Abstract
We evaluated a simple semi-quantitative (SSQ) method for determining pulmonary involvement in computed tomography (CT) scans of COVID-19 patients. The extent of lung involvement in the first available CT was assessed with the SSQ method and subjectively. We identified risk factors for the need of invasive ventilation, intensive care unit (ICU) admission and for time to death after infection. Additionally, the diagnostic performance of both methods was evaluated. With the SSQ method, a 10% increase in the affected lung area was found to significantly increase the risk for need of ICU treatment with an odds ratio (OR) of 1.68 and for invasive ventilation with an OR of 1.35. Male sex, age, and pre-existing chronic lung disease were also associated with higher risks. A larger affected lung area was associated with a higher instantaneous risk of dying (hazard ratio (HR) of 1.11) independently of other risk factors. SSQ measurement was slightly superior to the subjective approach with an AUC of 73.5% for need of ICU treatment and 72.7% for invasive ventilation. SSQ assessment of the affected lung in the first available CT scans of COVID-19 patients may support early identification of those with higher risks for need of ICU treatment, invasive ventilation, or death.
Highlights
IntroductionThe virus causes coronavirus disease 2019 (COVID-19), which rapidly became a pandemic
With regard to the frequency of symptoms, there were no significant differences between patients with/without the need for invasive ventilation or intensive care unit (ICU) admission
The simple semi-quantitative (SSQ) method is a good tool for predicting the need for both invasive ventilation and intensive care therapy
Summary
The virus causes coronavirus disease 2019 (COVID-19), which rapidly became a pandemic. COVID-19 has become a burden to health care systems all over the world and is still associated with significant mortality. Infected patients may present with symptoms ranging from mild to severe pneumonia with acute respiratory distress syndrome (ARDS), lung failure, and death. Most patients with a severe clinical course of COVID-19 have comorbidities and risk factors, such as older age, smoking, hypertension, cardiovascular disease, and diabetes mellitus [5]. Acute respiratory distress syndrome (ARDS) occurs in 60–70% of COVID-19 patients admitted to an ICU [8]. Limited medical equipment and supplies such as ventilators and oxygen as well as medical staff must be used as efficiently as possible in order to avoid a collapse of the health care systems
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