Computed tomography findings of COVID-19 pneumonia in Intensive Care Unit-patients.

Abstract

Background: In December 2019, a cluster of unknown etiology pneumonia cases occurred in Wuhan, China leading to identification of the responsible pathogen as SARS-coV-2. Since then, the coronavirus disease 2019 (COVID-19) has spread to the entire world. Computed Tomography (CT) is frequently used to assess severity and complications of COVID-19 pneumonia. The purpose of this study is to compare the CT patterns and clinical characteristics in intensive care unit (ICU) and non- ICU patients with COVID-19 pneumonia.Design and Methods: This retrospective study included 218 consecutive patients (136 males; 82 females; mean age 63±15 years) with laboratory-confirmed SARS-coV-2. Patients were categorized in two different groups: (a) ICU patients and (b) non-ICU inpatients. We assessed the type and extent of pulmonary opacities on chest CT exams and recorded the information on comorbidities and laboratory values for all patients.Results: Of the 218 patients, 23 (20 males: 3 females; mean age 60 years) required ICU admission, 195 (118 males: 77 females, mean age 64 years) were admitted to a clinical ward. Compared with non-ICU patients, ICU patients were predominantly males (60% versus 83% p=0.03), had more comorbidities, a positive CRP (p=0.04) and higher LDH values (p=0.008). ICU patients’ chest CT demonstrated higher incidence of consolidation (p=0.03), mixed lesions (p=0.01), bilateral opacities (p<0.01) and overall greater lung involvement by consolidation (p=0.02) and GGO (p=0.001).Conclusions: CT imaging features of ICU patients affected by COVID-19 are significantly different compared with non-ICU patients. Identification of CT features could assist in a stratification of the disease severity and supportive treatment. Significance for public health The major implication of our study is the differences in CT and laboratory findings in COVID-19 patients in ICU and non-ICU settings. Although the prospective impact of these findings was not assessed, recognition of these findings may help physicians anticipate the disease course and triage the patient to early ICU management. Our study highlights the importance of structured and quantitative reporting format where radiologists explicitly describe the specific pattern of pulmonary opacities (such as GGO, consolidation, and mixed) as well as lung areas and the number of lung lobes involved with COVID-19 pneumonia. To