Chest Chest Computed Tomography Score Research Articles

Comparison between high-flow nasal oxygen (HFNO) alternated with non-invasive ventilation (NIV) and HFNO and NIV alone in patients with COVID-19: a retrospective cohort study

BackgroundNon-invasive respiratory support (conventional oxygen therapy [COT], non-invasive ventilation [NIV], high-flow nasal oxygen [HFNO], and NIV alternated with HFNO [NIV + HFNO] may reduce the need for invasive mechanical ventilation (IMV) in patients with COVID-19. The outcome of patients treated non-invasively depends on clinical severity at admission. We assessed the need for IMV according to NIV, HFNO, and NIV + HFNO in patients with COVID-19 according to disease severity and evaluated in-hospital survival rates and hospital and intensive care unit (ICU) lengths of stay.MethodsThis cohort study was conducted using data collected between March 2020 and July 2021. Patients ≥ 18 years admitted to the ICU with a diagnosis of COVID-19 were included. Patients hospitalized for < 3 days, receiving therapy (COT, NIV, HFNO, or NIV + HFNO) for < 48 h, pregnant, and with no primary outcome data were excluded. The COT group was used as reference for multivariate Cox regression model adjustment.ResultsOf 1371 patients screened, 958 were eligible: 692 (72.2%) on COT, 92 (9.6%) on NIV, 31 (3.2%) on HFNO, and 143 (14.9%) on NIV + HFNO. The results for the patients in each group were as follows: median age (interquartile range): NIV (64 [49–79] years), HFNO (62 [55–70] years), NIV + HFNO (62 [48–72] years) (p = 0.615); heart failure: NIV (54.5%), HFNO (36.3%), NIV + HFNO (9%) (p = 0.003); diabetes mellitus: HFNO (17.6%), NIV + HFNO (44.7%) (p = 0.048). > 50% lung damage on chest computed tomography (CT): NIV (13.3%), HFNO (15%), NIV + HFNO (71.6%) (p = 0.038); SpO2/FiO2: NIV (271 [118–365] mmHg), HFNO (317 [254–420] mmHg), NIV + HFNO (229 [102–317] mmHg) (p = 0.001); rate of IMV: NIV (26.1%, p = 0.002), HFNO (22.6%, p = 0.023), NIV + HFNO (46.8%); survival rate: HFNO (83.9%), NIV + HFNO (63.6%) (p = 0.027); ICU length of stay: NIV (8.5 [5–14] days), NIV + HFNO (15 [10–25] days (p < 0.001); hospital length of stay: NIV (13 [10–21] days), NIV + HFNO (20 [15–30] days) (p < 0.001). After adjusting for comorbidities, chest CT score and SpO2/FiO2, the risk of IMV in patients on NIV + HFNO remained high (hazard ratio, 1.88; 95% confidence interval, 1.17–3.04).ConclusionsIn patients with COVID-19, NIV alternating with HFNO was associated with a higher rate of IMV independent of the presence of comorbidities, chest CT score and SpO2/FiO2.Trial registration ClinicalTrials.gov identifier: NCT05579080.

COVİD-19 Hastalarında Toraks BT Skoru: Nötrofil-Lenfosit Oranı, Monosit, Laktat Dehidrojenaz, Albümin ve Ferritin Arasındaki İlişki

Objective: Various Laboratory and vital parameters, including leukopenia, lymphopenia, neutrophil/lymphocyte ratio elevation, lactate dehydrogenase elevation, D-dimer and ferritin elevation, and low albumin can be used in the diagnosis and assessment of the severity of COVID-19 infection . &#x0D; Methods: The chest computed tomography (CT) scores, lymphopenia, neutrophil/lymphocyte ratio, neutrophil, lymphocyte, lactate dehydrogenase, albumin, C-reactive protein, white blood cells, platelets, basophil, eosinophil, monocytes, procalcitonin, D-dimer, ferritin, ages, genders, hospitalization units, oxygen-free fingertip saturations in room air, additional diseases and symptoms of 693 patients diagnosed with COVID-19 were recorded. The parameters of the patients were compared according to the severity of the chest CT score.&#x0D; Results: As a result of this study neutrophil/lymphocyte ratio was found to be significantly higher in the severe group when compared to the moderate group and the mild group. As chest CT score increased, lactate dehydrogenase level was higher at a statistically significant level in the severe group than in the mild group. Albumin levels were found to be lower in the severe group at a statistically significant level than in the mild group. Monocyte levels were found to be lower in the severe group at a statistically significant level when compared to the moderate and mild groups. Ferritin level was higher in the severe group at a statistically significant level when compared to the moderate and mild groups. When the practical effectiveness of using hematological and biochemical parameters to differentiate patients with severe CT scores from non-severe patients based on the chest CT score of the patients was examined by using the ROC Analysis, it was found that the neutrophil/lymphocyte ratio value had the strongest predictive ability (AUC, 0.787, SD=0.057, P

Association between lung opacities and visceral fat in COVID-19 patients.

To assess the relationship between the amount of the epigastric visceral fat area and the severity of pneumonia in the course of COVID-19 using chest computed tomography (CT) examinations. 177 patients (54 female), with COVID-19 infection were included. A routine chest CT was performed to assess the severity of pneumonia. The affected lung tissue as well as semi-quantitative scales such as the Chest CT Score and Total Opacity Score were calculated using SyngoVia VB30A CT Pneumonia Analysis software. The epigastric region area of visceral fat (L1) was also determined. The mean value of the visceral adipose tissue area was 196.23 ± 101.36 cm2. The area of adipose tissue significantly correlated with the percentage of the affected lung tissue (r = 0.1476; p = 0.050), the Chest CT Score (r = 0.2086; p = 0.005), and the Total Opacity Score (r = 0.1744; p = 0.200). The mean area of adipose tissue in the age group ≥ 65 years was 216.13 ± 105.19 cm2, while in the group < 65 years, it was 169.18 ± 89.69 cm2. This difference was statistically significant (p = 0.002). The study showed a relationship between the area of visceral adipose tissue and the degree of lung inflammation in COVID-19 disease in patients under 65 years of age.

A study on changes in lung function, neutralizing antibodies, and symptoms of adult patients hospitalized with COVID-19.

To identify changes in symptoms and pulmonary sequelae in patients with coronavirus disease 2019 (COVID-19). Patients with COVID-19 hospitalized at seven university hospitals in Korea between February 2020 and February 2021 were enrolled, provided they had ≥ 1 outpatient follow-up visit. Between January 11 and March 9, 2021 (study period), residual symptom investigations, chest computed tomography (CT) scans, pulmonary function tests (PFT), and neutralizing antibody tests (NAb) were performed at the outpatient visit (cross-sectional design). Additionally, data from patients who already had follow-up outpatient visits before the study period were collected retrospectively. Investigation of residual symptoms, chest CT scans, PFT, and NAb were performed in 84, 35, 31, and 27 patients, respectively. After 6 months, chest discomfort and dyspnea persisted in 26.7% (4/15) and 33.3% (5/15) patients, respectively, and 40.0% (6/15) and 26.7% (4/15) patients experienced financial loss and emotional distress, respectively. When the ratio of later CT score to previous ones was calculated for each patient between three different time intervals (1-14, 15-60, and 61-365 days), the median values were 0.65 (the second interval to the first), 0.39 (the third to the second), and 0.20 (the third to the first), indicating that CT score decreases with time. In the high-severity group, the ratio was lower than in the low-severity group. In COVID-19 survivors, chest CT score recovers over time, but recovery is slower in severely ill patients. Subjects complained of various ongoing symptoms and socioeconomic problems for several months after recovery.

Estimation of biochemical factors affecting survival in intensive care COVID-19 patients undergoing chest CT scoring: A retrospective cross-sectional study.

Coronavirus disease 2019 (COVID-19) is a rapidly spreading deadly respiratory disease that emerged in the city of Wuhan in December 2019. As a result of its rapid and widespread transmission, the WHO declared a pandemic on March 11, 2020 and studies evaluating mortality and prognosis in COVID-19 gained importance. The aim of this study was to determine the factors affecting the survival of COVID-19 patients followed up in a tertiary intensive care unit (ICU) and undergoing chest computed tomography (CT) scoring. This retrospective cross-sectional study was conducted with the approval of Uşak University Medical Faculty Ethics Committee between July and September 2020. It included 187 symptomatic patients (67 females, 120 males) with suspected COVID-19 who underwent chest CT scans in the ICU. Demographics, acute physiology and chronic health evaluation (APACHE II), chest CT scores, COVID-19 real-time polymerase chain reaction (RT PCR) results, and laboratory parameters were recorded. SPSS 15.0 for Windows was used for the data analysis. The ages of the patients ranged from 18 to 94 and the mean age was 68.0 ± 13.9 years. The COVID-19 RT PCR test was positive in 86 (46.0%) patients and 110 patients (58.8%) died during the follow-up. ICU stay (P = .024) and total invasive mechanical ventilation time (P < .001) were longer and blood urea nitrogen (BUN) was higher (P < .001) in the nonsurvivors. Patients with an APACHE II score of 23 and above had a 1.12-fold higher mortality rate (95% CI 0.061–0.263). There was no significant difference in total chest CT score between the survivors and nonsurvivors (P = .210). Chest CT score was not significantly associated with mortality in COVID-19 patients. Our idea that COVID-19 will cause greater mortality in patients with severe chest CT findings has changed. More studies on COVID-19 are needed to reveal the markers that affect prognosis and mortality in this period when new variants are affecting the world.

Association of severe COVID-19 outcomes with radiological scoring and cardiomegaly: findings from the COVID-19 inpatients database, Japan

PurposeWe aimed to characterize novel coronavirus infections based on imaging [chest X-ray and chest computed tomography (CT)] at the time of admission.Materials and methodsWe extracted data from 396 patients with laboratory-confirmed COVID-19 who were managed at 68 hospitals in Japan from January 25 to September 2, 2020. Case patients were categorized as severe (death or treatment with invasive ventilation during hospitalization) and non-severe groups. The imaging findings of the groups were compared by calculating odds ratios (ORs) and 95% confidence intervals (95% CIs), adjusted for sex, age, and hospital size (and radiographic patient positioning for cardiomegaly). Chest X-ray and CT scores ranged from 0 to 72 and 0 to 20, respectively. Optimal cut-off values for these scores were determined by a receiver-operating characteristic (ROC) curve analysis.ResultsThe median age of the 396 patients was 48 years (interquartile range 28–65) and 211 (53.3%) patients were male. Thirty-two severe cases were compared to 364 non-severe cases. At the time of admission, abnormal lesions on chest X-ray and CT were mainly observed in the lower zone/lobe. Among severe cases, abnormal lesions were also seen in the upper zone/lobe. After adjustment, the total chest X-ray and CT score values showed a dose-dependent association with severe disease. For chest X-ray scores, the area under the ROC curve (AUC) was 0.91 (95% CI = 0.86–0.97) and an optimal cut-off value of 9 points predicted severe disease with 83.3% sensitivity and 84.7% specificity. For chest CT scores, the AUC was 0.94 (95% CI = 0.89–0.98) and an optimal cut-off value of 11 points predicted severe disease with 90.9% sensitivity and 82.2% specificity. Cardiomegaly was strongly associated with severe disease [adjusted OR = 24.6 (95% CI = 3.7–166.0)].ConclusionChest CT and X-ray scores and the identification of cardiomegaly could be useful for classifying severe COVID-19 on admission.

Impact of chronic co-infection in pulmonary Mycobacterium avium complex disease after treatment initiation

BackgroundThe impact of co-infection with other pathogenic microorganisms after initiation of treatment for Mycobacterium avium complex pulmonary disease (MAC-PD) has not been clearly described. This study sought to clarify the clinical outcomes of co-infection with MAC after antimycobacterial therapy for MAC.MethodsCo-infection status was defined as the detection of pathogenic microorganisms other than MAC in at least two consecutive sputum cultures 6–24 months after initiation of treatment. Chest computed tomography (CT) findings and culture results were compared between co-infection and MAC alone groups.ResultsThe co-infection and MAC alone groups comprised 12 and 36 patients, respectively. The proportion of patients with sputum culture positive for MAC after 24 months of therapy did not differ significantly between the two groups [25% (3/12) vs. 16.7% (6/36); p = 0.671]. The proportion of patients with improved chest CT score after 24 months of starting treatment compared to baseline was significantly lower for the co-infection group than for the MAC alone group [16.7% (2/12) vs. 79.4% (27/34); p < 0.001]. In the co-infection group, median CT score values at 12 and 24 months did not differ from baseline. However, the MAC alone group showed significant improvement at 12 and 24 months compared with baseline.ConclusionsIn the patient group with co-infection of other pathogenic microorganisms after treatment initiation for MAC there was no impact on therapeutic efficacy compared to the MAC alone group. However, therapeutic intervention interfered with improvement in chest CT findings such as nodule formation, bronchiectasis, infiltration, and cavitary lesions.

Application of the advanced lung cancer inflammation index for patients with coronavirus disease 2019 pneumonia: Combined risk prediction model with advanced lung cancer inflammation index, computed tomography and chest radiograph.

The purpose of the present study was to evaluate the feasibility of applying the advanced lung cancer inflammation index (ALI) in patients with coronavirus disease 2019 (COVID-19) and to establish a combined ALI and radiologic risk prediction model for disease exacerbation. The present study included patients diagnosed with COVID-19 infection in our single institution from March to October 2020. Patients without clinical information and/or chest computed tomography (CT) upon admission were excluded. A radiologist assessed the CT severity score and abnormality on chest radiograph. The combined ALI and radiologic risk prediction model was developed via random forest classification. Among 79 patients (age, 43±19 years; male/female, 45:34), 72 experienced improvement and seven patients experienced exacerbation after admission. Significant differences were observed between the improved and exacerbated groups in the ALI (median, 47.6 vs. 13.2; P=0.011), frequency of chest radiograph abnormality (24.7 vs. 83.3%; P<0.001), and chest CT score (CCTS; median, 1 vs. 9; P<0.001). For the accuracy of predicting exacerbation, the receiver-operating characteristic curve analysis demonstrated an area under the curve of 0.79 and 0.92 for the ALI and CCTS, respectively. The combined ALI and radiologic risk prediction model had a sensitivity of 1.00 and a specificity of 0.81. Overall, ALI alone and CCTS alone modestly predicted the exacerbation of COVID-19, and the combined ALI and radiologic risk prediction model exhibited decent sensitivity and specificity.

Pulmonale &lt;i&gt;Mycobacterium-avium&lt;/i&gt;-Infektion: Beeinflusst eine Koinfektion mit anderen Erregern die Effektivität einer antimikrobiellen Therapie?

&lt;b&gt;Background:&lt;/b&gt; The impact of co-infection with other pathogenic microorganisms after initiation of treatment for &lt;i&gt;Mycobacterium avium&lt;/i&gt; complex pulmonary disease (MAC-PD) has not been clearly described. This study sought to clarify the clinical outcomes of co-infection with MAC after antimycobacterial therapy for MAC. &lt;b&gt;Methods:&lt;/b&gt; Co-infection status was defined as the detection of pathogenic microorganisms other than MAC in at least two consecutive sputum cultures 6–24 months after initiation of treatment. Chest computed tomography (CT) findings and culture results were compared between co-infection and MAC alone groups. &lt;b&gt;Results:&lt;/b&gt; The co-infection and MAC alone groups comprised 12 and 36 patients, respectively. The proportion of patients with sputum culture positive for MAC after 24 months of therapy did not differ significantly between the two groups [25% (3/12) vs. 16.7% (6/36); &lt;i&gt;p&lt;/i&gt; = 0.671]. The proportion of patients with improved chest CT score after 24 months of starting treatment compared to baseline was significantly lower for the co-infection group than for the MAC alone group [16.7% (2/12) vs. 79.4% (27/34); &lt;i&gt;p&lt;/i&gt; &amp;#x3c; 0.001]. In the co-infection group, median CT score values at 12 and 24 months did not differ from baseline. However, the MAC alone group showed significant improvement at 12 and 24 months compared with baseline. &lt;b&gt;Conclusions:&lt;/b&gt; In the patient group with co-infection of other pathogenic microorganisms after treatment initiation for MAC there was no impact on therapeutic efficacy compared to the MAC alone group. However, therapeutic intervention interfered with improvement in chest CT findings such as nodule formation, bronchiectasis, infiltration, and cavitary lesions.

Relationship of chest computed tomography score with disease severity and laboratory values in children with COVID-19.

Although chest computed tomography (CT) score has been well evaluated in adult coronavirus disease (COVID-19), its use in paediatric cases is insufficiently studied. Our aim is to evaluate the relationship of chest CT score with disease severity and laboratory parameters. Seventy-six paediatric patients with confirmed COVID-19 and chest CT evaluation on admission have been included in this study. Chest CT score was calculated for each of the five lobes considering the extent of anatomical involvement, as follows: 0: 0%; 1: <5%; 2: 5%-25%; 3: 26%-50%; 4: 51%-75% and 5: >75%. The resulting total CT score was the sum of each individual lobar score; the range was between 0 and 25. Total chest CT score was found to be positively correlated with alanine aminotransferase and d-dimer, and negatively correlated with lymphocyte count. In receiver operating characteristic analysis, total chest CT score had area under the curve 0.99 (95% confidence interval, 0.98-1.00) at cut-off 2 with 95% sensitivity and 96% specificity for the severe disease. Furthermore, in-depth analysis of lobar CT scores showed a correlation between left upper lobe with lymphocyte count, left lower lobe with d-dimer, right middle and lower lobes with alanine aminotransferase and right upper lobe with leukocyte count. There is a significant relationship between chest CT score and COVID-19 severity and laboratory findings in children. This suggests that chest CT scores can be used to assess the severity of the disease and can play an important role in paediatric clinical practice.

Role of Sodium Bicarbonate as Adjuvant Treatment of Nonsevere Computed Tomography-identified COVID-19 Pneumonia: A Preliminary Report

Background: Coronaviruses are classified as pH dependent. Alkaline media induced by sodium bicarbonate (SB) could impede viral entry into cells. We aimed to study the possible role of SB as an adjuvant treatment of nonsevere COVID-19 pneumonia. Methods: The study included 182 adults with confirmed nonsevere COVID-19 and chest computed tomography (CT) pneumonia; 127 assigned as study received conventional treatment plus adjuvant SB inhalation and nasal drops, as well as 55 assigned as control treated by conventional treatment only. Clinical and radiological assessments using chest CT score specific for COVID-19 were done at days 0 and 30. Results: Both the groups were comparable regarding demographic, clinical, and radiological characteristics. Clinical recovery was reported in 43/127 (33.9%) and 10/55 (18.2%) of the study and control groups, respectively (P = 0.03). The mean ± standard deviation time to clinical improvement was 3.31 ± 0.99 and 9.79 ± 6.29 days for the study and control groups, respectively (P

Correlation between Chest CT Score and Outcome of COVID-19 Patients: Experience from A COVID Hospital of Chattogram, Bangladesh

Background: Studies elsewhere in the world observed that, chest Computed Tomography (CT) scoring could help to stratify patient’s risk and predict short-term outcome of patients with COVID-19 pneumonia. But report from Bangladesh in this regard is in short supply. This study was aimed to investigate the relationship between the percentage of lung involvement as defined by CT scan score and outcome of COVID-19 patients admitted in a COVID dedicated hospital of Bangladesh.&#x0D; Materials and methods: This prospective observational study included 103 RTPCR confirmed COVID19 patients admitted in Chittagong Medical College Hospital (CMCH). All patients had a non-contrast HRCT scan done at presentation. Severity of CT score was categorized as Mild: score 7 or less, Moderate: score 8–17 and severe: score 18 or more. Outcome data in terms of oxygen requirement, length of hospital stay and in-hospital mortality were collected.&#x0D; Results: The mean age was 53.12 ± 12.69 years (58.3% males, 41.7% females). CT severity score was found to be positively correlated with clinical category of COVID-19. The oxygen requirements and length of hospital stay were increasing with the increase in scan severity. Multivariate analysis revealed that CT severity score was the only significant predictor for death (Odds ratio: 1.228; 95% CI:1.019-1.48).&#x0D; Conclusions: Our data suggest that chest CT scoring system can aid in predicting COVID-19 disease outcome and significantly correlates with oxygen requirements in a sample of Bangladeshi COVID-19 patients.&#x0D; JCMCTA 2021 ; 32 (1) : 78-82

Coronavirus Disease 2019 Phenotypes, Lung Ultrasound, Chest Computed Tomography and Clinical Features in Critically Ill Mechanically Ventilated Patients

Chest computed tomography (CT) may provide insights into the pathophysiology of coronavirus disease 2019 (COVID-19), although it is not suitable for a timely bedside dynamic assessment of patients admitted to intensive care unit (ICU); therefore, lung ultrasound (LUS) has been proposed as a complementary diagnostic tool. The aims of this study were to investigate different lungs phenotypes in patients with COVID-19 and to assess the differences in CT and LUS scores between ICU survivors and non-survivors. We also explored the association between CT and LUS, and oxygenation (arterial partial pressure of oxygen [PaO2]/fraction of inspired oxygen [FiO2]) and clinical parameters. The study included 39 patients with COVID-19. CT scans revealed types 1, 2 and 3 phenotypes in 62%, 28% and 10% of patients, respectively. Among survivors, pattern 1 was prevalent (p < 0.005). Chest CT and LUS scores differed between survivors and non-survivors both at ICU admission and 10 days after and were associated with ICU mortality. Chest CT score was positively correlated with LUS findings at ICU admission (r = 0.953, p < 0.0001) and was inversely correlated with PaO2/FiO2 (r = –0.375, p = 0.019) and C-reactive protein (r = 0.329, p = 0.041). LUS score was inversely correlated with PaO2/FiO2 (r = –0.345, p = 0.031). COVID-19 presents distinct phenotypes with differences between survivors and non-survivors. LUS is a valuable monitoring tool in an ICU setting because it may correlate with CT findings and mortality, although it cannot predict oxygenation changes.

A simple chest CT score for assessing the severity of pulmonary involvement in COVID-19

BackgroundA major role of CT in COVID-19 pneumonia is to assess disease severity and progress. In this study, we aimed to assess the validity, reliability, and survival outcomes of simple chest computed tomography (CT) score in the evaluation of the severity of lung involvement in coronavirus disease 2019 (COVID-19) compared with the current chest CT score.ResultsThis retrospective analysis included 213 patients (121 men and 92 women; mean age, 46 ± 15.6 years; range, 1–85 years). The ROC curve was used to compare the validity of both scores. Interreader agreement (IRA) for both scores was calculated using Cohen’s kappa statistic. The survival analysis of both scores was investigated using the Kaplan–Meier survival analysis. The simple score showed a comparable validity with the current score (AUC = 0.89 and 0.90, respectively; p = 0.61). The ROC analysis demonstrated that a simple score of > 3 and a current score of > 12 were potential predictors of death with sensitivity values of 81.8% and 86.4% and specificity values of 96.3% and 93.7%, respectively. The simple score showed a higher IRA compared with the current score (κ = 0.645 and 0.458, respectively). Both scores were comparable for predicting survival outcomes.ConclusionThe simple score was non-inferior for predicting survival outcome, compared with the current chest CT score. Furthermore, we suggest that the simple score should be used as it is simpler and more consistent.

Predicting the outcome in confirmed COVID-19 patients with coronary artery disease: a key role for the first chest computed tomography

BackgroundSerial chest computed tomography (CT) scans are used to detect coronavirus disease 2019 (COVID-19) pneumonia and monitor the disease course. This study investigates relationship between total severity score by first chest CT and the outcome of coronavirus COVID-19 patients with coronary artery disease (CAD).ResultsA total of 48 patients with a history of CAD (mean age=60.83±3.06 years, 75% male) with positive real-time reverse transcription-polymerase chain reaction for COVID-19 were included. Outcome was defined as acute respiratory distress syndrome or death. The unadjusted and adjusted effects of the CT score on the outcome were reported through odds ratio (OR) with 95% confidence interval (CI). Outcome occurred in 17 (35.5%) patients (8 deaths). The CT score was directly and significantly correlated with the outcome in the univariate analysis (OR 1.38, 95% CI 1.12–1.70; P=0.003) and remained significant after adjustment for diabetes, hypertension, body mass index, and serum level of highly sensitive C-reactive protein (OR 1.51, 95% CI 1.11–2.05; P=0.009). Outcome rate was 24.1% in patients with a CT score <2.5, whereas it was 8.3% in patients with a CT score>2.5.ConclusionsThe first chest CT score could be a robust predictor of adverse events in confirmed COVID-19 patients with coronary artery disease.

The Predictive Values of Respiratory Rate Oxygenation Index and Chest Computed Tomography Severity Score for High-Flow Nasal Oxygen Failure in Critically Ill Patients with Coronavirus Disease-2019.

Background:The prediction of high-flow nasal oxygen (HFNO) failure in patients with coronavirus disease-2019 (COVID-19) having acute respiratory failure (ARF) may prevent delayed intubation and decrease mortality.Aims:To define the related risk factors to HFNO failure and hospital mortality.Study Design:Retrospective cohort study.Methods:To this study, 85 critically ill patients (≥18 years) with COVID-19 related acute kidney injury who were treated with HFNO were enrolled. Treatment success was defined as the de-escalation of the oxygenation support to the conventional oxygen therapies. HFNO therapy failure was determined as the need for invasive mechanical ventilation or death. The patients were divided into HFNO-failure (HFNO-F) and HFNO-success (HFNO-S) groups. Electronic medical records and laboratory data were screened for all patients. Respiratory rate oxygenation (ROX) index on the first hour and chest computed tomography (CT) severity score were calculated. Factors related to HFNO therapy failure and mortality were defined.Results:This study assessed 85 patients (median age 67 years, 69.4% male) who were divided into two groups as HFNO success (n = 33) and HFNO failure (n = 52). The respiratory rate oxygenation (ROX) was measured at 1 hour and the computed tomography (CT) score indicated HFNO failure and intubation, with an area under the receiver operating characteristic of 0.695 for the ROX index and 0.628 for the CT score. A ROX index of <3.81 and a CT score of >15 in the first hour of therapy were the predictors of HFNO failure and intubation. Age, Acute Physiology and Chronic Health Evaluation II score, arterial blood gas findings “(i.e., partial pressure of oxygen [PaO2], PaO2 [fraction of inspired oxygen]/SO2 [oxygen saturation] ratio)”, and D-dimer levels were also associated with HFNO failure; however, based on logistic regression analysis, a calculated ROX on the first hour of therapy of <3.81 (odds ratio [OR] = 4.78, 95% confidence interval [CI] = 1.75–13.02, P = 0.001) and a chest CT score of >15 (OR = 2.83, 95% CI = 1.01–7.88, P = <0.001) were the only independent risk factors. In logistic regression analysis, a ROX calculated on the first hour of therapy of <3.81 (OR = 4.78, [95% CI = 1.75–13.02], P = 0.001) and a chest CT score of >15 (OR 2.83, 95% CI = 1.01–7.88, P = <0.001) were the independent risk factors for the HFNO failure. The intensive care unit and hospital mortality rates were 80.2% and 82.7%, respectively, in the HFNO failure group.Conclusion:The early prediction of HFNO therapy failure is essential considering the high mortality rate in patients with HFNO therapy failure. Using the ROX index and the chest CT severity score combined with the other clinical parameters may reduce mortality. Additionally, multi-centre observational studies are needed to define the predictive value of ROX and chest CT score not only for COVID-19 but also other causes of ARF.

Impact of COVID-19 infection on liver and alimentary tract: clinical insight.

Aim of the studyOur aim was to evaluate the impact of COVID-19 infection on the liver and alimentary tract.Material and methodsThis is a retrospective multicenter study that was performed in non-intensive care units (ICU) at Minia, Assiut, and Sohag University Hospitals from March 1st, 2020 to August 1st, 2020. The clinical characteristics of 1238 consecutively confirmed COVID-19 discharged cases were enrolled. Patients with respiratory distress were recorded as severe cases, while others were recorded as mild-moderate cases. Patients with ≥ 2× upper limit of normal of alanine aminotransferase (ALT), aspartate aminotransferase (AST), or bilirubin were defined as patients with liver injury, while others were recorded as patients without liver injury.ResultsThe severe group included 460 patients (37.2%) while the mild-moderate group included 778 patients (62.8%). Fever, white blood cell (WBC) and C-reactive protein (CRP) levels were significantly higher in the severe group (p < 0.05). The hepatic injury group included 296 patients (23.9%) while the group without hepatic injury included 942 patients (76.1%). Males were more likely to have liver injury (p < 0.05). Fever and abdominal pain were significantly higher in the hepatic injury group. Patients with liver injury had increased levels of WBCs, CRP and chest computed tomography (CT) score and had a longer hospital stay (p < 0.05). Chest CT score was a predictor of liver injury (p < 0.05).ConclusionsLiver injury in non-ICU hospitalized COVID-19 patients is common but it is mild and has a good prognosis. Liver injury may be related to the degree of chest CT lesions.

Prediction of an increase in oxygen requirement of SARS-CoV-2 pneumonia using three different scoring systems

IntroductionIn patients with severe coronavirus disease 2019 (COVID-19), respiratory failure is a major complication and its symptoms occur around one week after onset. The CURB-65, A-DROP and expanded CURB-65 tools are known to predict the risk of mortality in patients with community-acquired pneumonia. In this retrospective single-center retrospective study, we aimed to assess the correlations of the A-DROP, CURB-65, and expanded CURB-65 scores on admission with an increase in oxygen requirement in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia. MethodsWe retrospectively analyzed 207 patients who were hospitalized with SARS-CoV-2 pneumonia at the Self-Defense Forces Central Hospital in Tokyo, Japan. Performance of A-DROP, CURB-65, and the expanded CURB-65 scores were validated. In addition, we assessed whether there were any associations between an increase in oxygen requirement and known risk factors for critical illness in COVID-19, including elevation of liver enzymes and C-reactive protein (CRP), lymphocytopenia, high D-dimer levels and the chest computed tomography (CT) score. ResultsThe areas under the curve for the ability of CURB-65, A-DROP, and the expanded CURB-65 scores to predict an increase in oxygen requirement were 0.6961, 0.6980 and 0.8327, respectively, and the differences between the three groups were statistically significant (p < 0.001). Comorbid cardiovascular disease, lymphocytopenia, elevated CRP, liver enzyme and D-dimer levels, and higher chest CT score were significantly associated with an increase in oxygen requirement ConclusionsThe expanded CURB-65 score can be a better predictor of an increase in oxygen requirement in patients with SARS-CoV-2 pneumonia.

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

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.

Relationship of chest CT score with clinical characteristics of 108 patients hospitalized with COVID-19 in Wuhan, China

BackgroundIn December 2019, the outbreak of a disease subsequently termed COVID-19 occurred in Wuhan, China. The number of cases increased rapidly and spread to six continents. However, there is limited information on the chest computed tomography (CT) results of affected patients. Chest CT can assess the severity of COVID-19 and has sufficient sensitivity to assess changes in response to glucocorticoid therapy.ObjectiveAnalyze COVID-19 patients to determine the relationships of clinical characteristics, chest CT score, and levels of inflammatory mediators.MethodsThis retrospective, single-center case series of 108 consecutive hospitalized patients with confirmed COVID-19 at Tongji Hospital, Tongji Medical College of HUST (Wuhan, China) examined patients admitted from January 28 to February 20, 2020. Patient demographics, comorbidities, clinical findings, chest CT results, and CT scores of affected lung parenchyma were recorded. The relationships between chest CT score with levels of systemic inflammatory mediators were determined.ResultsAll patients exhibited signs of significant systemic inflammation, including increased levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin, chest CT score, and a decreased lymphocyte (LY) count. Chest CT score had positive associations with white blood cell (WBC) count, CRP, ESR, procalcitonin, and abnormal coagulation function, and a negative association with LY count. Treatment with a glucocorticoid increased the LY count, reduced the CT score and CRP level, and improved coagulation function.ConclusionsCOVID-19 infection is characterized by a systemic inflammatory response that affects the lungs, blood, digestive system, and circulatory systems. The chest CT score is a good indicator of the extent of systemic inflammation. Glucocorticoid treatment appears to reduce systemic inflammation in these patients.