Abstract
Computed tomography (CT) plays an important role in the diagnosis of COVID-19. The aim of this study was to evaluate a simple, semi-quantitative method that can be used for identifying patients in need of subsequent intensive care unit (ICU) treatment and intubation. We retrospectively analyzed the initial CT scans of 28 patients who tested positive for SARS-CoV-2 at our Level-I center. The extent of lung involvement on CT was classified both subjectively and with a simple semi-quantitative method measuring the affected area at three lung levels. Competing risks Cox regression was used to identify factors associated with the time to ICU admission and intubation. Their potential diagnostic ability was assessed with receiver operating characteristic (ROC)/area under the ROC curves (AUC) analysis. A 10% increase in the affected lung parenchyma area increased the instantaneous risk of intubation (hazard ratio (HR) = 2.00) and the instantaneous risk of ICU admission (HR 1.73). The semi-quantitative measurement outperformed the subjective assessment diagnostic ability (AUC = 85.6% for ICU treatment, 71.9% for intubation). This simple measurement of the involved lung area in initial CT scans of COVID-19 patients may allow early identification of patients in need of ICU treatment/intubation and thus help make optimal use of limited ICU/ventilation resources in hospitals.
Highlights
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in December2019 in Wuhan, China [1]
67 years), three patients were referred by general practitioners (10.7%; median age, 71 years), and seven age, 67 years), three patients referred by general(25%; practitioners age,our
Based on the instantaneous competing riskrisk model, we found independent that a 10% increase in potential affected lung area increased the cause-specific of intubation of other risk factors almost two-fold
Summary
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first identified in December. 2019 in Wuhan, China [1]. The main transmission route of the virus is via droplet infection [2]. The course of coronavirus disease 2019 (COVID-19) is unspecific and varies greatly, ranging from asymptomatic cases to severe pneumonia with lung failure and death [3]. In about 3–6% of COVID-19 patients, a critical or even life-threatening course has been reported [4]. Up to 17% of patients require ventilation [5]. Risk factors for a severe course include older age, smoking, and pre-existing conditions such as chronic lung diseases, or diabetes mellitus [4]. Intensive care unit (ICU) capacity is Diagnostics 2020, 10, 929; doi:10.3390/diagnostics10110929 www.mdpi.com/journal/diagnostics
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