Background Typical features differentiate COVID-19-associated lung injury from acute respiratory distress syndrome. The clinical role of chest computed tomography (CT) in describing the progression of COVID-19-associated lung injury remains to be clarified. We investigated in COVID-19 patients the regional distribution of lung injury and the influence of clinical and laboratory features on its progression. Methods This was a prospective study. For each CT, twenty images, evenly spaced along the cranio-caudal axis, were selected. For regional analysis, each CT image was divided into three concentric subpleural regions of interest and four quadrants. Hyper-, normally, hypo- and non-inflated lung compartments were defined. Nonparametric tests were used for hypothesis testing ( α = 0.05). Spearman correlation test was used to detect correlations between lung compartments and clinical features. Results Twenty-three out of 111 recruited patients were eligible for further analysis. Five hundred-sixty CT images were analyzed. Lung injury, composed by hypo- and non-inflated areas, was significantly more represented in subpleural than in core lung regions. A secondary, centripetal spread of lung injury was associated with exposure to mechanical ventilation ( p < 0.04), longer spontaneous breathing (more than 14 days, p < 0.05) and non-protective tidal volume ( p < 0.04). Positive fluid balance ( p < 0.01), high plasma D-dimers ( p < 0.01) and ferritin ( p < 0.04) were associated with increased lung injury. Conclusions In a cohort of COVID-19 patients with severe respiratory failure, a predominant subpleural distribution of lung injury is observed. Prolonged spontaneous breathing and high tidal volumes, both causes of patient self-induced lung injury, are associated to an extensive involvement of more central regions. Positive fluid balance, inflammation and thrombosis are associated with lung injury. Trial registration Study registered a priori the 20th of March, 2020. Clinical Trials ID NCT04316884. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03685-4.
【저자키워드】 COVID-19, ARDS, SARS-CoV2, acute respiratory distress syndrome, mechanical ventilation, Computed tomography, 【초록키워드】 Inflammation, thrombosis, Prospective Study, severe respiratory failure, lung, D-dimer, ferritin, Lung injury, progression, Clinical features, Spread, Chest computed tomography, Cohort, Region, clinical, Patient, plasma, correlation, distribution, acute respiratory distress, Hypothesis, Prolonged, Analysis, Injury, COVID-19 patient, nonparametric test, Volume, supplementary material, syndrome, Registered, subpleural distribution, regions, feature, Spearman correlation test, Result, selected, defined, analyzed, was used, detect, significantly more, recruited, composed, investigated, were used, cause, predominant, eligible, laboratory feature, subpleural, Typical, 【제목키워드】 Prospective Study, Lung injury, Chest computed tomography, distribution, Quantitative analysis, extension,