Chest CT manifestations with emphasis on the role of CT scoring and serum ferritin/lactate dehydrogenase in prognosis of coronavirus disease 2019 (COVID-19)

Rehab Abdel Rahman El Bakry,Ayman Ibrahim Tharwat Sayed

doi:10.1186/s43055-021-00459-4

Rehab Abdel Rahman El Bakry, Ayman Ibrahim Tharwat Sayed

Open Access

https://doi.org/10.1186/s43055-021-00459-4

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Abstract

BackgroundIn March 2020, the World Health Organization announced coronavirus disease 2019 (COVID-19) a pandemic, and because of the primary pulmonary manifestations of the disease, chest CT is essential in the evaluation of those patients. The aim of the study was to evaluate the role of chest CT findings and chest CT scoring along with serum ferritin and LDH in the prognosis of COVID-19 patients in a cohort of the Egyptian population.ResultsThis retrospective study included 250 patients with positive RT-PCR for COVID-19, 138 males [55.2%] and 112 females [44.8%], age range 17–82 years with median 49.5. Two hundred patients had a positive significant correlation between age, serum ferritin, serum LDH, and CT score. Bilateral affection was 88% while unilaterality was 12%, and peripheral chest CT findings were stratified as follows: mild [score from 1 to 10], 114 patients [57%]; moderate [score from 11 to 19], 65 patients [32.5%]; and severe [score from 20 to 25], 21 patients [10.5%]. In severe cases, males constitute 85.7% while females were only 14.3%. Statistical and central distribution was 67%, peripheral was 31%, and central was 2%. Ground glass opacity (GGO) was the highest pattern 39.2%, consolidation 31.2%, fibrosis 15.2%, and CP 13.7%, with lymph nodes only 0.6%. Fifteen cases [6%] were critical; all showed severe scores ranging from 21 to 23 with three times increase in serum ferritin and four times increase in LDH. A follow-up study done to 8 cases [3.2%] showed an increase in CT scoring, serum ferritin, and serum LDH.ConclusionChest CT findings are crucial for early diagnosis of COVID-19 disease especially for asymptomatic patients with old age and male sex considered risk factors for poor prognosis. Chest CT score, serum ferritin, and serum LDH help in predicting the short-term outcome of the patients aiming to decrease both morbidity and mortality.

Highlights

In March 2020, the World Health Organization announced coronavirus disease 2019 (COVID-19) a pandemic, and because of the primary pulmonary manifestations of the disease, chest CT is essential in the evaluation of those patients
A non-contrast chest CT scan was done to all patients within 1 week from the onset of symptoms or from the appearance of positive RT-PCR result, and estimation of serum ferritin level and serum lactate dehydrogenase (LDH) was done within 1 day of chest CT
COVID-19 is a new highly contagious infectious disease that causes lower respiratory inflammation; it starts by alveolar hyaline membrane injury or interstitial edema which appears on CT as Ground glass opacity (GGO) progresses to alveolar filling with exudate which is the consolidation after which an autoimmune reaction begins by activation of both humeral and cellular immunity mediated by virusspecific B and T cells causing the formation of proinflammatory cytokines which are the cause of interlobular septal thickening, giving rise to first crazy paving lung fibrosis [12]

Summary

Introduction

In March 2020, the World Health Organization announced coronavirus disease 2019 (COVID-19) a pandemic, and because of the primary pulmonary manifestations of the disease, chest CT is essential in the evaluation of those patients. A viral pneumonia of unknown etiology appeared in China in late December 2019, and the Chinese scientific centers declared that the cause is a new strain of coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and the disease is named coronavirus disease 2019 (COVID-19) [1] It is a highly contagious disease, and by March 2020, the World Health Organization declared it as a pandemic causing a global health emergency [2] making early diagnosis mandatory for proper management of the patients and rapid detection of contacts for quarantine purpose; real-time reverse transcriptasepolymerase chain reaction of the viral nucleic acid (RT-PCR) within body specimens mainly nasopharyngeal or oro-phangeal swab is the gold standard for diagnosis [3]. The purpose of the study was to investigate the role of chest CT findings and CT scores along with serum biomarkers namely serum ferritin and lactate dehydrogenase (LDH) in the proper effective management of COVID-19 patients

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