reading by radiologists in case of COVID-19.
Keywords: COVID-19; Pneumonia; Severe acute respiratory syndrome; Tomography, x-ray computed.

All Keywords
【저자키워드】 COVID-19, Pneumonia, Severe acute respiratory syndrome, Tomography, X-Ray Computed, 【초록키워드】 COVID-19 pneumonia, Mortality, severity, Infection, Comorbidities, Comorbidity, tomography, oxygen, risk factor, discharge, COVID-19 disease, risk stratification, X-ray, Severe acute respiratory syndrome, oxygen saturation, Chest CT, severity of COVID-19, ground glass opacities, Algorithm, Patient, age, ground glass, Follow-up, troponin I, prospective cohort, disease, Admission, consolidation, early stage, COVID-19 patients, association, 30-Day mortality, COVID-19 patient, AUC, respiratory rate, lung damage, independent of, Radiologists, Non-survivors, acute respiratory syndrome, significant difference, 95%CI, significant differences, lobe, early stages, single-center, cut-off, radiologist, survivor, independent, non-survivor, extensive lung damage, performed, detect, evaluate, the disease, evaluated, significantly higher, lung lobe, was related, 【제목키워드】 Hospital admission, COVID-19 patient, Visual,
{{{ 추상적인 }}} {{ 목적: }} 흉부 CT는 중증 급성 호흡기 증후군이 없는 감염 초기 단계에서 COVID-19 질병을 선별하고 중증도를 평가하는 데 널리 사용되었지만 폐의 정도 사이의 관계를 연구하기 위한 전향적 데이터는 없습니다. 손상 및 단기 사망. 목적은 소프트웨어가 필요하지 않은 입원 시 표준화된 단순 시각 폐 손상 CT 점수(vldCT)와 30일 사망률 간의 연관성을 평가하는 것이었습니다. {{ 방법: }} 4주 동안 포함된 COVID-19 환자의 단일 센터 전향적 코호트에서 그라운드 유리 불투명도(GGO), 강화 불투명도 또는 둘 모두의 존재 및 정도를 5가지 각각에서 시각적으로 평가했습니다. COVID-19 폐렴을 감지하기 위해 수행된 첫 번째 흉부 CT 후 폐 엽(백분율에 따라 엽당 0에서 4까지의 점수 및 환자당 20점 만점 = vldCT). {{ 결과: }} 코로나19 확진자 210명 중 30일 기준 생존자와 비생존자는 각각 162명(77%), 48명(23%)이었다. vldCTs는 비생존자에서 유의하게 더 높았고, 생존자와 비생존자를 구별하기 위한 vldCT의 AUC는 0.72(95%CI 0.628-0.807, p < 0.001); 최고의 컷오프 vldCT 값은 7이었습니다. 추적 기간 동안 vldCTs ≥ 7 대 vldCTs < 7인 환자 간에 퇴원 및 30일 사망률에서 유의한 차이가 관찰되었습니다. (98 [85.2%] 대 49 [51.6%]; p < 0.001 및 36 [37.9%] 대 12 [12.4%], p < 0.001 각각 vldCT가 7 이상인 경우 30일 사망률이 증가했습니다(위험률, 3.16(1.50-6.43), p = 0.001), 연령과 무관 , 호흡수와 산소포화도, 입원 시 동반질환. {{ 결론: }} COVID-19 환자에서 흉부 CT를 사용하여 광범위한 폐 손상을 질병의 기존 위험 요소와 무관하게 30일 사망률과 관련된 점수로 시각적으로 평가할 수 있습니다. {{ 요점: }} • 4주 동안 전향적으로 포함된 선택되지 않은 COVID-19 환자에서 단순 시각적 점수로 평가된 GGO(ground glass opacities) 및 통합 불투명도의 정도는 연령과 무관한 30일 사망률과 관련이 있었습니다. , 호흡수, 산소포화도, 동반질환, 입원 시 hs-troponin I 수치. • 이 심각도 점수는 위험 계층화 알고리즘과 COVID-19의 경우 방사선 전문의가 표준화된 판독을 요구하는 구조화된 흉부 CT 보고서에 통합되어야 합니다. {{ 키워드: }} 코로나19; 폐렴; 중증 급성 호흡기 증후군; 단층 촬영, 엑스레이 계산.