Prognostic Value of Admission Chest CT Findings for Invasive Ventilation Therapy in COVID-19 Pneumonia

Eva Gresser,Michael Irlbeck,Nicola Fink,Daniel Puhr-Westerheide,Wolfgang G Kunz,Johannes Rueckel,Bastian O Sabel,Vincent Schwarze,Michael Ingrisch,Dietmar Wassilowsky,Jens Ricke

doi:10.3390/diagnostics10121108

Eva Gresser, Michael Irlbeck + Show 9 more

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https://doi.org/10.3390/diagnostics10121108

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Abstract

(1) Background: To assess the value of chest CT imaging features of COVID-19 disease upon hospital admission for risk stratification of invasive ventilation (IV) versus no or non-invasive ventilation (non-IV) during hospital stay. (2) Methods: A retrospective single-center study was conducted including all patients admitted during the first three months of the pandemic at our hospital with PCR-confirmed COVID-19 disease and admission chest CT scans (n = 69). Using clinical information and CT imaging features, a 10-point ordinal risk score was developed and its diagnostic potential to differentiate a severe (IV-group) from a more moderate course (non-IV-group) of the disease was tested. (3) Results: Frequent imaging findings of COVID-19 pneumonia in both groups were ground glass opacities (91.3%), consolidations (53.6%) and crazy paving patterns (31.9%). Characteristics of later stages such as subpleural bands were observed significantly more often in the IV-group (52.2% versus 26.1%, p = 0.032). Using information directly accessible during a radiologist’s reporting, a simple risk score proved to reliably differentiate between IV- and non-IV-groups (AUC: 0.89 (95% CI 0.81–0.96), p < 0.001). (4) Conclusions: Information accessible from admission CT scans can effectively and reliably be used in a scoring model to support risk stratification of COVID-19 patients to improve resource and allocation management of hospitals.

Highlights

In December 2019, a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed as the cause of a new disease, which was termed coronavirus disease 2019 (COVID-19) by the World Health Organization [1]
According to meta-analyses, around 15–30% of hospitalized patients develop a critical course of the disease requiring intensive care unit (ICU) treatment and invasive ventilation (IV), with an ICU mortality rate of around 40–50% which is higher than usually seen in other viral pneumonia [5,6,7,8]
computed tomography (CT) evaluations confirmed most typical COVID-19 findings already described in the recent literature, the most predominant findings being ground glass opacities (91.3%), consolidations (53.6%), air bronchogram (46.4%), crazy paving pattern (31.9%) and subpleural bands (34.8%)

Summary

Introduction

In December 2019, a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was confirmed as the cause of a new disease, which was termed coronavirus disease 2019 (COVID-19) by the World Health Organization [1]. Polymerase chain reaction (PCR) testing has shown false negatives in the early stages of COVID-19 disease for some cases and test results may take some time, causing difficulties regarding the management of hospital capacities [10]. In this context, chest computed tomography (CT) scans demonstrated their high diagnostic value in cases with initially negative PCR-testing or pending results, and have since been an effective complementary tool for allocation and triage purposes [11,12,13,14,15,16]. Lymph node enlargement, bronchial wall thickening as well as mucus plugging might be seen more frequently in severe cases or later stages of the disease and may point to potential superimposed infections [18,19,20,25]

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