Abstract
The evolving dynamics of coronavirus disease 2019 (COVID-19) and the increasing infection numbers require diagnostic tools to identify patients at high risk for a severe disease course. Here we evaluate clinical and imaging parameters for estimating the need of intensive care unit (ICU) treatment. We collected clinical, laboratory and imaging data from 65 patients with confirmed COVID-19 infection based on polymerase chain reaction (PCR) testing. Two radiologists evaluated the severity of findings in computed tomography (CT) images on a scale from 1 (no characteristic signs of COVID-19) to 5 (confluent ground glass opacities in over 50% of the lung parenchyma). The volume of affected lung was quantified using commercially available software. Machine learning modelling was performed to estimate the risk for ICU treatment. Patients with a severe course of COVID-19 had significantly increased interleukin (IL)-6, C-reactive protein (CRP), and leukocyte counts and significantly decreased lymphocyte counts. The radiological severity grading was significantly increased in ICU patients. Multivariate random forest modelling showed a mean ± standard deviation sensitivity, specificity and accuracy of 0.72 ± 0.1, 0.86 ± 0.16 and 0.80 ± 0.1 and a receiver operating characteristic-area under curve (ROC-AUC) of 0.79 ± 0.1. The need for ICU treatment is independently associated with affected lung volume, radiological severity score, CRP, and IL-6.
Highlights
At the end of 2019, infections with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were first noted in Wuhan, China and rapidly spread to the rest of the world [1]
It stands to reason that the integration of imaging and clinical data can aid in the prediction of a severe course of disease in COVID-19 pneumonia and aid in patient stratification and triage, critical especially in an overloaded health care system as was observed in Italy [2] and more recently, New York [10]
The analysis of the blood samples revealed a significant increase of leukocyte counts, C-reactive protein (CRP) and IL-6 (p < 0.0001) and a significant reduction of the lymphocyte count in intensive care unit (ICU) patients (p < 0.0001) (Table 1)
Summary
At the end of 2019, infections with the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were first noted in Wuhan, China and rapidly spread to the rest of the world [1]. Even in highly developed health care systems, such as in Germany, with a very active testing and containment strategy alongside a federally guided preparation of the health care system for the coronavirus disease 2019 (COVID-19) pandemic, specific challenges are faced: pharyngeal swab-based polymerase chain reaction (PCR) testing is only highly sensitive during the early phase of infection and may miss the pulmonary phase of disease. Limited resources both with respect to testing reagents and intensive care unit (ICU) capacities warrant identification of patients with primarily pulmonary disease manifestation at high risk for a severe course.
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