COVID-19 yoğun bakım hastalarında klinik şiddet ve mortalite predüktörleri: CTSS ve CO-RADS

Abstract

Aim: Chest computed tomography (CT) plays an important role in the diagnosis of coronavirus infection disease 2019 (COVID-19) in patients with negative polymerase chain reaction (PCR) test but with clinical findings. The aim of this study; to determine whether the disease can predict clinical severity and/or mortality with CO-RADS and/or CTSS in intensive care COVID-19 patients.
 Materials and Methods: In the study retrospectively, COVID-19 intensive care patients with PCR positive and chest CT between 23 March - 31 December 2020 were included. CTs were evaluated by two independent radiologists without providing the clinical information of the patients. CO-RADS and CTSS were calculated for each CT, and pathological features were recorded. Demographic, clinical characteristics and mortality rates of the patients were recorded. Patients were divided into three groups [mild (nasal/mask oxygen), severe (noninvasive mechanichal ventilator (NIMV) or high flow nasal oxygen (HFO)), critically severe (invasive mechanichal ventilation (IMV))] according to the clinical severity of COVID-19. Mortality and clinical severity markers were determined by logistic regression analysis. 
 Results: Four hundered seventy three patients were included in the study. Patients were divided into three groups according to clinical severity, mild (34.7%), severe (11.8%), and critically severe (53.5%). The mean CTSS of all patients was 19.58 and the rate of patients in the CO-RADS 5 group was 50.7%. The mortality rate was 41.2%. APACHE II score and CTSS were preductors of clinical severity; age, female gender and CO-RADS were found as mortality preductors. The CO-RADS cut-off value predicting mortality was 5. Ground glass appearance was the most common pathological finding with a rate of 84.4%. Receiver operating characteristic (ROC) curves were drawn for mortality markers CO-RADS and APACHE II, and the area under the curve (AUC) values were 0.580 and 0.881, respectively. AUC was found to be 0.697 in the ROC curve drawn for CTSS, which is a clinical indicator of severity. The mortality cut-off value was found to be 16.5 with 77% sensitivity and 79% specificity for the APACHE II score (LR:3.7). The clinical severity cut-off value was found to be 18.5, with 61% sensitivity and 66% specificity for the CTSS.
 Conclusion: CO-RADS can be used to predict mortality and CTSS can be used to predict clinical severity which are radiological-based scoring systems.