CT Severity Score Research Articles

Role of D-Dimer in Covid-19 pneumonia: sensitive marker of inflammation, predictor of mechanical ventilation, thromboembolic events and early marker of post covid-lung fibrosis; Prospective Multicentric, Observational, Interventional study in tertiary care setting in India

Introduction: Covid-19 pneumonia is heterogeneous disease with variable effect on lung parenchyma, airways and vasculature leading to long term effects on lung functions. Materials and methods: Multicentric, prospective, observational and interventional study included 1000 covid-19 cases confirmed with RT PCR. All cases were assessed with HRCT thorax, oxygen saturation, inflammatory marker as D-Dimer at entry point and follow up. Age, gender, Comorbidity and use BIPAP/NIV and outcome as with or without lung fibrosis were key observations. In selected cases, lower limb venous doppler and CT pulmonary angiography to rule out DVT or PTE. Statistical analysis is done by using Chi square test. Observations and analysis: Age (<50 and >50 years) and gender (male versus female) has significant association with D-Dimer level. [p<0.00001] & [p<0.010] respectively. CT severity score at entry point with D-Dimer level has significant correlation. [p<0.00001] D-Dimer level has significant association with duration of illness prior to hospitalization. [p<0.00001] Comorbidities have significant association with D-Dimer level. [p<0.00001] D-Dimer level has significant association with oxygen saturation. [p<0.00001] BIPAP/NIV requirement has significant association with D-Dimer level. [p<0.00001] Timing of BIPAP/NIV requirement during hospitalization has significant association with DDimer level. [p<0.00001] Follow-up D-Dimer titer during hospitalization as compared normal & abnormal to entry point level has significant association with post-covid lung fibrosis, deep vein thrombosis and pulmonary thromboembolism. [p<0.00001]. Conclusion: D-Dimer has documented very crucial role in covid-19 pneumonia in predicting severity of illness and assessing response to treatment during hospitalization and follow up titers have significant role in step-up or step-down interventions in critical care setting.

LHSPred: A web based application for predicting lung health severity

Background and objectivesThe computed tomography (CT) scan facilities are crucial for diagnosis of pulmonary diseases and are overburdened during the current pandemic of novel coronavirus disease 2019 (COVID-19). LHSPred (Lung Health Severity Prediction) is a web based tool that enables users to determine a score that evaluates CT scans, without radiologist intervention, and predict risk of pneumonia with features of blood examination and age of patient. It can help in early assessment of lung health severity of patients without CT-scan results and also enable monitoring of post-COVID lung health for recovered patients. MethodsThis tool uses Support Vector Regression (SVR) and Multi-Layer Perceptron Regression (MLPR), trained on COVID-19 patient data reported in the literature. It allows to compute a score (CT severity score) that evaluates the involvement of lesions in lung lobes and to predict risk of pneumonia. A web application was implemented that uses the trained regression models. ResultsThe application has proven to be effective and user friendly in a clinical setting for pulmonary disease treatment. The SVR model achieved Pearson correlation coefficient (PCC) of 0.77 and mean absolute error (MAE) of 2.239 while determining the computed tomography (CT) severity score. The MLPR model achieved PCC of 0.77 and MAE of 2.309. Thus, it can be applied as a useful tool in predicting pneumonia in the post COVID-19 era. ConclusionLHSPred can be used as a decision support system by the clinicians and as a tool for self-assessment by the patients with only six blood test input features.

Evaluation of Covid Severity in Diabetic vs Non-Diabetic Individuals using CT Severity Score

Background/Objectives: The Corona virus disease 2019 (Covid 19) pandemic has emerged as a great challenge to healthcare system with high rate of hospitalization and deaths. People with co morbidities such as diabetes are at increased risk of complications and Covid 19 associated deaths. The present study was done to evaluate Covid 19 severity among diabetic and nondiabetic patients using Chest CT severity score. Methods: A total of 106 Patients were subjected to standardized High Resolution Computed Tomography (HRCT) chest imaging. The analyzed images and Computed Tomography (CT) severity score was grouped into mild, moderate, severe and no lung involvement in both diabetic and nondiabetic group. Findings: Among the diabetic patients 39.47% showed CT severity score of 15-25 compared to 8.82% in nondiabetic patients. Lung involvement was observed in 89.47% diabetic compared to 88.24% nondiabetic patients. Novelty: Diffuse ground glass opacity involving all the lobes was observed among poorly controlled diabetic patients whereas patch ground glass opacity was observed among nondiabetic group. By chest CT severity scoring, the severity of lung involvement due to Covid 19 in Diabetes mellitus patients was found to be greater (39.47%) when compared to nondiabetic individual (8.82%). Keywords: Computed Tomography chest imaging; Computed Tomography severity score; Diabetes mellitus; Lung involvement; Covid 19 severity

MO145: Chest CT Total Severity Score on Admission to Predict In-Hospital Mortality in Patients with Acute and Chronic Renal Impairment with COVID-19 Infection

BACKGROUND AND AIMSCOVID-19 is an infection that has spread widely and quickly over the world, resulting in a pandemic with substantial consequences for the sociopolitical environment and healthcare delivery systems. The aim of this study was to explore the clinical, laboratory characteristics and chest CT severity score in patients with renal impairment who died with COVID-19 infection.METHODThis retrospective study examined the electronic clinical and laboratory data of consecutive patients aged 18 years and older, with serum creatinine > 2 mg/dL who tested positive for COVID-19 and admitted to Mansoura University Hospital between June 2020 and May 2021. CT scans of the chest were retrospectively examined by one reviewer with 10 years’ experience in thoracic imaging for the following characteristics based on the Fleischner Society Nomenclature recommendations: ground-glass opacity (GGO), consolidation, nodules, crazy-paving pattern, subpleural lines, bronchial wall thickening, lymph node enlargement and pleural effusion. We attempted to measure the magnitude of the abnormalities by the total severity score to assess the severity of lung parenchymal involvement. The total severity score was primarily a numeric score that assessed the existence of GGOs, consolidation or mixed GGOs in each of the five lobes of both lungs. Each lobe will be rated from 0 to 4 points based on the percentage of the involved lobe: (0) = 0%, (1) = 1–25%, (2) = 26–50%, (3) = 51–75% or (4) = 76–100%. The overall score, which varies from 0 to 20, is the sum of the points from each lobe. Death events were collected, and the ROC curve analysis for CT severity score was used to determine the best cutoff that predict mortality.RESULTSOf a total 100 patients, 54 were males, with a mean age of 60 ± 15 years. Sixty patients died. Mortality was higher in those with acute renal impairment (P = .033) than chronic kidney disease. Non-survivors had higher respiratory rate (P = .000), C-reactive protein (CRP) (P = .003), ICU admission (P = .000), oxygen supply needs (P = .005), pulmonary consolidation (P = .000) and crazy paving pattern (P = .000). Furthermore, non-survivors had higher CT chest total severity score (P = .000). Univariate regression analysis showed increasing odds of in-hospital mortality associated with increased respiratory rate (OR 1.149, 95% CI 1.057–1.248, P = .001), total bilirubin (OR 2.532, 95% CI 1.099–5.836, P = .029), lactate dehydrogenase (OR 1.001, 95% CI 1.000–1.003, P = .018), CRP (OR 1.010, 95% CI 1.002–1.017, P = .012), invasive mechanical ventilation (OR 7.667, 95% CI 2.118–27.755, P = .002), predominant pattern of pulmonary consolidation (OR 21.714, 95% CI 4.799–98.261, P = .000) and high CT chest total severity score (OR 2.082, 95% CI 1.579–2.745, P = .000) . The optimum cut-off value of CT chest total severity score to predict in-hospital mortality was 8.5 with a sensitivity of 86.7% and a specificity of 87.5% (Figure 1).FIGURE 1:ROC curve for CT chest total severity score sensitivity and specificity to predict mortality in patients with renal impairment with COVID-19 infection.CONCLUSIONIn-hospital mortality is high in patients with renal impairment with COVID-19 infection especially those with acute renal impairment. High bilirubin, predominant pattern of pulmonary consolidation and CT chest total severity score are the most significant predictors of mortality in these patients. CT chest total severity score on admission ≥8.5 could effectively predict in-hospital mortality in these patients.

Short term impact of COVID-19 pneumonia in patients with reduced left ventricular ejection fraction (LVEF)

Abstract Funding Acknowledgements Type of funding sources: None. Background The coronavirus disease 2019 (COVID-19) is mainly a respiratory disease potentially leading to acute respiratory distress syndrome but can have multiple system involvement. Data pertaining to cardiac sequalae is of urgent importance to define subsequent cardiac surveillance. Purpose To describe the short-term impact of COVID-19 pneumonia in patients with reduced Left ventricular ejection fraction (LVEF). Methods This single center, prospective observational study included 141 RT-PCR confirmed COVID-19 patients who had reduced ejection fraction on echocardiography quantitively assessed by modified Simpson’s method. The study group were divided into three groups based on the ejection fraction: 34 patients had mild left ventricular (LV) dysfunction (LVEF>41-50%), 50 patients had moderate left ventricular dysfunction (LVEF=31-40%) and 57 patients had severe left ventricular dysfunction (LVEF <30%). Demographics, clinical characteristics, in hospital events and clinical sequelae of survivors during 6 months follow up period were analyzed. Results Mean age of the study population was 60.22± 12.53 years.71.6% were males and 28.3% were females. Average length of hospital stay in the study group was 10.93±6.9 days. Patients with mild LV dysfunction had longer hospital stay (13.65± 7.09 days) than patients with moderate LV dysfunction (10.90±6.05 days) and patients with severe LV dysfunction (9.33±6.83 days) (p=0.01). Patients with severe LV dysfunction had higher Interleukin-6 levels (IL-6) and BNP levels in comparison to other groups.50% of patients with severe LV dysfunction required invasive ventilation during the course of hospital stay, while it was 20.6% in patients with mild LV dysfunction and 32% in patients with moderate LV dysfunction. 63% of patients with severe left ventricular dysfunction expired in the study period compared to 26.4% of patients with mild LV dysfunction and 40% of patients with moderate LV dysfunction (P=0.001). Patients with severe LV dysfunction had increased major adverse cardiac events in 6 months follow up compared to patients with mild and moderate LV dysfunction. Patients with severe LV dysfunction had increased in hospital mortality (40%) compared to patients with mild LV dysfunction (20%) and patients with moderate LV dysfunction (32%). Patients with higher levels of IL-6 (OR: 1.004, 95% CI: 1.002-1.01, P<0.001), procalcitonin (OR: 1.24, 95% CI: 1.07-1.44, P=0.004) and CT severity score (OR1.21, 95% CI: 1.13-1.28, P<0.01) are independent predictors of mortality in the study population. Conclusion Patient with reduced ejection fraction (LVEF <30%) have a poor 6 month outcome after COVID 19 pneumonia.

To Study the Correlation of CT Severity Score with Oxygen Saturation and Inflammatory Biomarkers in Patients with Covid -19 Infection

To Study the Correlation of CT Severity Score with Oxygen Saturation and Inflammatory Biomarkers in Patients with Covid -19 Infection

Measurement of Tracheobronchial Angles of COVID-19 Patients on Computed Tomography and Correlation with Pneumonia Severity in Turkish Population

Aim: This study aimed to evaluate the values of tracheobronchial angles on computed tomography (CT) and to investigate the relationship between angles and CT severity scores (CT-SS) of coronavirus disease 2019 (COVID-19) patients. There is no available literature measuring tracheobronchial angles of adult COVID-19 patients and investigating the relationship of angles with pneumonia severity. Material and Methods: This study was a single-center retrospective analysis of 92 RT-PCR positive patients, aged between 18-40 years, who underwent CT between May and October 2020. The right bronchial angles (RBA), left bronchial angles (LBA), subcarinal angles (SCA), and interbronchial angles (IBA) were measured by a radiologist on coronal CT images with the measurement model used in past. CT-SS was calculated by using a visual scoring system with a global score of 0-25. Results: Thirty-seven (40.2%) patients had normal CT imaging and 55 (59.8%) patients had pulmonary involvement. The CT-SS were ranged from 0 to 24, with a median value of 2.5. The mean IBA was calculated as 81.67±15.20°, mean SCA 77.65±15.78°, mean RBA 39.26±7.51°, and mean LBA 43.35±8.43°. No statistically significant difference was found in SCA, IBA, RBA, and LBA between the groups with and without COVID-19 pneumonia (p=0.277, p=0.389, p=0.218, and p=0.227, respectively). Also, no significant correlation was found between tracheobronchial angles and pneumonia CT-SS of the patients. Conclusion: We calculated the distribution range of tracheobronchial angle values in the adult Turkish COVID-19 patients. According to our study, tracheobronchial angles don’t affect the disease severity and clinical outcome of COVID-19 patients.

Role of Computed Tomography in Diagnosis and Assessment of Disease Severity in Covid 19; Trends in Pakistan

Objective: To observe and compare relationship of High Resolution Computed Tomography severity score with presenting symptoms of COVID-19 positive patients in mild, moderate and severe disease and to analyze the trends of morbidity and mortality in Pakistan. Study Design: Retrospective Observational study Subjects and Methods: All OPD and admitted adult male and female patients serially presented to Fatima Memorial and Sir Ganga Ram Hospital Lahore with positive COVID PCR test or clinical symptoms were included in the study. These patients were classified in three groups; Group I: Mild disease, i.e. symptomatic patients who didn’t need hospital admission or oxygen support. Group II: Moderate disease, i.e. patients having oxygen saturation more than 90% & needing oxygen support at times, and Group III: severe disease, i.e. patients needing hospital admission or ventilator support and having oxygen saturation less than 90%. High resolution chest CT scan was the approach in all cases. CT severity score was used to assess the severity of lung parenchymal involvement by COVID-19 on all the HRCT. Data collected was entered and analysis made using SPSS v 25. Results: Total number of patients were 200(100%) with age ranging from 14-85 years and mean age was 49.5+ 5 years, out of which 135(67%) were males and 65(32%) were females with male to female ratio 2:1. HRCT scans of all patients were done with COVID PCR test positive in 146(73%) patients. Group I had 98(49%) patients, 87(43.5%) patients were included in Group II and 15(7.5%) patients in Group III. Oxygen was required in 78(39%) patients from group II and 14(7%) patients from severe disease required ventilator. Conclusion: Our research work presented the trends of CT severity scoring having positive correlation to clinical symptoms of patients. Moreover, most of the patients in our country were having mild and moderate disease and only 7% patients showed severe disease symptoms and CT scoring in our study. Out of those severe disease patients, mortality was only 1% as compared to 2.89% mortality reported in Iran. Keywords: COVID-19 infection, HRCT Chest, Severity score

Making the best use of CT Quantification Scores in Management of COVID-19 Patients

Because of the primary involvement of the respiratory system, chest computed tomography (CT) is strongly recommended in suspected COVID-19 cases, for both initial evaluation and follow-up [1]. At least seven scoring systems using chest CT have been proposed to quantify lung involvement in COVID-19 which are summarized in table 1 [1-10] and we use the term CT severity score (CTSS) to refer to them with numbers 1-7 to refer to a specific scoring system.

Prediction of SARS-CoV-2-Related Lung Inflammation Spreading by V:ERITAS (Vanvitelli Early Recognition of Inflamed Thoracic Areas Spreading).

Background Coronavirus disease 2019 (COVID-19) can be complicated by interstitial pneumonia, possibly leading to severe acute respiratory failure and death. Because of variable evolution ranging from asymptomatic cases to the need for invasive ventilation, COVID-19 outcomes cannot be precisely predicted on admission. The aim of this study was to provide a simple tool able to predict the outcome of COVID-19 pneumonia on admission to a low-intensity ward in order to better plan management strategies for these patients. Methods The clinical records of 123 eligible patients were reviewed. The following variables were analyzed on admission: chest computed tomography severity score (CTSS), PaO2/FiO2 ratio, lactate dehydrogenase (LDH), neutrophil to lymphocyte ratio (NLR), lymphocyte to monocyte ratio, C-reactive protein (CRP), fibrinogen, D-dimer, aspartate aminotransferase (AST), alanine aminotransferase, alkaline phosphatase, and albumin. The main outcome was the intensity of respiratory support (RS). To simplify the statistical analysis, patients were split into two main groups: those requiring no or low/moderate oxygen support (group 1); and those needing subintensive/intensive RS up to mechanical ventilation (group 2). Results The RS intensity was significantly associated with higher CTSS and NLR scores; lower PaO2/FiO2 ratios; and higher serum levels of LDH, CRP, D-dimer, and AST. After multivariate logistic regression and ROC curve analysis, CTSS and LDH were shown to be the best predictors of respiratory function worsening. Conclusions Two easy-to-obtain parameters (CTSS and LDH) were able to reliably predict a worse evolution of COVID-19 pneumonia with values of >7 and >328 U/L, respectively.

A retrospective study of association of CT severity with clinical profile and outcomes of patients with COVID-19 in the second wave

ObjectivesThis study aimed to find out the association of CT severity score with demographic and clinical characteristics as well as mortality in the patients who were confirmed to have COVID-19 disease in the second wave.Material and MethodsThis retrospective study included collection and assessment of the demographic, clinical, laboratory data, and mortality of the patients, suspected with COVID-19 infection who underwent chest HRCT scan during March to April 2021. The findings of the chest HRCT were retrieved manually from the Medical Records section. Determination of the severity was done by the scoring system that involved the visual evaluation of the affected lobes.ResultsCT severity score was mild, moderate, and severe in 21.94%, 41.60%, and 30.48% patients, respectively. Mortality rate was 5.70%. Age of the patients with mild, moderate, and severe CT severity score was significantly more than those with normal severity score (50 vs. 50 vs. 50 vs. 31, P=0.0009). When compared to patients with normal score, those with mild, moderate, and severe CT severity score had significantly higher dyspnoea (10.39% vs. 67.81% vs. 97.20% vs. 0%), significantly more cases with diabetes mellitus (16.88% vs. 25.34% vs. 31.78% vs. 9.52%, P=0.044), hypertension (27.27% vs. 21.23% vs. 32.71% vs. 4.76%, P=0.026), and obesity (6.49% vs. 8.90% vs. 23.36% vs. 0%, P=0.0005). Total leucocyte counts, absolute neutrophil counts, creatinine, serum glutamic pyruvic transaminase (SGPT), lactate dehydrogenase (LDH), ferritin, and D-dimer were deranged in significantly more patients of severe score (53.27%, 62.62%, 60.75%, 85.05%, 90.65%, 97.20%, and 95.35%, respectively). Interleukin-6 (IL-6) and C-reactive protein were deranged in significantly more patients with moderate disease (98.18% and 98.63%, respectively). Increasing severity scores were associated with increased mortality (mild vs. moderate vs. severe: 1.30% vs. 1.37 vs. 15.89%, P<.0001). Oxygen saturation (SpO2) was significantly lowest in severe score followed by moderate, mild and normal scores (87 vs. 90 vs. 96 vs. 97, P<.0001). Duration of non-rebreather mask (NRBM), noninvasive ventilation (NIV), high-flow nasal cannula (HFNC), Venture/face mask, and intubation was also associated with increasing severity scores (P<0.0001).ConclusionCT scans play an important role in guiding physicians with their management plans and can serve as a predictor of disease severity and outcomes.

Computed Tomography Severity Scoring on High-Resolution Computed Tomography Thorax and Inflammatory Markers With COVID-19 Related Mortality in a Designated COVID Hospital.

IntroductionRadiological Society of the Netherlands introduced the coronavirus disease 2019 (COVID-19) Reporting and Data System (CO-RADS) and the corresponding CT severity score (CTSS) to diagnose COVID-19 severity. However, data regarding the same is very limited.ObjectivesThe objective of this study was to correlate the computed tomography severity scoring (CTSS) on high-resolution computed tomography (HRCT) thorax and inflammatory markers with COVID-19 related mortality.MethodsA retrospective observational study was conducted in a tertiary center between June 2020 to May 2021 among 2343 adult patients at the department of radio-diagnosis with suspected and confirmed COVID-19 cases who received an HRCT thorax. Data was collected retrospectively from the records regarding age, sex, and information regarding inflammatory markers such as C-reactive protein (CRP), ferritin, lactate dehydrogenase (LDH), erythrocyte sedimentation rate (ESR), D-dimer, and neutrophil-to-lymphocyte ratio. Information on HRCT thorax of patients was reviewed for radiological suspicion of COVID-19 related lung changes using CO-RADS scoring and severity of lung involvement using CT-severity scoring. Data was analyzed using SPSS version 22 (IBM Inc., Armonk, New York).ResultsThe mean age was 51.69 ± 16.02 years, and most of the study participants were male (1592, 67.95%). The majority (999, 42.64%) had diabetes as a comorbidity. The reverse transcription polymerase chain reaction (RT-PCR) test was positive in 1571 (67.05%) participants. The majority (1571, 67.05%) had a CO-RADS score of six, and only 150 (6.40%) had CO-RADS score of four. The CT severity score was normal in 147 (6.27%), mild in 724 (30.90%), moderate in 903 (38.54%), and severe in 569 (24.29%) participants. The CRP levels were moderate in 1200 (51.22%) and severe in 428 (18.27%) participants. The mean ferritin, D-dimer and interleukin-6 (IL-6) levels were 321.83 ± 266.42 ng/ml, 1.51 ± 0.85mg/l, and 323.05 ± 95.52pg/ml, respectively. The mean length of hospital stay was 10.25 ± 6.52 days. Most of them (1926 out of 2343, 82.20%) survived, and nearly 417 out of 2343 (17.80%) died. Out of 2343, 569 participants had severe CT severity scores, out of which 205 (36.03%) died, and 364 (63.97%) participants survived.ConclusionA positive correlation was found between CT severity scoring on HRCT thorax and inflammatory markers with COVID-19 related mortality and can be used in early diagnosis and timely management of COVID-19 positive patients.

CT severity score: an imaging biomarker to estimate the severity of COVID-19 pneumonia in vaccinated and non-vaccinated population

BackgroundIn India, two vaccines received emergent use authorization, namely Covishield (a brand of the Oxford—Astra Zeneca vaccine manufactured by the Serum institute of India) and Covaxin (developed by Bharat Biotech) against COVID-19 disease. Chest CT is an objective way to assess the extent of pulmonary parenchymal involvement. This study aims to estimate the disease severity and outcome due to COVID-19 among vaccinated and non-vaccinated symptomatic patients and compare the same in Covishield versus Covaxin recipients using CT severity score.ResultsA total of 306 patients were retrospectively evaluated. The mean age was 62.56 ± 8.9 years, and males [n-208 (67.97%)] were commonly affected. Of 306 patients, 143 were non-vaccinated (47%), 124 were partially vaccinated (40%), and 39 were completely vaccinated (13%). CT severity scores were reduced in both Covishield and Covaxin recipients in comparison with the non-vaccinated group [χ2 (2) = 16.32, p < 0.001]. There is a reduction in LOS among the vaccinated group, predominantly among the Covishield recipients.ConclusionVaccination confers protection from severe SARS-CoV2 infection and is associated with an overall reduction in mortality.

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.

Presentation of COVID 19 Patients: An Experience at Military Hospital Rawalpindi

Objective: The objective of this study is to document the initial presentation of COVID 19 cases reporting to hospital.Study Design: Cross sectional study.Place and Duration of Study: The study was carried out at COVID-19 ward of Tertiary care hospital, Rawalpindi from May to June 2020.Materials and Methods: This study was conducted on 647 patients admitted at COVID-19 ward. Data was collected from the patient’s presenting complaints, history taking, examination, charts, treatment and nursing records. Pattern of clinical presentation was taken as the presenting symptoms and signs of the patients. They were grouped as mild, moderate and severe by chest computed tomography severity score. The data was presented as frequency distribution tables.Results: Out of 647 patients 84% were male while 16% were females.48.5% of the cases were asymptomatic while 41.5% cases were having symptoms. The most common clinical presentation was fever (38%) followed by dry cough (32.9%), fatigue (31.1%), productive cough (25.3%) and headache (24.7%). Majority of the patients (71.8%) presented with mild severity on HRCT.Conclusion: This study gives the insight into the clinical picture of the patients presenting with COVID-19. Majority of the patients presented with the mild to moderate severity. Many patients being asymptomatic are overlooked and become carrier for COVID-19 Disease.&#x0D; How to cite this: Siddiqui FA, Hassan N, Sehar B, Khan JA, Asmat F. Presentation of COVID 19 Patients: An Experience at Military Hospital Rawalpindi. Life and Science. 2022; 3(2): 65-69. doi: http://doi.org/10.37185/LnS.1.1.213&#x0D; This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited

An Analytical Study to Determine the Severity of COVID-19 Among Smokers.

IntroductionIn December of the year 2020, the SARS-CoV-2 virus was discovered in Wuhan, China. It extended to over 180 nations around the world. It can manifest in patients who are asymptomatic to those who are symptomatic, with symptoms ranging from anosmia to severe respiratory distress syndrome. It affects both men and women. The existence of comorbidity is also linked to a significant worsening of the infection. Despite the fact that the principal consequences of coronavirus disease 2019 (COVID-19) damage the lungs, the prevalence of current smokers among COVID-19 hospitalized patients has repeatedly been observed to be lower than the prevalence of smokers in the general community. As a result, the evidence from various studies appears to cast doubt on active smoking as a risk factor for COVID-19 pneumonia. Thus, with this background, this study has been conducted with the aim of assessing the influence of smoking as a risk factor for COVID-19 mortality.MethodologyAn observational study was conducted in a tertiary care center in Tamil Nadu for a period of three months (April 2021 to June 2021). The study participants were all the patients admitted to the COVID-19 ward of the department of general medicine during the study period. Those who were not willing to participate in the study were excluded. The questionnaire contains variables including socio-demographic characteristics, vitals, and investigations, and the outcome variable was death due to COVID-19. The data obtained were entered in Microsoft Excel (Microsoft Corporation, Redmond, WA) and the results were analyzed using SPSS version 21 (IBM Corp., Armonk, NY).ResultsAbout 401 individuals participated in the study. The mean age, COVID-19 Reporting and Data System (CO-RADS) score, and CT severity score of the study participants were 50 years, 4.91, and 10.61, respectively. About 63.3% of participants were males, about 92% have not been vaccinated, about 91.8% have a CO-RADS score of 5, about 45.1% were smokers, and about 15.7% have died despite effective treatment. When looking for adverse outcomes, being male (p = 0.047), non-vaccinated for COVID-19 (p = 0.042), and being a smoker (p = 0.008) were the factors that showed statistical significance.ConclusionThe mortality due to COVID-19 is high among smokers than non-smokers with statistical significance. Thus, before admitting COVID-19 patients, to classify the patients as mild, moderate, and severe, the risk factor of the habit of smoking can be added. Cigarette smoke is harmful to the lungs in a variety of ways, and further research is needed to understand why there is such a low proportion of current smokers among COVID-19 patients in hospitals. The impact of current smoking on SARS-CoV-2 infection is a delicate and complex topic that should be thoroughly investigated before sending out potentially misunderstood signals.

Association of HRCT severity score, pre-existing comorbidities, and ABO blood group with treatment outcomes of COVID-19 patients admitted in a hospital of Western Nepal

Background: Although many studies have reported the association of different factors with the severity of coronavirus disease (COVID) patients, no concrete scientific conclusions have been reported till date. Aim and Objective: This study aimed to conduct a prospective analysis on different factors associated with the severity and outcome of the COVID-19 patients. Materials and Methods: The study was conducted in a 100-bedded hospital of West Nepal for 3 months, with the total number of hospitalized patients 78. Demographic data, pre-existing comorbidities, ABO blood group, high-resolution computed tomography (CT) severity score, and outcomes of the respondents were recorded and analyzed statistically using Chi-square, binomial regression test, and significance level was considered P&lt;0.05 at 95% confidence intervals. Results: Although the improvement rate was higher among males (84.0%) than females (75.0%), no significant association was observed between sex of the patient and treatment outcomes. Similarly, no significant association was observed in between age and ABO blood grouping of patients and treatment outcome. Furthermore, the chance of improvement is about 6 times higher (OR-6.214, 95% CI: 1.452–26.599; P=0.014) among patients with single comorbidity compared with patients with two or more comorbidities. Moreover, the chance of improvement is 8 times higher (OR-8, 95% CI: 2.034–31.461; P=0.001) in patients with CT severity score 1–15 compared with patients with CT severity score 16–25. Conclusion: CT severity score and pre-existing comorbid conditions play an important role among the different associated factors with the severity and treatment outcomes of COVID-19 patients.

IDF21-0411 Correlation of Chest CT severity score with blood glucose levels in patients with COVID-19

Background: Coronavirus disease 2019 (COVID 19) is caused by severe acute respiratory syndrome corona virus 2 (SARS – CoV-2) which predominantly affects lungs and leads to COVID 19 pneumonia. Hyperglycemia is frequently associated with severe COVID-19 infection and with a worse prognosis. Evidence in the COVID-19 pandemic shows that hyperglycemia, not only in people with diabetes, worsens the prognosis and increases mortality. Studies have also shown that patients with new-onset hyperglycemia even without a frank diabetes due to any cause (Stress-induced/ COVID-19-induced/ pre-existing dysglycemia), are associated with a poorer outcome compared to the normoglycemic individuals as well as those with pre-existing diabetes and COVID-19. Aim: This retrospective study aims to evaluate the correlation of CT severity score with blood glucose levels among patients with COVID-19 infection. Method: In this observational study 174 patients with COVID-19 infection were included at a dedicated COVID hospital in Rural Maharashtra. The COVID19 positivity was defined on the basis of RT PCR done at government approved laboratory. Random blood glucose level done at the time of admission and chest CT examinations were retrospectively evaluated. A semi-quantitative CT score was calculated based on the extent of lobar involvement (0:0%; 1: < 5%; 2: 5–25%; 3: 26–50%; 4: 51–75%; 5: > 75%; range 0–5; global score 0–25). Pearson correlation test was used to analyze the data. Results: Pearson correlation test showed that CT score had significant positive correlation with blood glucose levels with p: 0.001 (r = 0.257). Our study showed that as blood glucose value increases CT severity score increases in patients with COVID 19. Discussion: This observational study shows COVID-19 patients with increased blood glucose levels had significant pulmonary involvement on HRCT chest. Hyperglycemia in COVID 19 patients is more likely to cause more severe pneumonia with severe hypoxia. As patients with hyperglycemia have a dysregulated innate and adaptive immune response and their already having chronic low-grade inflammation which makes them more susceptible to more severe pulmonary disease (1). Hyperglycemia has been identified as an independent risk factor for developing respiratory infections. Persistent hyperglycemia can lead to endothelial dysfunction and inflammation which can lead to thrombus formation. Hyperglycemia induces glycosylation of ACE2 receptors which ultimately favours cellular intrusion of SARS-CoV2 leading to severe pulmonary involvement in COVID-19. Acute increase of blood glucose is accompanied by a huge increase of inflammatory mediators leading to cytokine storm. Various studies have shown that cytokine storm is more common in patients with hyperglycemia in COVID-19 (2). Therefore, fast normalization of hyperglycemia during COVID-19 is most important to decrease inflammatory cytokines release and ACE2 binding of the virus, two facts which consistently might help in improving the prognosis in patients affected by SARS-CoV-2.

Treatment and Outcomes of Coronavirus Disease 2019 in Kidney Transplant Recipients: A Single-center Experience.

There is a paucity of literature about the outcomes of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 after kidney transplantation in developing countries (e.g., India). We included 50 consecutive kidney transplant recipients diagnosed with COVID-19 from August 2020 to December 2020. The mean age was 50 ± 10 years, and the median interval since transplantation was 34 months. Fever (100%), cough (40%), and shortness of breath (32%) were the most common presenting symptoms. Mild disease occurred in 26 patients, moderate disease in 12, and severe disease in 12. All 24 patients with moderate-to-severe disease received remdesivir and high-dose steroids, whereas 17 of 26 patients with mild disease received favipiravir. Convalescent plasma was given to 13 of 24 patients with moderate-to-severe disease, and 7 of 12 patients with severe disease received tocilizumab. The median hospital stay was 7 days (interquartile range: 4-20 days). Of 30 patients who developed acute kidney injury, seven required renal replacement therapy and eight required mechanical ventilation. Eight patients with severe disease died. An age of >50 years, coughing, shortness of breath at presentation, C-reactive protein levels of >100 mg/dL, D-dimer levels of >1 mg/L, computed tomography severity scores of >20 at presentation, supplemental oxygen, and mechanical ventilation correlated significantly with mortality in our cohort. COVID-19 infection in kidney transplant recipients had a high mortality rate; however, remdesivir and high-dose steroids were associated with better outcomes compared with earlier studies.

Remdesivir in Renal Transplant Patients with Coronavirus Disease 2019

Introduction: Remdesivir has shown broad-spectrum antiviral activity. This drug is approved by the Food and Drug Administration for coronavirus disease 2019 (COVID-19) management. Other than a few case series and case reports, not much information is available on its use in kidney transplant recipients (KTRs). Materials and Methods: We describe our experience of seven KTRs with COVID-19. All the patients were hypoxemic. High-resolution computed tomography (CT) chest was done in all the patients. Injection remdesivir 200 mg on day 1 followed by 100 mg daily was given for a maximum of 5 days irrespective of estimated glomerular filtration rate (eGFR). Observations and Results: Mean age of patients was 46.28 ± 10.41 years and one patient was female. Mean CT severity score was 15. In our study, 2 patients who required mechanical ventilation expired. None of our patient had worsening of acute kidney injury (AKI) or new-onset AKI after institution of remdesivir. Discussion: Optimal management for this patient population remains unknown, therefore, treatment of COVID-19 in KTRs varies from center to center. The studies on remdesivir use in KTRs with COVID-19 are not extensive. Our series does indicate safety of remdesivir in KTRs. Conclusion: We observed that remdesivir can be used in KTRs with COVID-19 with hypoxemia irrespective of eGFR. We suggest that large-scale studies should be done to substantiate these findings.