Chest CT severity score as a predictor of mortality and short-term prognosis in COVID-19.

Abstract

As India was slowly coming out of shock from the second wave wrecked by the Delta strain, the world population is now struck once again with a new strain of coronavirus disease 2019 (COVID-19), designated as B.1.1.529, named as OMICRON. Though several international studies have evaluated the role of computed tomography (CT) in diagnosis, predicting prognosis, and monitoring the progression of disease, to our best knowledge, there are no Indian studies published in this context. (1) To determine the use of chest CT severity score as predictor of mortality in COVID-19 patients. (2) To determine the prognosis based on length of hospital stay. A observational cohort study was done at Travancore Medical College Hospital. A retrospective analysis of patients who presented to the Emergency Medicine Department with a positive COVID antigen or reverse transcriptase-polymerase chain reaction (RT-PCR) results and those who underwent a CT chest at the time of presentation was conducted. Data was analyzed by using Statistical Package for Social Sciences (SPSS) version 16. Descriptive statistics such as mean, frequency, and percentages were calculated. Chi-square test was used to find the statistical significance. The Kaplan-Meier method was used to evaluate the relationship between CT score and mortality, which was compared with the log-rank test. A total of 252 patients with positive COVID antigen or RT-PCR who underwent CT chest were included in our study. Our study population was composed of 139 (55.2%) males and 113 (44.8%) females. Only one patient with mild CT severity score required >14 days of ICU stay, whereas two (2%) and five (9.6%) patients with moderate and severe CT severity score, respectively, required ICU stay for >14 days. The P value was 0.001, which again is statistically significant. In our study, out of 44 patients categorized under mild CT severity score, only two (4.5%) patients had expired. Out of 98 patients categorized under moderate CT severity score, 14 (14.3%) patients had expired, whereas out of 52 patients categorized under severe CT severity score at the time of admission, 25 (48.1%) patients had expired. The P value was 0.001, which is statistically significant. Our study could prove that patients with CT severity score ≥15 had high risk of mortality and required prolonged ICU stay of >5 days. CT severity score helps the primary care physicians to predict probable outcome and length of hospital stay at the time of admission itself and allocate the limited resources appropriately.