Maximum chest CT score is associated with progression to severe illness in patients with COVID-19: a retrospective study from Wuhan, China

Jianwei Xiao,Zengfa Huang,Xiang Wang,Dan Du,Bin Liu,Yuanliang Xie,Pei Yang,Shengchao Zhao,Xiang Li,Yi Ding

doi:10.1186/s12879-020-05683-3

Abstract

BackgroundThe Coronavirus Disease 2019 (COVID-19) pandemic is a world-wide health crisis. Limited information is available regarding which patients will experience more severe disease symptoms. We evaluated hospitalized patients who were initially diagnosed with moderate COVID-19 for clinical parameters and radiological feature that showed an association with progression to severe/critical symptoms.MethodsThis study, a retrospective single-center study at the Central Hospital of Wuhan, enrolled 243 patients with confirmed COVID19 pneumonia. Forty of these patients progressed from moderate to severe/critical symptoms during follow up. Demographic, clinical, laboratory, and radiological data were extracted from electronic medical records and compared between moderate- and severe/critical-type symptoms. Univariable and multivariable logistic regressions were used to identify the risk factors associated with symptom progression.ResultsPatients with severe/critical symptoms were older (p < 0.001) and more often male (p = 0.046). A combination of chronic obstructive pulmonary disease (COPD) and high maximum chest computed tomography (CT) score was associated with disease progression. Maximum CT score (> 11) had the greatest predictive value for disease progression. The area under the receiver operating characteristic curve was 0.861 (95% confidence interval: 0.811–0.902).ConclusionsMaximum CT score and COPD were associated with patient deterioration. Maximum CT score (> 11) was associated with severe illness.

Highlights

The Coronavirus Disease 2019 (COVID-19) pandemic is a world-wide health crisis
Based on the new coronavirus pneumonia diagnosis and treatment protocols developed by the National Health Commission of the People’s Republic of China, the clinical classification of COVID-19 was stratified as follows: moderate-type cases included individuals with fever, respiratory tract involvement, and other symptoms, as well as imaging findings of pneumonia; severetype cases met any of the following criteria: (1) respiratory distress with a respiratory rate ≥ 30 beats/ min; (2) oxygen saturation ≤ 93% at rest; and (3) arterial blood oxygen partial pressure (PaO2)/oxygen concentration (FiO2) ≤ 300 mmHg (1 mmHg = 0.133 kPa); criticaltype cases exhibited any of the following conditions: (1) respiratory failure requiring mechanical ventilation; (2) shock; (3) intensive care unit (ICU) admission for combined organ failure
Exclusion criteria were as follows: (1) patient was still hospitalized at the end of follow-up; (2) patient transferred to another medical institution; (3) diagnosis not confirmed by repeated tests for the presence of severe acute respiratory syndrome (SARS)-CoV-2 RNA; (4) fatality; (5) patient diagnosed with severe-type or critical-type COVID-19 on admission; (6) incomplete medical records; or (7) case records lacked a second chest computed tomography (CT) scan

Summary

Introduction

The Coronavirus Disease 2019 (COVID-19) pandemic is a world-wide health crisis. Limited information is available regarding which patients will experience more severe disease symptoms. We evaluated hospitalized patients who were initially diagnosed with moderate COVID-19 for clinical parameters and radiological feature that showed an association with progression to severe/critical symptoms. Relatively few deaths have been observed in patients with mild COVID-19, the rate of case fatality clearly is elevated among critically ill patients. More than 80% of the laboratory-confirmed cases in China (including both non-pneumonia and pneumonia cases) were of the mild to moderate types [5]. A fifth of these cases progressed to a severe or critical stage, with the highest reported case fatality rate reaching 4.47% for patients in Wuhan diagnosed before March 2020 [6]. Few studies (to our knowledge) have investigated clinical findings in patients who progress from moderate- to severe/critical-type symptoms

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Conclusion