CT Severity Score Research Articles

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.

18 months computed tomography follow-up after Covid-19 interstitial pneumonia.

Background: Our aim is to evaluate the possible persistence of lung parenchyma alterations, in patients who have recovered from Covid-19.Design and methods: We enrolled a cohort of 115 patients affected by Covid-19, who performed a chest CT scan in the Emergency Department and a chest CT 18 months after hospital discharge. We performed a comparison between chest CT scan 18 months after discharge and spirometric data of patients enrolled. We obtained quantitative scores related to well-aerated parenchyma, interstitial lung disease and parenchymal consolidation. A radiologist recorded the characteristics indicated by the Fleischner Society and “fibrotic like” changes, expressed through a CT severity score ranging from 0 (no involvement) to 25 (maximum involvement).Results: 115 patients (78 men, 37 women; mean age 60.15 years old ±12.52). On quantitative analysis, after 18 months, the volume of normal ventilated parenchyma was significantly increased (16.34 points on average ±14.54, p<0.0001). Groundglass opacities and consolidation values tend to decrease (-9.80 and -6.67 points, p<0.0001). On semiquantitative analysis, pneumonia extension, reactive lymph nodes and crazy paving reached statistical significance (p<0.0001). The severity score decreased by 2.77 points on average (SD 4.96; p<0.0001). There were not statistically significant changes on “fibrotic-like” changes correlated with level of treatment and there was not a statistically significant correlation between CT lung score and spirometric results obtained 18 months after discharge.Conclusions: Patients recovered from Covid-19 seem to have an improvement of ventilated parenchyma and “fibrotic-like” alterations. The level of treatment does not appear to influence fibrotic changes. Significance for public health After more than a year from first SARS-CoV-2 infection cases in Europe, alongside the always current problems of diagnosis and clinical management, a new criticism is emerging: the possible long-term outcomes that Covid-19 patients may have. To try to answer at least in part this question, in agreement with the pulmonologists of our center, we decided to select a group of patients who have overcome Covid-19, with heterogeneous levels of intensity of care, and to perform a radiological and clinical 18 months follow-up. In this paper we made a comparison between the chest CT performed at the onset of the disease and the CT performed after 18 months, evaluating the evolution of the parenchymal alterations. We hope that the results obtained in this study can provide useful information in the future follow-up of patients affected by Covid-19, a central issue of public health in the coming years in many areas of the world.

INITIAL CT SEVERITY SCORE IN PROGNOSIS AND OUTCOME OF THE SWAB POSITIVE PATIENT IN COVID 19

Introduction: According to WHO recommendations, the real-time reverse transcription-polymerase chain reaction (RTPCR) assay, is the initial technique used in COVID-19 diagnosis. Though this test is conclusive, this test can't predict the severity of the disease. Computed tomography (CT - chest), has been crucial in the diagnosis, assessment, and treatment of COVID-19 patients. This study has been conducted to assess the performance of a semi-quantitative CT severity score in predicting the severity of the patients. Methods: This is an observational analytical study done in Vinayaka Missions Kirupananda Variyar (VMKV) Medical College and Hospital, Salem, Tamil Nadu from the period of September 2020 to December 2020. After getting the informed consent, the patients with age 18 years and more, who were admitted to the hospital with CT thorax CORADS score more than and equal to 4 with irrespective of the RT-PCR report status were included in the study. Totally, 531 individuals participated in the study Results: . The majority of the study participants were females. About 36 percent of the patients have ageusia and anosmia. About 4.3 percent of them have died. When comes to CT-chest severity score, the mean score in our study was about 11 and about 17 percent have severe illness according to the CT-chest severity score category. The CT-chest severity scores have a statistically signicant correlation with the duration of the hospital admission in days (p &lt; 0.001). The CT-chest severity Conclusion: score is a trustworthy tool in predict the severity of COVID-19 disease

Can Thorax Computed Tomography Severity Score in Coronavirus Disease 2019 Patients Differentiate Smokers from Non-smokers?

OBJECTIVEThe aim of this study was to explore the impact of smoking history on the severity of coronavirus disease 2019 radiologic findings. Therefore, we compared the computed tomography severity scores of smoking coronavirus disease 2019 patients with those of non-smoking coronavirus disease 2019 patients.MATERIAL AND METHODSA total of 121 patients were included in our study group. We retrospectively reviewed 121 patients who underwent reverse transcription-polymerase chain reaction sampling and computed tomography examination in our hospital between April 1, 2020, and July 30, 2020. All computed tomography images were independently reviewed by 2 radiologists.ResultsThere were 15 (12.4%) active smokers, 38 (31.4%) former smokers, and 68 (56.2%) never-smokers in this study. Among the 85 patients with evidence of pneumonia in thorax computed tomography, mean computed tomography severity scores were 8.02 and standard deviation 5.812. Computed tomography severity scores for patients with pathological computed tomography scans (n = 85) were performed for evaluating smoking status (never-smokers and smokers). We found a statistically significant relationship between computed tomography severity scores of never-smokers (n = 39) and smokers (n = 46) (Z = 2.243, P = .025). The computed tomography severity scores threshold for differentiating smokers in our study group was 8, with a sensitivity of 52.2% and a specificity of 79.5%. Among the 121 patients, 34 (28.1%) were in the asymptomatic group, 36 (29.75%) were in the mild group, 28 (23.14%) were in the common group, and 23 (19.0%) were in the severe group with severe pneumonia and respiratory distress. Five (1.47%), 16 (44.44%), 14 (50%), and 18 (78.26%) of the patients in these groups were smoking, respectively.ConclusionAmong coronavirus disease 2019 patients, smoking is associated with the progression of the disease and increased adverse effects. In our study, smoking status was significantly correlated with thorax computed tomography findings on admission. Computed tomography severity scores assessment helps to evaluate the disease extent in coronavirus disease 2019 patients.

Chest CT of Lung Injury 1 Year after COVID-19 Pneumonia: The CovILD Study.

BackgroundThe long-term pulmonary sequelae of COVID-19 is not well known.PurposeTo characterize patterns and rates of improvement of chest CT abnormalities 1 year after COVID-19 pneumonia.Materials and MethodsThis was a secondary analysis of a prospective, multicenter observational cohort study conducted from April 29 to August 12, 2020, to assess pulmonary abnormalities at chest CT approximately 2, 3, and 6 months and 1 year after onset of COVID-19 symptoms. Pulmonary findings were graded for each lung lobe using a qualitative CT severity score (CTSS) ranging from 0 (normal) to 25 (all lobes involved). The association of demographic and clinical factors with CT abnormalities after 1 year was assessed with logistic regression. The rate of change of the CTSS at follow-up CT was investigated by using the Friedmann test.ResultsOf 142 enrolled participants, 91 underwent a 1-year follow-up CT examination and were included in the analysis (mean age, 59 years ± 13 [SD]; 35 women [38%]). In 49 of 91 (54%) participants, CT abnormalities were observed: 31 of 91 (34%) participants showed subtle subpleural reticulation, ground-glass opacities, or both, and 18 of 91 (20%) participants had extensive ground-glass opacities, reticulations, bronchial dilation, microcystic changes, or a combination thereof. At multivariable analysis, age of more than 60 years (odds ratio [OR], 5.8; 95% CI: 1.7, 24; P = .009), critical COVID-19 severity (OR, 29; 95% CI: 4.8, 280; P < .001), and male sex (OR, 8.9; 95% CI: 2.6, 36; P < .001) were associated with persistent CT abnormalities at 1-year follow-up. Reduction of CTSS was observed in participants at subsequent follow-up CT (P < .001); during the study period, 49% (69 of 142) of participants had complete resolution of CT abnormalities. Thirty-one of 49 (63%) participants with CT abnormalities showed no further improvement after 6 months.ConclusionLong-term CT abnormalities were common 1 year after COVID-19 pneumonia.© RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Leung in this issue.

Interim Analysis of Impact of Adding Low Dose Pulmonary Radiotherapy to Moderate COVID-19 Pneumonia Patients: IMpaCt-RT Study.

BackgroundTreatment for coronavirus disease 2019 (COVID-19) pneumonia remains largely supportive till date and multiple clinical trials took place within the short span of time to evaluate the role of investigational therapies. The anti-inflammatory effect of low dose whole lung radiation in treating pneumonia has been documented earlier. This clinical trial analyzed the effect of low dose radiation therapy (LDRT) in a moderately affected COVID-19 pneumonia patient cohort and has evaluated its effect in stopping the conversion of moderate disease into severe disease.MethodsPatients with moderate COVID-19 pneumonia as characterized by the Ministry of Health and Family Welfare (MOHFW), Government of India, were randomized (1:1) to low dose whole lung radiation versus no radiation. All treatment of patients was concurrently being given as per institutional protocol. Patients were followed up with clinical and laboratory parameters monitored on Days 1, 3, 7, and 14. Computed tomography scan (CT scan) of thorax was performed on Days 1 and 7. Patients were evaluated for conversion of moderate into severe disease as per National Early Warning Score-2 (NEWS-2 score) as the primary end point. The secondary endpoints included changes in ratio between peripheral capillary oxygen saturation and fraction of inspired oxygen (SpO2/FiO2), biochemical markers, 25-point CT severity score, and radiation induced acute pulmonary toxicities.FindingsAt the interim analysis, there were seven patients in the radiation arm and six in the control. A whole lung LDRT improved the outcome of SpO2/FiO2 at Day 3; however it did not convert into a statistically significant improvement for the NEWS-2 score. The serum levels of LDH, CRP, Ferritin and D-dimer were significantly reduced on 14 days in the LDRT arm in comparison to the baseline value but were not significant between the two groups.InterpretationLDRT seems to have the potential to prevent moderate COVID-19 pneumonia from a deteriorating to severe category. However, further randomized clinical trial with an adequate number of such patients is warranted to establish the definitive role of LDRT in the management of COVID-19 pneumonia.FundingAn intramural research project bearing code: I-27/621, was sanctioned from the All India Institute of Medical Sciences, Patna, India.Clinical Trial RegistrationClinical Trials Registry-India (CTRI/2021/06/033912, 25th May 2021) ctri.nic.in/Clinicaltrials/login.php

Association between high resolution computed topography chest severity scores of COVID positive patients with their clinical severity in the COVID care hospital, Jhalawar, Rajasthan

Background: Novel coronavirus is a new emerging infectious disease caused by SARS-CoV-2 that has led to a global pandemic. Early diagnosis, treatment and prognosis is essential to manage the disease. The present study was undertaken to determine the relationship between HRCT (high resolution computed topography) severity scores with clinical severity of COVID positive patients.Methods: A cross sectional study was conducted on reports of HRCT scan of RT-PCR positive patients admitted in COVID care hospital of JMCH. A pretested questionnaire was used to collect all the relevant information including clinical symptoms and post COVID symptoms.Results: CT scores of 236 patients in mild, moderate and severe category were 111 (47%), 83 (35.2%) and 42 (17.8%) respectively. The mean age group was 52.35 years with male preponderance showing a number of 173 (73.3%). The most common clinical symptoms of COVID positive patients in mild, moderate, severe category were cough (82%) and fever (74.8%); cough (95.2%) and SOB (90.40%) and SOB (97.6%) and cough (85.70%) respectively followed by other symptoms. The mean interval of days between initial positive to subsequent RT-PCR negative results in CT severity scores of mild, moderate, severe categories were 5.22, 6.22, 7.12 days respectively.Conclusions: The study suggests that chest CT scoring can add in predicting disease diagnosis and outcome significantly.

Correlation between chest CT severity scoring system with oxygen saturation and laboratory inflammatory markers in adult patients with COVID-19 infection

BackgroundCOVID-19 pneumonia is responsible for the latest pandemics. Chest computed tomography (CT) scan is known to be an essential tool for diagnosis of COVID-19. In this research, the relationship between on-admission chest CT severity score, capillary blood oxygen saturation level, and laboratory inflammatory markers results in patients with SARS-COV-2 pneumonia was investigated.MethodsThis prospective analytical study was conducted in COVID-19 isolation unit, Zagazig University Hospitals, from 1st to end of April 2021. Adult patients with COVID-19 infection were included. Chest CT scan was performed for all patients, and CT severity score was computed. The initial capillary oxygen saturation was also assessed at the time of admission. The information was gathered and analyzed.ResultsA total number of 305 COVID-19 patients were involved in the study with the following data: age, gender, presence of co morbidities, capillary blood oxygen saturation, laboratory tests including absolute lymphocytic count, CRP, D-dimer and ferritin levels, as well as chest CT severity score. Based on chest CT severity score, we found that 110 cases (36.1%) were mild, 163 cases (53.4%) were moderate, and 32 cases (10.5%) were severe, with significant male predominance among moderate and severe cases. The initial measurements of blood oxygen saturation values revealed that mean blood oxygen saturation was 95.6% among mild to moderate cases and 85.4% among severe cases. Furthermore, there was a high statistically significant negative correlation between chest CT severity score and absolute lymphocytic count of studied cases, while there was a statistically significant positive correlation with D-dimer, CRP and ferritin levels.ConclusionsCT scans can help clinicians in developing a management strategy and serve as a predictor of illness severity and possible outcomes. In individuals with COVID-19 infection, the severity of a chest CT scan is positively correlated to inflammatory markers and oxygen demand.

Vitamin D Levels and its Association with Inflammatory Markers, Severity and Outcome in Hospitalised COVID-19 Patients - An Indian Perspective

Background: The recent COVID-19 pandemic has taken over the world in enormous proportions like none other in recent times. Vitamin D plays an essential role in the immune system and has proven to have importance in the context of many respiratory infections. This study aims to unveil the possible correlation between vitamin D levels and disease outcome and affirm the role of hypovitaminosis D as an independent risk factor for severity in COVID 19.Methods: We studied 209 RTPCR confirmed COVID 19 positive cases. Serum 25(OH) D levels were done at the time of admission. HRCT chest and inflammatory markers (serum ferritin, D dimer, IL6 and CRP) were estimated on admission and repeated on case-to-case basis.Results: Out of 209 patients studied, 44.49% had vitamin D deficiency, 24.40% had Vitamin D insufficiency, and 31.11% had normal Vitamin D levels. Vitamin D deficiency significantly increased with advancing age. The mean vitamin D level in our study is 27.47 ± 21.86. 27.8% had mild COVID-19 disease as evidenced by HRCT imaging, 21.1% showed moderate disease, and 51.2% showed severe COVID-19. The mean values of inflammatory markers in Vitamin Ddeficient patients were as follows: D dimer (3298.88 ± 2230.14), Serum Ferritin (530.88 ± 497.14) CRP (175.34 ± 87.27) IL6 (125.39 ± 275.72). Significant correlation of Vitamin D with C reactive protein (r = -0.18, p ≤ 0.05), D-Dimer (r = -0.42, p &lt; 0.0001), and CT severity score (r = -0.24, p ≤ 0.0001) was noted. Conclusion: In our study, Vitamin D inversely proportional levels were inversely proportional to CRP, D-Dimer, and CT severity.

Mediastinal lymph node enlargement in COVID-19: Relationships with mortality and CT findings

BackgroundThe presence of mediastinal lymph node enlargement (MLNE) in computed tomography (CT) of Coronavirus disease 2019 (COVID-19) patients can be associated with disease severity. ObjectivesTo investigate the relationship between MLNE with intensive care unit admission (ICU), mortality rates, and CT findings, especially in early-stage COVID-19 patients. MethodsThis single-center retrospective case-control study, included aged ≥18 years, 250 COVID-19 patients with positive RT-PCR tests. We included two patient groups, 125/250 with and without MLNE. Demographic information of the patients, laboratory findings, length of stay in hospital or ICU, mortality rates, initial CT imaging findings and CT severity scores (CT-SS) were recorded and their relationship with MLNE was investigated. ResultsPatients with MLNE were older (69.61 ± 11.16; p < 0.001) and had a higher CT-SS (14.67 ± 7.55; p < 0.001). There was a significant difference between the presence of MLNE with mortality (58/77, 75.3%; p < 0.001) and ICU admission (49/61, 80.3%; p < 0.001). Also, a statistical association was found between MLNE with ICU admission (p = 0.001) and (p < 0.001) mortality rates in patients with CORADS≤2 CT findings. In multivariate logistic regression analysis, MLNE was 8.8-fold (95% CI: 1.62–47.86, p = 0.01) more correlated with linear opacity and 0.25-fold with bronchial wall thickening (95% CI: 0.07–0.92, p = 0.04). ConclusionMediastinal lymph node enlargement is an important CT finding that can predict the severe prognosis of COVID-19 patients. Even in patients without lung involvement on initial CT, the presence of MLNE should be carefully examined as it is associated with disease severity.

Correlation between chest CT scores and clinical impact in patients re-infected with COVID-19 during the two attacks: an observational study

BackgroundWorldwide, millions of people got COVID-19 infection since the start of the pandemic with a large number of deaths. Re-infection with SARS-CoV-2 is possible, because it can mutate into new strains as it is an RNA virus. The main objective of our study is to correlate between CT severity score of the patients re-infected with COVID-19 during the first and second attack and its clinical impact.ResultsWe performed a retrospective cohort study. It was carried out on fifty symptomatic patients (11 females and 39 males). Their ages ranged from 38 to 71 years. We included only patients who were re-infected after more than 6 months of the first infection and showed clinical symptoms with SARS-CoV-2 PCR-positive test. We found that CT severity score was decreased in the second infection in 47 (94%) of our patients associated with decreased respiratory distress as well as oxygen requirements, while the CT severity score was increased in two patients and only one patient showed no change in CT score severity between two infections.ConclusionThe reduction in CT severity score in the majority of re-infected patients suggested the role of the immunity developed from first infection in protection against severe lung affection in case of repeated infection even after 6 months despite poor immunity against re-infection.

Relationship of Computed Tomography Severity Score With Patient Characteristics and Survival in Hypoxemic COVID-19 Patients.

BackgroundComputed tomography (CT) scans and CT severity scores (CTSS) are widely used to assess the severity and prognosis in coronavirus disease 2019 (COVID-19). CTSS has performed well as a predictor in differentiating severe from non-severe cases. However, it is not known if CTSS performs similarly in hospitalized severe cases with hypoxia at admission.MethodsWe conducted a retrospective comparative study at a COVID-care center from Western India between 25th April and 31st May 2021, enrolling all consecutive severe COVID-19 patients with hypoxemia (peripheral oxygen saturation < 94%). Neutrophil-lymphocyte ratio (NLR), C-reactive protein (CRP), interleukin-6 (IL-6), lactate dehydrogenase (LDH), D-dimer, ferritin, and CT thorax were done within 24h of admission before being initiated on any anti-COVID-19 therapy. CTSS was calculated by visual assessment and categorized into three severity categories and was correlated with laboratory markers and overall survival (OS). Statistical analysis was done using John's Macintosh Project (JMP) 15.0.0 ver. 3.0.0 (Cary, North Carolina).ResultsThe median age of the study population (n-298) was 59 years (24-95) with a male preponderance (61.41%, n=183). The 15 and 30-day survivals were 67.64% and 59.90%, respectively. CTSS did not correlate with age, gender, time from vaccination, symptoms, or comorbidities but had a significant though weak correlation with LDH (p=0.009), D-dimer (p=0.006), and NLR (p=0.019). Comparing demographic and laboratory aspects using CT severity categories, only NLR (p=0.0146) and D-dimer (p=0.0006) had significant differences. The 15d-OS of mild, moderate, and severe CT categories were 88.62%, 70.39%, and 52.62%, respectively, while 30d-OS of three categories were 59.08%, 63.96%, and 49.12%, respectively.ConclusionAmong hospitalized severe COVID-19 patients with hypoxemia at admission, CT severity categories correlate well with outcomes but not inflammatory markers at admission.

Abstract 68: Hypertriglyceridemia-induced acute pancreatitis – Experience from a single center of 20 patients

Background and Aim: Although hypertriglyceridemia (HTG) is a well-established cause of acute pancreatitis (AP), there are no clear-cut therapeutic guidelines. Furthermore, studies regarding treatment and outcome of hypertriglyceridemia-induced acute pancreatitis (HTGAP) in comparison to non-HTGAP are scarce. The present study was aimed to determine the frequency and outcome of HTGAP in comparison to non-HTGAP.Materials and Methods: All patients admitted with AP from January 2017 to August 2021 at St. John's Medical College Hospital, Bengaluru were included, and data were collected prospectively. Patients with HTGAP and non-HTGAP were compared.Results: Of 964 patients admitted with AP, 20 (2.12%, M: F -13:7) were HTG related. The mean age was 39.05 years and the mean triglyceride levels were 3620.8 mg/dl (range 1094 - 11,991). Patients with HTGAP in comparison to non- HTGAP had significantly (p <0.05) high BMI (29.22 v/s 25.69), high severity scores (BISAP and CT severity score, 2.6 v/s 2.06 and 7.5 v/s 4.80) and required prolonged hospitalization (12.9 v/s 6.5 days). 16 patients were treated with insulin infusion and rest conservatively.Conclusion: HTGAP occurred in young patients with high BMI and was associated with more severe disease and required prolonged hospitalization in comparison to patients with non-HTGAP.

Early intervention with anti-fibrotic pirfenidone is effective than corticosteroids in preventing pulmonary fibrosis in severe COVID pneumonia patients

Background: The COVID-19 pandemic caused by SARS-CoV-2 has made nearly 120 million people sick with more than 2 million dead. Many survivors of severe COVID-19 are experiencing post-COVID complications beyond 4 weeks from the disease onset. The decrease in lung function and pulmonary fibrosis are the serious manifestations of COVID-19. The burden of even a relatively mild fibrotic change could have considerable morbidity and mortality, especially in the elderly and those with comorbidities. Aim: To evaluate the effect of early intervention with anti-fibrotic pirfenidone and corticosteroids in preventing pulmonary fibrosis in severe COVID pneumonia patients. Methods: This randomised open-label pilot trial was conducted was conducted at Government Medical College, Srinagar for evaluating the role of anti-fibrotic drugs in preventing post-COVID pulmonary fibrosis. In this study, 60 patients with severe COVID-19 infection were screened and randomised into two groups, one receiving anti-fibrotic drug– pirfenidone (n = 17) and other receiving corticosteroids (n = 19). The study participants were evaluated at the baseline and after 6 ± 1 week using 6-min walk test, spirometry and high-resolution computed tomography (HRCT). Results: The mean (±standard deviation [SD]) age of the pirfenidone and steroid group was 64.16 ± 11.36 and 67.19 ± 13.32 (P = 0.929), respectively. There were no significant differences in clinically relevant baseline characteristics at the time of enrolment in the two treatment groups. The initial CT severity score was 14.84 ± 4.031 and 14.81 ± 4.722 (P = 0.400) in pirfenidone and corticosteroids groups. The mean (±SD) baseline forced expiratory volume in the first second (FEV1) in pirfenidone and corticosteroid was 73.32 ± 18.10 and 71.71 ± 17.92 (P = 0.670), while FEV1/forced vital capacity was 95.89 ± 23.40 and 90.00 ± 21.09 (P = 0.920), respectively, between the two groups. The final fibrosis score was 115.52 ± 12.32 and 138.22 ± 43.90 (P = 0.004) in the pirfenidone and corticosteroids groups, respectively. At the 6th week, the proportion of patients who had died was less in the pirfenidone group as compared in the corticosteroid group (02 patients [11.76%] in the pirfenidone group vs. 08 patients [42.10%] P &lt; 0.001). Conclusion: Pirfenidone, an anti-fibrotic agent, has a better outcome than corticosteroids in preventing post-COVID pulmonary fibrosis without serious adverse effects. Our study concludes that early initiation of pirfenidone therapy in patients with severe COVID-19 infection, especially those at higher risk like the elderly and those with co-morbidities has a better treatment and survival outcome compared to corticosteroids.

India's Second COVID Wave: How is it different from the First Wave?

PurposeIndia is witnessing the resurgence of the COVID-19 pandemic in the form of a hard-hitting second wave. We wanted to compare the clinical profile of the first wave (April-June 2020) with the second wave (March-May 2021) of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), to help prioritize the target population group and management strategies. This will further help in the management of any upcoming third COVID wave.Methods & MaterialsWe conducted a retrospective observational study and examined the demographic profile, symptoms, illness severity, baseline investigations, treatment given, comorbidities, and outcomes of the COVID-19 patients belonging to the first (W1) and the second (W2) waves of the Indian COVID pandemic.ResultsW2 had most people affected in the age group 50.5 (17.7) years compared with 37•1 (16•9) for W1. Baseline oxygen saturation was lower for W2 [84•0 (13•4) % versus(v/s) 91•9 (7•4) %] than W1. 70.2 % of the cases belonged to the severe category in W2 compared to 37.5% in W1. The level of hepatic transaminases was higher for W2 [AST, 108.3 (99.3) v/s 54.6 (69.3); ALT, 97.6 (82.3) v/s 58.7 (69.7) IU/L] than W1. CT severity score in W2 [29.5 (6.7)] was greater than W1 [23•2 (11•5)] [All P<0.05]. The standardized mortality ratio for W2 was 3.5 times that of W1. Higher proportion of patients require oxygen (81.8% v/s 11.2%), high flow nasal cannula (11.4% v/s 5.6%), non-invasive ventilation (41.2% v/s 1.5%), invasive ventilation (24.5% v/s 0.9%), and ICU admissions (56.4% v/s 12.0%) in W2 as compared with W1. We found the second wave to be stronger in terms of oxygen requirement, organ dysfunction, and mortalityConclusionHigher age, oxygen and ventilator requirement, ICU admissions, and organ failure are more prevalent in the second COVID wave that has hit India compared to the first wave and is associated with more deaths. India swiftly needs to scale up the prevalent ICU set up and oxygen production capacity to help accommodate the higher load.

Evaluation of simple cost-effective immuno-haematological markers to predict outcome in hospitalized COVID-19 patients during second wave

Background: COVID-19 pandemic has strained the health infrastructure globally, hence the importance of cost-effective biomarkers. We aimed to identify simple haematological prognostic markers in hospitalized COVID-19 patients to differentiate between milder and severe cases, thus predicting outcome.Methods: A retrospective study of COVID-19 patients admitted at Malla Reddy institute of medical sciences was conducted from April to June 2021. Total leukocyte count (TLC), neutrophil-to-lymphocyte ratio (NLR), derived NLR ratio (dNLR) and platelet-to-lymphocyte ratio (PLR) were calculated and correlated with outcome. These parameters were compared with other inflammatory markers using ROC (receiver operator curve) analysis.Results: 303 patients of 397 fulfilled the inclusion criteria (male-198, female-105). There was a significant higher mean of NLR in patients with death (14.46±5.84) compared to patients recovered (8.43±4.33), similarly the dNLR was higher in death (8.06±2.34) compared to recovered (4.97±1.49). A significant positive strength of association between the NLR and dNLR with the ESR, CRP, CORADS score and CT severity score in the patients. The ROC analysis showed the NLR (AUC=0.777) and dNLR (0.799) a better marker to predict the outcome.Conclusions: In COVID-19, immuno-haematological markers like NLR, dNLR, PLR found to be a simple and cost-effective tool to prognosticate the clinical outcome among hospitalized patients and were in concordance with the other inflammatory markers. Hence, these markers serve as better indicators in risk stratification and better management.

Comparison of Chest Computed Tomography Between the Two Waves of Coronavirus Disease 2019 in Belgium Using Artificial Intelligence.

BackgroundIn this study, we aimed to compare two outbreaks of coronavirus disease 2019 (COVID-19) in Belgium in tomographic and biological-clinical aspects with artificial intelligence (AI).MethodologyWe performed an observational retrospective study. Adult patients who were symptomatic in the first seven days with COVID-19 infection, diagnosed by chest computed tomography (CT) and/or reverse transcription-polymerase chain reaction, were included in this study. The first wave of the pandemic lasted from March 25, 2020, to May 25, 2020, and the second wave lasted from October 7, 2020, to December 7, 2020. For each wave, two subgroups were defined depending on whether respiratory failure occurred during the course of the disease. The quantitative estimation of COVID-19 lung lesions was performed by AI, radiologists, and radiology residents. The chest CT severity score was calculated by AI.ResultsIn the 202 patients included in this study, we found statistically significant differences for obesity, hypertension, and asthma. The differences were predominant in the second wave. Moreover, a mixed distribution (central and peripherical) of pulmonary lesions was noted in the second wave, but no differences were noted regarding mortality, respiratory failure, complications, and other radiological and biological elements. Chest CT severity score was among the risk factors of mortality and respiratory failure. There was a mild agreement between AI and visual evaluation of pulmonary lesion extension (K = 0.4).ConclusionsBetween March and December 2020, in our cohort, for the majority of the parameters analyzed, we did not record significant changes between the two waves. AI can reduce the experience and performance gap of radiologists and better establish a hospitalization criterion.

Severity of COVID-19 Infection Using Chest Computed Tomography Severity Score Index Among Vaccinated and Unvaccinated COVID-19-Positive Healthcare Workers: An Analytical Cross-Sectional Study.

Introduction: Coronavirus disease 2019 (COVID-19) vaccines protect against severe illness. However, data on post-vaccination COVID-19 breakthrough infections are limited.Methods: An analytical cross-sectional study was conducted from May 2021 to July 2021 among 2043 COVID-19-positive healthcare workers who were divided into a vaccinated group (n=1010) and an unvaccinated group (n=1033). A pre-tested questionnaire was circulated among the healthcare workers using Google Forms. Chest computed tomography (CT) severity score was the primary outcome variable analyzed using coGuide.Results: The average age of the study population was less than 45 years in both groups (43.05 ± 13.02 years). Most respondents (62%) were males. Hypertension (39%) and diabetes (33%) were the most common underlying diseases. Significant differences in age and cardiac disease were observed between the two groups (p = 0.07 and p <0.001, respectively). However, the difference was insignificant (p >0.05) for gender, hypertension, and diabetes. Most unvaccinated respondents had an increased CT severity score, and the difference between the studies groups was significant (p <0.001). Of the 1,010 vaccinated individuals, 382 (37.82%) received the only first vaccination dose, and 628 (62.18%) received both doses. The CT severity score decreased after receiving both vaccination doses, and the difference between CT severity score and vaccination status was significant (p <0.001).Conclusion: COVID-19 was mild in the vaccinated group. Chest CT severity score index can be considered an efficient tool in predicting prognosis and monitoring disease in patients with COVID-19 in India.

ChestCTseverityscore: assessment of COVID‑19 severity andshort-term prognosis in hospitalized Iranian patients.

BackgroundThe aim of this study was to evaluate the value of chest computed tomography (CT) severity score in the assessment of coronavirus disease 2019 (COVID‑19) severity and short-term prognosis.MethodsIn this cross-sectional study, we evaluated all patients who were referred to our university hospital, from 21 May 2020 to 22 June 2020 with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription-polymerase chain reaction (RT-PCR) test. The patients suspected of having other respiratory diseases including influenza, according to an infectious disease specialist, and those without chest CT scan were excluded. A chest CT was obtained for all patients between days 4 and 7 days after symptom onset. Chest CT severity score was also calculated based on the degree of involvement of the lung lobes as 0%, (0 points), 1–25% (1 point), 26–50% (2 points), 51–75% (3 points), and 76–100% (4 points). The CT severity score was quantified by summing the 5 lobe indices (range 0–20). The ROC curve analysis was performed for the clinical value of CT scores in distinguishing the patients based on the severity of disease (mild/moderate group versus severe group), ICU admission, intubation requirement, and mortality.ResultsOf the 148 patients included, 93 patients recovered, while 55 patients died (mortality rate 37%). The area under the curve of CT score for discriminating of recovered patients from deceased individuals was 0.726, and the optimal CT score threshold was 15.5 with 61.8% sensitivity and 76.3% specificity. The best CT score cut-off for discriminating of patients based on the severity of disease was 12.5 with 68.3% sensitivity and 72.7% specificity. In addition, with CT score cut-off of 15.5, sensitivities of 70.8% and 51.6% and specificities of 78% and 72.6% were observed for intubation and ICU admission, respectively.ConclusionCT scan and semiquantitative scoring method could be beneficial and applicable in predicting the patient’s condition.