Chest CT Severity Scores Research Articles

Role of Tocilizumab in Combating Cytokine Storm in Moderate & Severe Covid 19 Patients: Retrospective Observational Study

Background: The wide spread of COVID-19 disease and mortality associated with it as never seen before urged the medical research field to formulate and investigate the efficacy of various new drugs alongside with the existing drugs.
 Objective: To evaluate the potential benefits of Tocilizumab (TCZ) in addition to the Standard of Care (SoC) in reducing mortality in moderate & severely ill COVID 19.
 Methodology: Study population is sorted by 1:1 matching depending on the High-Resolution Computed Tomography (HRCT) Chest CT Severity Score. Outcome is measured as deaths, discharge with or without Long Term Oxygen Therapy (LTOT) along with clinical improvement of the patient measured using 9 points ordinary scale score of WHO and length of stay in Intensive Care Unit (ICU) post administration & levels of inflammatory markers (CRP, IL 6) on day of administration- baseline (D0), 1- & 3-days post administration (D+1 & D+3). The group received TCZ+SoC is considered as Test Group and the group received only SoC as Control Group.
 Results: Deaths and discharge with LTOT were slightly higher in test group with OR 1.68 & 1.63 respectively. Clinical improvement in terms of 9-point ordinary scale score & difference in the levels of CRP & IL 6 was insignificant in both the groups. No difference in post administration ICU stay is observed between the groups.
 Conclusions: Our study concludes no marked benefits with the addition of TCZ to the SoC in treating moderate and severe COVID 19 patients.

A novel chest CT severity score in COVID-19 and its correlation with severity and prognosis of the lung disease: A retrospective cohort study.

BackgroundHRCT chest has a high sensitivity in the diagnosis of patients with COVID-19 infection. Through our study, we intend to evaluate the diagnostic accuracy and inter-reader variability of a semi-quantitative CT severity score, a novel parameter designed for risk stratification and prognostication of COVID-19 pneumonia with clinical staging of disease.MethodsIt was a single-center retrospective analysis performed on an original cohort of 4180 symptomatic patients with the suspicion of SARS-CoV-2 interstitial pneumonia. Out of 4180, a total of 4004 patients with COVID-19 were confirmed by an RT-PCR. We used an HRCT chest severity score (CT-SS) to evaluate the COVID-19 disease burden on the initial scan obtained at admission. The data were analyzed with IBM SPSS Statistics Version 22.0 Release 2013.ResultsOur study subjects demonstrated the most common clinical features fever, cough, dyspnea, and body aches. Raised CRP levels (CRP >0.5 mg/dL) were found in 81.86% and increased D-dimer levels (>500 ng/mL) were found in 92.3% of patients. The most common radiological findings of the disease included ground-glass opacities, observed in 98.8%. Our study has a sensitivity of 89.2%, a specificity of 94.8%, a positive predictive value (PPV) of 90.6%, and a negative predictive value (NPV) of 94%.ConclusionAs per our findings, this novel CT scoring system might aid in the risk stratification and the short-term prognostication of patients suffering from COVID-19 pneumonia. This will eventually help in curtailing the extensive burden on the healthcare system amid the current pandemic.

Chest CT Severity Score and Systemic Inflammatory Biomarkers as Predictors of the Need for Invasive Mechanical Ventilation and of COVID-19 Patients' Mortality.

Background: Numerous tools, including inflammatory biomarkers and lung injury severity scores, have been evaluated as predictors of disease progression and the requirement for intensive therapy in COVID-19 patients. This study aims to verify the predictive role of inflammatory biomarkers [monocyte to lymphocyte ratio (MLR), neutrophil to lymphocyte ratio (NLR), systemic inflammatory index (SII), Systemic Inflammation Response Index (SIRI), Aggregate Index of Systemic Inflammation (AISI), and interleukin-6 (IL-6)] and the total system score (TSS) in the need for invasive mechanical ventilation (IMV) and mortality in COVID-19 patients. Methods: The present study was designed as an observational, analytical, retrospective cohort study and included all patients over 18 years of age with a diagnosis of COVID-19 pneumonia, confirmed through real time-polymerase chain reaction (RT-PCR) and radiological chest CT findings admitted to County Emergency Clinical Hospital of Targu-Mureș, Romania, and Modular Intensive Care Unit of UMFST “George Emil Palade” of Targu Mures, Romania between January 2021 and December 2021. Results: Non-Survivors patients were associated with higher age (p = 0.01), higher incidence of cardiac disease [atrial fibrillation (AF) p = 0.0008; chronic heart failure (CHF) p = 0.01], chronic kidney disease (CKD; p = 0.02), unvaccinated status (p = 0.001), and higher pulmonary parenchyma involvement (p < 0.0001). Multivariate analysis showed a high baseline value for MLR, NLR, SII, SIRI, AISI, IL-6, and TSS independent predictor of adverse outcomes for all recruited patients. Moreover, the presence of AF, CHF, CKD, and dyslipidemia were independent predictors of mortality. Furthermore, AF and dyslipidemia were independent predictors of IMV need. Conclusions: According to our findings, higher MLR, NLR, SII, SIRI, AISI, IL-6, and TSS values at admission strongly predict IMV requirement and mortality. Moreover, patients above 70 with AF, dyslipidemia, and unvaccinated status highly predicted IMV need and fatality. Likewise, CHF and CKD were independent predictors of increased mortality.

Comparison of CT findings of coronavirus disease 2019 (COVID-19) pneumonia caused by different major variants

PurposeTo explore the CT findings and pneumonnia progression pattern of the Alpha and Delta variants of SARS-CoV-2 by comparing them with the pre-existing wild type.MethodIn this retrospective comparative study, a total of 392 patients with COVID-19 were included: 118 patients with wild type (70 men, 56.8 ± 20.7 years), 137 with Alpha variant (93 men, 49.4 ± 17.0 years), and 137 with Delta variant (94 men, 45.4 ± 12.4). Chest CT evaluation included opacities and repairing changes as well as lesion distribution and laterality. Chest CT severity score was also calculated. These parameters were statistically compared across the variants.ResultsGround glass opacity (GGO) with consolidation and repairing changes were more frequent in the order of Delta variant, Alpha variant, and wild type throughout the disease course. Delta variant showed GGO with consolidation more conspicuously than did the other two on days 1–4 (vs. wild type, Bonferroni corrected p = 0.01; vs. Alpha variant, Bonferroni corrected p = 0.003) and days 5–8 (vs. wild type, Bonferroni corrected p < 0.001; vs. Alpha variant, Bonferroni corrected-p = 0.003). Total lung CT severity scores of Delta variant were higher than those of wild type on days 1–4 and 5–8 (Bonferroni corrected p = 0.01 and Bonferroni corrected p = 0.005, respectively) and that of Alpha variant on days 1–4 (Bonferroni corrected p = 0.002). There was no difference in the CT findings between wild type and Alpha variant.ConclusionsPneumonia progression of Delta variant may be more rapid and severe in the early stage than in the other two.

Correlation between chest CT severity scores and clinical and biochemical parameters of COVID-19 pneumonia.

BackgroundThe COVID‐19 pandemic, which first appeared in Wuhan, China, in December 2019 and spread rapidly around the globe, continues to be a serious threat today. Rapid and accurate diagnostic methods are needed to identify, isolate and treat patients as soon as possible because of the rapid contagion of COVID‐19. In the present study, the relation of the semi‐quantitative scoring method with computed tomography in the diagnosis of COVID‐19 in determining the severity of the disease with clinical and laboratory parameters and survival of the patients were investigated along with its value in prognostic prediction.Material and methodA total of 277 adult patients who were followed up in the chest diseases clinic because of COVID‐19 pneumonia between 11.03.2020 and 31.05.2020 were evaluated retrospectively in the present study. Both lungs were divided into five regions in line with their anatomical structures, and semiquantitative radiological scoring was made between 0 and 25 points according to the distribution of lesions in each region. The relations between semiquantitative radiological score and age, gender, comorbidity, and clinical and laboratory parameters were examined.ResultsA significant correlation was detected between advanced age, lymphopenia, low oxygen saturation, high ferritin, D‐dimer, and radiological score in the univariate analysis performed in the present study. The cut‐off value of the semiquantitative radiology score was found to be 15 (AUC: 0.615, 95% CI: 0.554–0.617, p = 0.106) in ROC analysis. The survival was found to be better in cases with a radiology score below 15, in Kaplan–Meier analysis (HR: 4.71, 95% CI: 1.43–15.46, p < 0.01). In the radiological score and nonparametric correlation analyses, positive correlations were detected between CRP, D‐dimer, AST, LDH, ferritin, and pro‐BNP, and a negative correlation was found between partial oxygen pressure and oxygen saturation (p = 0.01, r = 0.321/0.313/0.362/0.343/0.313/0.333/−0.235/−0.231, respectively)ConclusionIt was found that the scoring system that was calculated quantitatively in thorax HRCTs in Covid‐19 patients is a predictive actor in determining the severity and prognosis of the disease in correlation with clinical and laboratory parameters. Considering patients who have a score of 15 and above with semiquantitative scoring risky in terms of poor prognosis and short survival and close follow‐up and early treatment may be effective to reduce mortality rates.

Reduction in Chest CT Severity and Improved Hospital Outcomes in SARS-CoV-2 Omicron Compared with Delta Variant Infection.

BackgroundThe SARS-Cov-2 Omicron variant demonstrates rapid spread but with reduced disease severity. Studies evaluating the lung imaging findings of Omicron infection versus non-Omicron variants remain lacking.PurposeTo compare Omicron and Delta variants of SARS-CoV-2 by their chest CT radiological pattern, biochemical parameters, clinical severity and hospital outcomes after adjusting for vaccination status.Materials and MethodsRetrospective study of hospitalized adult patients rt-PCR positive for SARS-CoV-2 with CT pulmonary angiography performed within 7 days of admission between December 1, 2021 and January 14, 2022. Blinded radiological analysis with multiple readers including RSNA CT classification, chest CT severity score (CT-SS, range 0 least severe to 25 most severe) and CT imaging features including bronchial wall thickening.Results106 patients (Delta n=66, Omicron n=40) were evaluated (mean age, 58 years ± 18, 58 men). In the Omicron group, 37% (15/40) of CT pulmonary angiograms were categorized as normal compared with 15% (10/66) in the Delta group (p=.016). Using a generalized linear model to control for confounding variables, including vaccination status, Omicron variant infection was associated with a CT-SS that was lower by 7.2 points compared to infection with Delta variant (β=-7.2, 95%CI: -9.9, -4.5; p <.001). Bronchial wall thickening was more common with Omicron than with the Delta variant (odds ratio [OR] 2.4, 95%CI: 1.01, 5.92, p=.04). Vaccination with a booster shot was associated with a protective effect on chest infection compared with the unvaccinated (CT-SS median 5 (IQR 0-11), CT-SS median 11 (IQR 7.5-14), respectively; p = .03). The Delta variant was associated with a higher odds ratio of severe disease (OR 4.6, 95%CI: 1.2, 26, p=.01) and critical care admission (OR 7.0, 95%CI: 1.5, 66, p=.004) than the Omicron variant.ConclusionThe SARS-COV-2 Omicron variant was associated with fewer and less severe changes on chest CT compared with the Delta variant. Patients with Omicron had greater frequency of bronchial wall thickening but lower clinical severity and improved hospital outcomes than those with Delta.

Assessment of COVID-19 Severity Using Chest CT Severity Score on High-Resolution Computed Tomography Chest in Pakistani Patients

Objective: The current review aims at portraying the high-resolution CT (HRCT) chest findings of corona virus pandemic that emerged in 2019 amongst the COVID-19 patients, admitted to the tertiary healthcare facilities in Punjab, Pakistan. It also aims to study the imaging features and dispensation of COVID-19 infection in different segments of the lungs. Moreover, a survey was also conducted for the job to analyze the chest CT severity score index (CT-SS) aims at identifying those patients with acute infections. Methods: This cross-sectional descriptive analysis led from May 15, 2020 to November 26, 2021, incorporates 97 diagnosed patients of the COVID-19 who received the HRCT scan in the tertiary healthcare facilities in Punjab, Pakistan. The HRCT chest of the infected patients was collected following the proper protocol. Each case was assessed for the presence of imaging features such as ground glass opacities (GGOs), consolidation, mixed pattern, crazy paving appearance and other findings along with their distribution in lung segments. Furthermore, to determine the CT-SS we divided each lung into 20 sub segments. The Linkert Score system of degree of 0,1 and 2 was provided. This indicates the intensity of involvement. It states that zero score indicates no involvement, whereas the Linkert figure 1 shows the involvement which is less than &lt;50%. However, the remaining figure Linkert indicator figure 2 indicates the intensity of involvement if more than &gt;50% by one zone. The total range of score for this test lies between 0-40. This score helps us to categories the patients based on their mild and severe cases. Here the score of less than &lt;20 indicated mild infection, whereas, the score which appears more than &gt;20 indicates the severity of the case. Results: The ground glass opacities which are trailed by consolidation of 49.4% and that of crazy paving by 21.64% was recorded as the most recognized finding. In most of the patients, the distribution of disease, with basal predilection, was recorded as bilateral, peripheral as well as multilobar. The ratio of vascular dilatation was recorded 19.5% and that of bronchiectasis was noted at 13.4% in patients. 3% of the patients showed the Halo, whereas reverse halo sign was noted in 1% of patients. None of the patients was seen to be carrying the Pleural effusion. Lung cavitation was seen in 2% of patients and isolated lobar consolidation without GGO was seen in 1% of patients. The segment which was most commonly involved bilaterally was the posterior segment of the lower lobes. As per the data collected from CT-SS, 80(82.4%) patients had mild and 17 (17.4%) patients had an acute disease symptoms respectively. Conclusion: GGOs are the most common imaging findings of COVID-19 pneumonia on HRCT chest having multilobar, bilateral and peripheral involvement with basal predilection. This proves CT-SS as a useful mechanism in placing pneumonia patients as mild and acute types. This helps categorizing the distinguishing the acute or severe patients from mild and to manage them accordingly. Keywords: Covid-19, CT-SS, HRCT chest, ground glass opacities, consolidation, crazy paving

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.

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.

Comparison of chest CT severity scoring systems for COVID-19.

Purpose To compare the diagnostic performance and inter-observer agreement of five different CT chest severity scoring systems for COVID-19 to find the most precise one with the least interpretation time.Methods and materialsThis retrospective study included 85 patients (54 male and 31 female) with PCR-confirmed COVID-19. They underwent CT to assess the severity of pulmonary involvement. Three readers were asked to assess the pulmonary abnormalities and score the severity using five different systems, including chest CT severity score (CT-SS), chest CT score, total severity score (TSS), modified total severity score (m-TSS), and 3-level chest CT severity score. Time consumption on reporting of each system was calculated.ResultsTwo hundred fifty-five observations were reported for each system. There was a statistically significant inter-observer agreement in assessing qualitative lung involvement using the m-TSS and the other four quantitative systems. The ROC curves revealed excellent and very good diagnostic accuracy for all systems when cutoff values for detection severe cases were > 22, > 17, > 12, and > 26 for CT-SS, chest CT score, TSS, and 3-level CT severity score. The AUC was very good (0.86), excellent (0.90), very good (0.89), and very good (0.86), respectively. Chest CT score showed the highest specificity (95.2%) in discrimination of severe cases. Time consumption on reporting was significantly different (< 0.001): CT-SS > 3L-CT-SS > chest CT score > TSS.ConclusionAll chest CT severity scoring systems in this study demonstrated excellent inter-observer agreement and reasonable performance to assess COVID-19 in relation to the clinical severity. CT-SS and TSS had the highest specificity and least time for interpretation.Key Points • All chest CT severity scoring systems discussed in this study revealed excellent inter-observer agreement and reasonable performance to assess COVID-19 in relation to the clinical severity. • Chest CT scoring system and TSS had the highest specificity. • Both TSS and m-TSS consumed the least time compared to the other three scoring systems. Supplementary InformationThe online version contains supplementary material available at 10.1007/s00330-021-08432-5.

Association between Chest CT Severity Scores and SARS-CoV-2 Vaccination among COVID-19 patients: A Cross-sectional Study from Pune, India

Introduction: The novel Coronavirus disease-2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is seen to primarily affect the human respiratory system. Chest CT Severity Score (CTSS) provides a semi quantitative assessment of pulmonary involvement in COVID19 patients. COVID-19 pandemic mitigation measures such as SARS-CoV-2 vaccination are being deployed worldwide. However, with the emerging variants of concern of SARS-CoV-2, a high prevalence of post vaccination breakthrough infections is seen. Aim: To assess the association of CTSS with the vaccination status in a cohort of COVID-19 patients referred to a tertiary diagnostic centre and to evaluate the association of CTSS with other clinical parameters including co-morbidities in these patients. Materials and Methods: This cross-sectional observational study was conducted at a tertiary care diagnostic imaging centre in the city of Pune, Maharashtra, India. Data of 1002 symptomatic, adult patients who underwent chest CT and SARSCoV-2 Reverse Transcription Polymerase Chain Reaction (RTPCR)/Rapid Antigen Test (RAT) laboratory test between March 13, 2021 and June 22, 2021, were collected. COVID-19 reporting and Data System (CO-RADS) categories and the corresponding semi quantitative CTSS were calculated for each patient. Based on their vaccination status, patients were categorised into three groups: unvaccinated, partially vaccinated and fully vaccinated. The association of CTSS with various categories of vaccination status, demographics, co-morbidities and stages of the disease of the patients, was evaluated. Results: Of the 1002 COVID-19 patients, 768 (76.6%) were unvaccinated, 190 (19.0%) were partially vaccinated and 44 (4.4%) were fully vaccinated. Mean CTSS in the fully vaccinated cohort was significantly lower (3.75±4.7) than that in the partially vaccinated (6.05±5.7) and unvaccinated (8.29±4.9) patients (mean 3.75 vs. 6.05 vs. 8.29, respectively; (p&lt;0.05). Mean CTSS in patients with no co-morbidities was significantly lower than that in patients with hypertension and diabetes (7.12 vs. 8.75 vs. 10.39, respectively; (p&lt;0.05). Conclusion: Significant association was noted between the Chest CTSS and the vaccination status, age, gender, co-morbidities and stage of disease in this large cohort of COVID-19 patients. The study reiterates that full vaccination aids in reducing the severity of lung involvement in COVID-19 infection.

Association of Chest CT Severity Scores and Vaccination Status in COVID-19 Disease: A Cross-sectional Study

Introduction: Coronavirus Disease 2019 (COVID-19) has emerged as a pandemic with substantial morbidity and mortality. While global efforts towards mitigating the infection are focused on the vaccination of population, studies are warranted to prove the efficacy of vaccine in prevention of infection or reducing the severity of infection in affected patients. The 25-point High Resolution Computed Tomography (HRCT) severity score has proved to be an effective tool in estimating the severity of lung infection and correlates with laboratory parameters and disease outcome. The HRCT scores hence provide an objective evidence to prove the efficacy of vaccines in vaccinated individuals by assessing the extent of lung involvement. Aim: To compare the chest CT severity score in vaccinated and unvaccinated COVID-19 infected patients. Materials and Methods: This cross-sectional study was conducted in the Department of Radiology, at Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysuru, Karnataka, India. The data of HRCT scores and vaccination status was collected during the month of April 2021 from patients who were suspected to have COVID-19 infection and underwent a chest HRCT scan. The severity of lung infection in vaccinated and unvaccinated individuals was compared based on the HRCT scores and the association between these variables were analysed. The association between the respective variables were studied using Fischer’s-exact and Kruskal-Wallis tests. Results: The study involved a total of 178 subjects (males were 98), where 127 (71.3%) were unvaccinated and 51 (28.6%) were vaccinated with one or both doses {Covaxin (Bharat Biotech) vaccine or Covishield (Oxford-AstraZeneca) vaccine approved by Emergency Use Authorisation (EUA)}. The frequency of disease was least in 14 (7.9%) among fully vaccinated subjects. Severe COVID-19 associated pneumonia with severity score of 18 or more was seen in 7% of unvaccinated individuals, while none of the partial/fully vaccinated individuals had severe disease. The median CT severity score was significantly higher among unvaccinated patients compared to partially and fully vaccinated patients (p-value=0.001). Fully vaccinated patients had almost low CT severity score indicating mild form of disease. Conclusion: To the best of authors knowledge, this study is the first to describe the chest CT severity scores of vaccinated individuals in comparison with the unvaccinated COVID-19 infected patients. The disease severity was significantly higher among unvaccinated patients compared to partially and fully vaccinated patients. The present study has provided substantial evidence of vaccine efficacy in reducing the disease severity in COVID-19 infected patients.

Significance of Chest Computed Tomography Scan Findings at Time of Diagnosis in Patients with COVID-19 Pneumonia

Background and objectives: Many published reports demonstrated the cardinal hallmark of COVID-19 infection, such as bilateral ground glass opacities (GGO) with or without consolidation in posterior and peripheral lungs fields. Various CT algorithms including CT scoring system were used to assess quantitively and qualitatively the severity of COVID-19 pneumonia. The aim of this study was to summarize the significance of certain radiological features in evaluating Covid-19 pneumonia severity in Iraqi patients. Materials and methods: This was a cross sectional study conducted in Erbil tertiary hospitals in Iraq from June 2020, until August 2020. Review of chest CT scan for 132 patients was done and the main chest CT manifestations of patients with COVID-19 infection was reported. Then, CT scoring system was implicated in a quantitative comparison with radiological findings observed in chest CT examinations of patients having different disease severity at time of diagnosis. Results: The mean age of study sample was 51.08 ±14.2 years. The typical CT findings were consistent with mainly GGOs (78.8%) followed by consolidation. Atypical CT patterns according to previous reports were also observed including tree in bud, crazy paving, bronchiectasis, round organizing pneumonia, pulmonary nodules, mediastinal lymphadenopathy, cavitation and pleural thickening. Lung involvement was significantly more in the lower lobes than upper lobes. CT severity score was significantly higher in the lower lobes as well. Chest CT severity score (CT-SS) was significantly higher in cases with most common pathological lung changes (p &lt; 0.001) except for tree in bud, crazy paving and cavitation. Conclusion: CT-SS is an essential examination tool in the diagnosis, disease severity evaluation and lobar extension of COVID-19 infection. High CT-SS are significantly associated with certain chest CT findings like GGOs, consolidation, bronchiectasis and interlobular septa thickening which reflects the seriousness of such CT findings in COVID-19 at time of diagnosis.

Chest CT Severity Score in COVID-19 at the Time of Admission and Relationship with Outcome and Duration of Admission-an Early Promising Prognostic Indicator

Chest CT Severity Score in COVID-19 at the Time of Admission and Relationship with Outcome and Duration of Admission-an Early Promising Prognostic Indicator

Study of clinical features, laboratory and radiological findings, morbidity, and mortality in COVID-19 patients with controlled and uncontrolled diabetes mellitus

Introduction: Coronavirus disease 19 (COVID-19) is a pandemic caused by a novel coronavirus, the Severe Acute Respiratory Syndrome Coronavirus 2. Diabetes and its complications are major causes of morbidity and mortality. Patients with uncontrolled diabetes may be associated with poorer outcomes as compared with patients with good glycemic control. Methodology: A total of 120 patients with type 2 diabetes mellitus with COVID-19 were taken from a tertiary care center in Pune, Maharashtra, and included in the study following their voluntary informed consent. Results: It was observed that patients with poor glycemic control had a greater prevalence of symptoms including fever (64.9% vs 55.4%), cough (51.3% vs 42.2%), and dyspnoea (40.5% vs 27.7%). C-reactive protein (9.40 vs 5.66), D-dimer (668.2 vs 457.9), and ferritin levels (352 vs 238) were observed to be greater in patients with poor glycemic control. Chest X-Ray changes (45.9% vs 17.2%) and CT severity score (9.32 vs 5.79) were significantly greater in patients with poor glycemic control. Patients with poor glycemic control also had an increased incidence of O2 requirement, increased mortality, and a longer duration of hospital stay. Poor glycemic control was also associated with an increased incidence of complications like acute respiratory distress syndrome (35.1% vs 18.0%), sepsis with or without septic shock (18.9% vs 9.6%), acute coronary syndrome (13.5% vs 8.4%), acute kidney injury (18.9% vs 3.6%), acute hepatic injury (13.5% vs 2.4%), and other complications like diabetic ketoacidosis, pulmonary thromboembolism, and cerebrovascular accident (10.8% vs 6.0%).Conclusion: On the basis of our findings, we concluded that patients with poor glycemic control were associated with poorer outcomes and increased complications.

Chest CT Severity Score, CURB-65 Score, and Their Relationship with In-Hospital- Mortality in COVID-19 Patients

Abstract: Objective: With every new strain of the SARS-CoV-2 spreading on a fast pace across the borders, an easy-to-calculate and reliable scoring system seems invaluable to identify high-risk patients. This study aims to investigate the relationship between CT severity score (CTSS) and CURB-65 score with mortality in COVID-19 patients. Methods: This study was conducted on RT-PCR confirmed COVID-19 patients admitted to a tertiary teaching center during fifth national wave of disease in one of the early disease epicenters in the country. All enrolled patients underwent chest CT scan within first day of admission. CTSS and CURB-65 scores were calculated and assigned to patients, while radiologist was blinded to clinical and laboratory findings, and they were evaluated for their correlation with in-hospital mortality, additively and separately. Results: Total number of 216 patients (140 males) with a mean age of 56.02 ± 17.34 years (ranging from 4 to 95) were enrolled. We found no significant relationship between CURB-65 score and CTSS (correlation coefficient: 0.065; P: 0.338). CURB-65 scores above 1 was predictive of in-hospital mortality with sensitivity of 56.4% and specificity of 81.9% (P: 0), those for CTSS above 11 were 79.5% and 4 51.5%, respectively (P: 0.001). CURB-65 score &gt;1 and CTSS &gt;11 predicted in-hospital mortality with sensitivity and specificity of 61.5% and 79.7% (P: 0.000). CURB-65 score and CTSS had a higher sensitivity and specificity to predict mortality comparing to each of those separately, but these enhanced statistics were not significant. Conclusion: CURB-65 score is meaningfully stronger than CTSS to prognosticate in-hospital mortality in patients with COVID-19, and it is not significantly correlated with CTSS.

590 ACE-I and ARBS do not influence the chest CT presentation and 1-year survival of COVID-19 patients: Italian multicentre registry

AimsA possible interference between ACE-i or ARBs with ACE-2 receptor and SARS-CoV-2 pathway has been raised. Despite data have shown no clinical impact of therapy with ACE-I or ARBs on COVID-19, these drugs are often discontinued upon hospitalization or diagnosis. To evaluate the effects of cardiovascular risk factors (CVRF) and prior outpatient therapy with RAAS inhibitors on the chest CT severity score performed within 24 h of diagnosis of SARS-CoV-2 infection (before stopping medications or starting specific therapy for COVID-19) and on 1-year survival.Methods and resultsThis is a multicentre, prospective, observational study. All admitted patients diagnosed with SARS-CoV-2 infection who performed chest CT within 24 h of arrival were consecutively enrolled from 1 March to 1 June 2020. A severity score was attributed to Chest CT by two radiologists in blind to the patient’s clinical information and a cut-off value of 19.5 was considered to define severe radiological pneumonia. A 1-year telephone follow-up was performed in order to evaluate the determinants of 1-year survival. 590 patients with a mean age of 63 ± 14 years were included. Seventy-three (12.4%) patients were treated with ACE-I, 85 (14.4%) with ARBs and 62 (10.5%) with CCB. Cox regression analysis showed that male gender (OR: 1.4; 95% CI: from 1.02 to 2.07; P = 0.035), diabetes (OR: 1.6; 95% CI: from 1.03 to 2.7; P = 0.037), age (OR: 1.02; 95% CI: from 1.008 to 1.033; P = 0.001), and obesity (OR: 3.04; 95% CI: from 1.3 to 6.7; P < 0.001) were independently associated with a severe CT score. Of note, while prior outpatient therapy with ACE-I and ARBs was not independently associated with severe CT score, therapy with CCB was independently associated with a severe CT score (OR: 1.9, 95% CI: from 1.05 to 3.4, P = 0.033). Severe chest CT severity score (OR: 1.05; 95% CI: from 1.02 to 1.08; P < 0.001), P/F ratio (OR: 0.998; 95% CI: from 0.994 to 0.998; P < 0.001), and older age (OR: 1.06; 95% CI: from 1.03 to 1.1; P < 0.001) were independently associated with mortality at 1-year follow-up. Neither ACE-I, ARBs, and CCB were associated with mortality at 1 year follow-up.ConclusionsACE-I and ARBs do not influence the chest CT presentation of COVID-19 patients at the time of diagnosis. Furthermore, ACE-I and ARBs do not influence 1-year survival of COVID-19 survivors.

Correlation Between CT Severity Scoring and Diabetes Mellitus in Patients With COVID-19 Infection.

Background and objectiveSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), was first identified in Wuhan, China in December 2019. Since then, It has spread across multiple countries and was declared a pandemic by WHO in March 2020. Patients with underlying diabetes mellitus (DM) are deemed at-risk for developing severe COVID-19 infection. In light of this, we aimed to evaluate the correlation between DM and chest CT severity scores (CTSS) in COVID-19 patients.MethodsThis was a hospital-based descriptive, analytical retrospective study conducted at our tertiary care hospital. A quantitative severity score was calculated among 220 patients with COVID-19 infection based on the degree of lung lobe involvement on CT chest scans. Based on CTSS, the patients were classified into groups of mild, moderate, and severe lung involvement. The association between DM and CTSS was evaluated using the chi-square test.ResultsThe severity of lung involvement was higher among COVID-19 patients with a co-diagnosis of DM (29.3%) compared to those without DM (11.7%). This association of severe lung involvement with DM was statistically significant (p=0.002).ConclusionBased on our findings, diabetic patients are at an increased risk of developing the severe form of COVID-19 with a higher CT lung involvement score compared to non-diabetic patients.

Chest CT Severity Score, CURB-65 Score and Their Relationship with in-Hospital-Mortality in COVID-19 Patients

Objective: With every new strain of the SARS-CoV-2 spreading on a fast pace across the borders, an easy-to-calculate and reliable scoring system seems invaluable to identify high-risk patients. This study aims to investigate the relationship between CT Severity Score (CTSS) and CURB-65 score with mortality in COVID-19 patients. Methods: This study was conducted on RT-PCR confirmed COVID-19 patients admitted to a tertiary teaching center during fifth national wave of disease in one of the early disease epicenters in the country. All enrolled patients underwent chest CT scan within first day of admission. CTSS and CURB-65 scores were calculated and assigned to patients, while radiologist was blinded to clinical and laboratory findings, and they were evaluated for their correlation with in-hospital mortality, additively and separately. Results: Total number of 216 patients (140 males) with a mean age of 56.02 ± 17.34 years (ranging from 4 to 95) were enrolled. We found no significant relationship between CURB-65 score and CTSS (correlation coefficient: 0.065; P: 0.338). CURB-65 scores above 1 was predictive of in-hospital mortality with sensitivity of 56.4% and specificity of 81.9% (P: 0), those for CTSS above 11 were 79.5% and 4 51.5%, respectively (P: 0.001). CURB-65 score &gt;1 and CTSS &gt;11 predicted in-hospital mortality with sensitivity and specificity of 61.5% and 79.7% (P: 0.000). CURB-65 score and CTSS had a higher sensitivity and specificity to predict mortality comparing to each of those separately, but these enhanced statistics were not significant. Conclusion: CURB-65 score is meaningfully stronger than CTSS to prognosticate in-hospital mortality in patients with COVID-19, and it is not significantly correlated with CTSS.

Correlation of chest CT severity score with D-dimer levels in patients with COVID-19

Abstract Background Coronavirus disease 2019 (COVID 19) caused by severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) predominantly affects lungs and leads to COVID-19 pneumonia. Studies have shown that COVID 19 is hypercoagulative prothrombotic state. The innate tropism of SARS CoV-2 for vascular endothelial cells and their consequent damage, together with the intense activation of inflammatory responses and of coagulation pathways, may explain the intense pro-coagulative state. It ultimately predisposes to systemic micro-thrombotic alterations and gives rise to the consistent rate of multi-organ failure, DIC and ARDS in severe COVID-19 patients. Purpose Aims of this retrospective study were to determine the correlation between a CT-based semi-quantitative score of pulmonary involvement in COVID-19 pneumonia with D-dimer and CRP levels. Materials and methods 174 symptomatic SARS-CoV-2 patients were enrolled from August 4 to October 12, 2020, for this single-center analysis in rural India and chest CT examinations were retrospectively evaluated. The COVID 19 positivity was defined on the basis of RTPCR done at ICMR (Indian Council of Medical Research) approved laboratory. A semi-quantitative CT score was calculated based on the extent of lobar involvement (0:0%; 1: &amp;lt;5%; 2: 5–25%; 3: 26–50%; 4: 51–75%; 5: &amp;gt;75%; range 0–5; global score 0–25). D-dimer and CRP were done at the time of admission. One way ANOVA and post hoc Tukey test were performed to compare the variables of Chest CT score in percentage to various other variables. Results CT score had significant positive correlation with D-dimer levels (p=0.002, r: 0.237). CT score was significantly correlated with CRP (p&amp;lt;0.001, r: 0.392) levels. Subgroup analysis by post hoc Tukey test further showed that D-dimer levels were significantly elevated in 51–75% and &amp;gt;75% lobar involvement groups on Chest CT with statistically significant p value of &amp;lt;0.001. Conclusions This study data suggests that CT score has significant positive correlation with D-dimer and CRP. D-dimer is significantly elevated in the group where lobar involvement is more significant on Chest CT. D-dimer is an indirect marker of active coagulation and thrombin formation. Elevated D-dimer represents activation of endovascular thrombotic processes. This hypercoagulative infection-induced state is systemic, and may lead to various clinical manifestations such as myocardial infarction, stroke, limb ischemia and DIC. Monitoring of pro-thrombotic activity of SARS-CoV-2 with tests such as D-dimer, with consequent labelled administration of adjusted doses of anticoagulants are of paramount importance in order to prevent worsening of global conditions due to vascular parenchymal or systemic thrombotic dysfunction in COVID-19 patients. Funding Acknowledgement Type of funding sources: None.