Predicting mortality rate in ICU admitted COVID-19 patients implementing visual semi-quantitative CT severity scoring system

Abstract

Objectives: The aim of this study was to identify the clinical and laboratory features and CT scan (CT intensity score and pleural effusion) associated with COVID-19 pneumonia to evaluate the relationship between CT scan findings and mortality by comparing deceased patients with normal patients. Methods: In this retrospective case-control study, 290 ICU admitted patients with RT-PCR confirmed COVID-19 pneumonia were investigated. Totally, 150 deceased patients (with confirmed COVID-19 related death) were extracted from the COVID-19 registry of the affiliated university hospital belonging to mentioned period of time (in-hospital mortality subgroup, case), and 150 patients who survived the admission course were randomly selected from the same data set (surviving subgroup, control). Available electronic records for each patient were enlisted, including laboratory and clinical information, and their on-admission Computed Tomography (CT) images were reviewed. Mortality-related risk factors were compared between case and control subgroups. Results: The mean age of deceased patients (68.20 ± 16.07) was significantly higher than that of the surviving patients (54.72 ± 19.50) (p<0.001). Diabetes, hypertension, and Chronic Kidney Disease (CKD) were significantly related with higher mortality rates (62.2%, 58.7%, and 80.4% mortality in diabetic, hypertensive, and CKD patients versus 41.7%, 42.1%, and 35.9% in non-diabetics, normotensives, and patients without CKD). Additionally, the mean on-admission air-room SPO2 level in deceased patients (90%) was significantly lower than that of the survivors (93%) (p = 0.001). Lymphocyte count, Neutrophil to Lymphocyte Ratio (NLR), Erythrocyte Sedimentation Rate (ESR), CReactive Protein (CRP), Lactate Dehydrogenase (LDH), Fasting Blood Sugar (BS), Blood Urea Nitrogen (BUN), and Creatinine (Cr), mean CT Severity Score (CT-ss), and O2 supportive therapy requirement were significantly higher in the mortality subgroup (p<0.05). Pleural effusion showed no significant correlation with short-term mortality. CTss of >11, in isolation or in combination with above-mentioned prognosticators, was 64% or 81.4% sensitive, and 60% or of 78.6% specific, to predict mortality. Conclusions: Factors such as advanced age, underlying diseases such as diabetes, hypertension, and CKD, decreased air-room SPO2 , and increased lymphocyte count, higher NLR, ESR, CRP, LDH, BS, BUN, and Cr level, as well as higher CT-ss and O2 supportive therapy, are all significantly correlated with higher mortality in ICU-admitted COVID-19 patients. Keywords: COVID-19; CT scan; CT Severity score; ICU; pneumonia.