Abstract
BackgroundThe relationship between computed tomography (CT) and prognosis of patients with COVID-19 pneumonia remains unclear. We hypothesized that the Ichikado CT score, obtained in the first 24 h of hospital admission, is an independent predictor for all-cause mortality during hospitalization in patients with COVID-19 pneumonia.MethodsSingle-center retrospective cohort study of patients with confirmed COVID-19 pneumonia admitted at our institution between March 20th, 2020 and October 31st, 2020. Patients were enrolled if, within 24 h of admission, a chest CT scan, an arterial blood gas, a complete blood count, and a basic metabolic panel were performed. Two independent radiologists, who were blinded to clinical data, retrospectively evaluated the chest CT scans following a previously described qualitative and quantitative CT scoring system. The primary outcome was all-cause in-hospital mortality or survival to hospital discharge. Secondary outcomes were new requirements for invasive mechanical ventilation and hospital length of stay. Cox regression models were used to test the association between potential independent predictors and all-cause mortality.ResultsTwo hundred thirty-five patients, 197 survivors and 38 nonsurvivors, were studied. The median Ichikado CT score for nonsurvivors was significantly higher than survivors (P < 0.001). An Ichikado CT score of more than 172 enabled prediction of mortality, with a sensitivity of 84.2% and a specificity of 79.7%. Multivariate analysis identified Ichikado CT score (HR, 7.772; 95% CI, 3.164–19.095; P < 0.001), together with age (HR, 1.030; 95% CI, 1.030–1.060; P = 0.043), as independent predictors of all-cause in-hospital mortality.ConclusionsIchikado CT score is an independent predictor of both requiring invasive mechanical ventilation and all-cause mortality in patients hospitalized with COVID-19 pneumonia. Further prospective evaluation is necessary to confirm these findings.Trial registration: The WCG institutional review board approved this retrospective study and patient consent was waived due to its non-interventional nature (Identifier: 20210799).
Highlights
The relationship between computed tomography (CT) and prognosis of patients with COVID-19 pneumonia remains unclear
The aim of this study was to determine the prognostic value of the Ichikado CT score upon admission for allcause mortality in patients admitted to a COVID-19 intensive care unit (ICU) or intermediate care unit (IMU)
At the time of CT scan and bloodwork obtention, 110 (46.8%) patients were on nasal cannula, 81 (34.5%) on high-flow nasal cannula (HFNC), and 8 (3.4%) were endotracheally intubated
Summary
The relationship between computed tomography (CT) and prognosis of patients with COVID-19 pneumonia remains unclear. We hypothesized that the Ichikado CT score, obtained in the first 24 h of hospital admission, is an independent predictor for all-cause mortality during hospitalization in patients with COVID-19 pneumonia. By February 14th 2021, the United States of America had a total of 27,221,607 cases of COVID-19, and 477,147 fatalities [4]. While most patients will have mild symptoms and recover without medical management, some will develop dyspnea, requiring supplemental oxygen therapy, and eventually worsen to respiratory or multi-organ failure, requiring mechanical ventilation and intensive care unit (ICU) monitoring [8, 9]. As the number of people infected by SARS-CoV-2 continues to climb, early recognition of patients at risk of deterioration may aid in the triage and medical management of COVID-19 patients [10]
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