Degree Of Lung Involvement Research Articles

Impact of preexisting hypertension and antihypertensive medication on prognosis of COVID-19 patients

Objectives: Coronavirus disease-2019(COVID-19) patients with comorbidities experience severe disease. Hypertension (HTN) is one of the most common comorbidities seen in these patients. The published reports are conflicting regarding the role of HTN and antihypertensive medication on the in-hospital prognosis of COVID-19 patients. This study investigated the effect of HTN on the prognosis of hospitalized COVID-19 individuals and sought to identify the risk factors for worse clinical outcomes in this population. Methods: This descriptive-analytical observational study was conducted on COVID-19 patients hospitalized in two teaching hospitals (Shahid Rahnemoon and Shahid Sadoughi) in Yazd, Iran from February 20, 2022, to April 20, 2022. All hospitalized patients with positive polymerase chain reaction (PCR) tests for COVID-19 were included in the study. The demographic, laboratory, imaging, pharmaceutical and clinical data were extracted and analyzed by SPSS v-26. Results: Out of 615 participants, 243 had HTN. Hypertensive patients had significantly more need for Intensive Care Unit (ICU) admission (P=0.001) and endotracheal intubation (P<0.001) and experienced higher mortality (P<0.001). The length of hospital and ICU stay and duration of endotracheal intubation were not significantly different. No antihypertensive medication was found to impact the patient's prognosis significantly. In hypertensive individuals, the multivariate regression analysis revealed the vaccination status (OR=0.27; CI 95%: 0.10-0.69), a score of Computed tomography (CT) scan involvement (OR=7.49; CI 95%: 3.50-16.01), and neutrophil-to-lymphocyte ratio (NLR) (OR=1.05; CI 95%: 1.00-1.11) as the predictors of need to ICU admission. Conclusions: Hypertensive COVID-19 patients experience higher mortality and require more ICU admission and endotracheal intubation. None of the antihypertensive drugs had a significant effect on prognosis. The vaccination status, NLR, and the degree of lung involvement in chest imaging predicted the need for ICU admission in this subgroup of patients.

Factors Associated with COVID-19 Mortality in Elderly Patients in Intensive Care Unit

Objectives: Mortality rates in patients with COVID-19 infection admitted to the intensive care unit are influenced by various factors. In this study, we aimed to investigate the mortality rate and factors affecting mortality in patients admitted to the intensive care unit due to COVID-19 infection who had not been vaccinated. 
 Methods: Our study was conducted retrospectively by scanning patients admitted to the intensive care unit of Izmir Bozyaka Education and Research Hospital of Health Sciences University from the beginning of 2020 to the end of 2022. Patients who were admitted to the intensive care unit were 65 years of age and older with COVID-19 infection. The patients' presenting complaints, degree of lung involvement, laboratory findings, and comorbidities were compared between patients who survived and those who passed away.
 Results: A total of 166 patients were evaluated in our study. Of these, 48 patients were discharged, while 118 patients experienced an excitus. The median age (IQR) for discharged patients was 71.5 (8), and for patients who experienced an excitus, it was 78 (15), which was found to be statistically significant (p

COVID-19-induced cardiovascular complexities

This study aimed to investigate the features of the clinical course of COVID-19 in combination with the pathology of the cardiovascular system (CVS). A prospective study was carried out. The main group (n=150) consisted of patients with changes in the cardiovascular system associated with COVID-19, i.e. newly diagnosed CV pathology, and patients with exacerbation of cardiac pathology against the background of COVID-19. The comparison group (n=154) included patients with COVID-19, but without any significant concomitant cardiac pathology. The average age of patients in the main group was 67.7 years (from 47 to 86 years), in the comparison group of 66.1 years (from 48 to 88 years). The study groups were representative and did not differ statistically in the nature of COVID-19 symptoms and the degree of lung involvement. Among the cardiac pathology, progressing or first occurring against the background of infection with COVID-19, in most cases, arterial hypertension of II-III degree (60.0%), coronary heart disease (48.7%), arrhythmias (23.3%) were diagnosed. Echocardiographic abnormalities included right ventricular dysfunction (22.7%), left ventricular contractility disorders (18.7%), with decreased ejection fraction (17.3%), diastolic dysfunction (14.0%), and toxic myocarditis (7.3%). The most significant risk factors were the presence of a burdened medical history (RR=10.39), elevated body mass index over 30 (RR=2.63) and diabetes mellitus (RR=1.55). In patients with COVID-19 in combination with CVS pathology, a relatively high incidence of acute onset (64.0% vs. 44.2%; p<0.001), respiratory failure (83.7% vs. 62.0%; p<0.001), admission to the intensive care unit (25.3% vs. 11.7%; p=0.004), development of acute respiratory distress syndrome (20.0% vs. 9.1%; p=0.012), hospital mortality (10.7% vs. 2.7%; p=0.006). Cardiac manifestations of COVID-19 included focal or global myocardial inflammation, ventricular dysfunction, heart failure, and arrhythmias. A high frequency of acute onset of the disease, respiratory failure and hospital mortality is determined.

COVID-19-induced cardiovascular complexities

This study aimed to investigate the features of the clinical course of COVID-19 in combination with the pathology of the cardiovascular system (CVS). A prospective study was carried out. The main group (n=150) consisted of patients with changes in the cardiovascular system associated with COVID-19, i.e. newly diagnosed CV pathology, and patients with exacerbation of cardiac pathology against the background of COVID-19. The comparison group (n=154) included patients with COVID-19, but without any significant concomitant cardiac pathology. The average age of patients in the main group was 67.7 years (from 47 to 86 years), in the comparison group of 66.1 years (from 48 to 88 years). The study groups were representative and did not differ statistically in the nature of COVID-19 symptoms and the degree of lung involvement. Among the cardiac pathology, progressing or first occurring against the background of infection with COVID-19, in most cases, arterial hypertension of II-III degree (60.0%), coronary heart disease (48.7%), arrhythmias (23.3%) were diagnosed. Echocardiographic abnormalities included right ventricular dysfunction (22.7%), left ventricular contractility disorders (18.7%), with decreased ejection fraction (17.3%), diastolic dysfunction (14.0%), and toxic myocarditis (7.3%). The most significant risk factors were the presence of a burdened medical history (RR=10.39), elevated body mass index over 30 (RR=2.63) and diabetes mellitus (RR=1.55). In patients with COVID-19 in combination with CVS pathology, a relatively high incidence of acute onset (64.0% vs. 44.2%; p<0.001), respiratory failure (83.7% vs. 62.0%; p<0.001), admission to the intensive care unit (25.3% vs. 11.7%; p=0.004), development of acute respiratory distress syndrome (20.0% vs. 9.1%; p=0.012), hospital mortality (10.7% vs. 2.7%; p=0.006). Cardiac manifestations of COVID-19 included focal or global myocardial inflammation, ventricular dysfunction, heart failure, and arrhythmias. A high frequency of acute onset of the disease, respiratory failure and hospital mortality is determined.

Enrichment strategies for clinical trials targeting skin fibrosis and interstitial lung disease in systemic sclerosis.

This review gives an update on enrichment strategies for clinical trials in patients with systemic sclerosis (SSc) in two contexts - skin fibrosis in early diffuse cutaneous disease, and SSc-related interstitial lung disease (ILD) - focusing on reports from the last 18 months. Lessons have been learnt from recent studies, making this review timely. Recent trials have highlighted how patients included into trials must be carefully selected to include 'progressors', that is, those most likely to benefit from treatment, and how drug mechanism action of action will influence trial design. For skin fibrosis, current enrichment strategies are mainly on clinical grounds (including disease duration, extent of skin thickening, tendon friction rubs and anti-RNA polymerase III positivity). Gene expression signatures may play a role in the future. For ILD, current enrichment strategies (degree of lung involvement as assessed by pulmonary function and high-resolution computed tomography) may help to recruit the most informative patients, but should avoid being too stringent to be feasible or for findings to be generalizable. Both skin fibrosis and ILD trials are challenging in SSc. Ongoing work on enrichment strategies should help to differentiate effective new treatments from placebo with smaller sample sizes than have been included in recent studies.

Levels of soluble TNF receptors (sTNFR1 and sTNFR2) increase with clinical worsening of patients and are related to COVID-19 mortality

The present study aimed to inspect the serum levels of the soluble receptors, sTNFR1 and sTNFR2, in patients with COVID-19. The large production of inflammatory cytokines is an essential process in the pathogenesis of COVID-19. TNF is a multifaceted proinflammatory cytokine which has soluble and membrane receptors. Thus, knowing the role of these receptors will help better understand this disease's immunopathogenesis. We included 131 patients confirmed for SARS-CoV-2, separated into three groups: ward patients without O2 support, group A (n = 14); ward patients with O2 support, group B (n = 85), and patients in an intensive care unit (ICU), group C (n = 32), making up the receptors dosed by flow cytometry. The results showed that sTNFR1 and sTNFR2 are associated with disease severity, being higher in group C when compared to group A. As for the levels of receptors and their relationship with the degree of lung involvement, we found higher values of sTNFR1 in patients in group 1 (pulmonary involvement < 25%), suggesting that inflammatory processes related to TNF are not necessarily associated with the primary site of infection. When we analysed the patients who passed away compared to those who recovered, both receptors significantly increased the mortality numbers. These findings suggest a relevant influence of soluble receptors in the inflammatory processes involved in the pathogenesis of COVID-19. Wherefore, we suggest using these receptors as biomarkers of severity and mortality of the disease.

Assessment of lung involvement using HRCT among vaccinated and non-vaccinated elderly COVID-19 patients admitted in a designated hospital, Tamil Nadu - A retrospective study.

The COVID-19 pandemic is considered one of the most devastating situations globally, the worst affected were the senior citizens. A number of initiatives were carried out to control the COVID-19 pandemic; one such important measure is the development of COVID-19 vaccines to prevent the disease. But the continuous emergence of new SARS-COV2 variants (antigenic drift) and its demographic variation in virulence makes the vaccine's efficacy questionable. This study is intended to evaluate the association between the degree of lung involvement and the effectiveness of vaccination against the disease in cases admitted to a designated hospital in Tamil Nadu. A hospital records-based-retrospective research was conducted among COVID-19 patients admitted from the 1st of April 2021 to the 31st of May 2021, and information was gathered regarding their vaccination status, comorbid conditions, and CT severity score (CTSS) in the HRCT lung report. A consecutive sampling technique was used to choose the study participants; about 120 participants were included in the study. The Chi-square test and Fisher's extract test were used to evaluate the hypothesis. The relationship between a dependent variable and independent factors was estimated using multiple linear regression. Among 120 participants, about 60.2% were males and 39.8% were females. Vaccination status and comorbid conditions had a significant association with severe lung involvement in COVID-19 patients. Non-vaccinated patients had severe lung involvement based on the HRCT lung scan findings than the vaccinated patients. To reduce mortality, it is essential to ensure universal coverage of COVID-19 vaccination.

CT Severity Score in COVID-19 Patients and its Association with Diabetes Mellitus and Hypertension: A Retrospective Study

Introduction: The Coronavirus Disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), was first identified in Wuhan, China, in December 2019. It is thought that, people who have Diabetes Mellitus (DM) and Hypertension (HTN) are more likely to get a severe COVID19 infection. High-resolution Chest Computed Tomography (HRCT) has been shown to provide immediate results with high sensitivity and specificity for determining the severity of COVID19 infection and lung involvement. Aim: To determine the association between chest CT Severity Scores (CTSS) and DM and HTN in COVID-19 patients. Materials and Methods: This retrospective observational study was conducted in the Department of Radiodiagnosis at, Gajra Raja Medical College, Gwalior, Madhya Pradesh, India. The duration of the study was 1 month, from July 2020 to August 2020. Based on the degree of lung involvement seen on HRCT chest scans, A total of 100 patients (68 males and 32 females) with COVID-19 infection were given a quantitative CTSS. The patients were divided into groups with mild, moderate, and severe lung involvement based on the CTSS. The Chi-square test was used to assess the relationship between DM, HTN, and CTSS. The data was analysed using Statistical Package for Social Sciences (SPSS) version 17.0. Results: The mean age of study participants was 45.7±15.95 years. A total of 72 (72%) of the participants were of normal weight, 8 (8%) were overweight or obese, and 20 (20%) were underweight. COVID19 patients with a co-diagnosis of DM (61.9%) or HTN (69.2%) had more severe lung involvement than COVID-19 patients without DM (19%) or HTN (21%). DM and HTN were found to be significantly associated with severe lung involvement (p-value&lt;0.01). Conclusion: Diabetic and hypertensive patients are more likely than non diabetic and non hypertensive patients to develop the severe form of COVID-19 and have a higher CT lung involvement score. DM and HTN should be considered as risk factors for the severity of COVID-19 disease.

Evaluation of D-dimer as a predictor of severity, degree of pulmonary involvement and mortality in patients with COVID-19

Objective: To verify D-dimer values to predict disease severity, degree of lung involvement and mortality in patients with COVID-19. Method: The D-dimer levels of 200 confirmed COVID-19 patients were prospectively measured in the Emergency Department of Razi Hospital of Ahvaz on the admission day, and its relations with the illness severity, computed tomography (CT) score, and mortality were assessed. Results: D-dimer level &gt; 1.04 μg/mL and ≤ 1.12 μg/mL could indicate severe illness and high grade of pulmonary involvement but low risk of death. The mortality rate in the patients with D-dimer level &gt; 1.12 μg/mL (was significantly higher than its rate in those with D-dimer level ≤ 1.12 μg/mL (17.2% x 1.5%; P:0.02). An independent positive correlation was found between D-dimer and Chest CT score as well as the disease severity (OR: 1.84; 95%CI:1.38 - 2.45; P:0.0001). Conclusion: D-dimer level &gt; 1.12 μg/mL on the early stage of COVID-19 infection may independently predict the severe illness, high grade of pulmonary involvement, and high risk of death, indicating its beneficial role in timely management of critical patients.

The Impact of Chest Computed Tomography in A Covid-19 Reference Hospital - First Wave - Distrito Federal - Brazil

Objectives To evaluate the diagnostic accuracy of chest CT for the diagnosis of COVID-19 associated with the clinical presentation and in relation to the PCR-RT. Sensitivity, specificity, positive predictive value and negative predictive value, gender, age group and degree of lung involvement will be evaluated. Methods We evaluated 1545 patients with chest CT, delineating the age range and degree of lung involvement, and 306 patients with chest CT and PCR-RT. Results Of the 1545 examinations, 53% were men and 47% were women, there was greater involvement in the 50-59 age group. In the pulmonary study, 55.05% were COVID-19. In the degree of lung involvement 37.70% were mild, 35.76% were moderate, and 26.54% were severe. In the distribution by age, there was a greater involvement between 50-59 years with 56% between moderate (27.6%) and severe (28.0%). Between tomography and PCR-RT, the sensitivity was 68.8%, specificity 59.5%, accuracy 91.3%, with prevalence 31.9%, positive predictive value 44.3% and negative predictive value 80.3%, in females, sensitivity 55.3%, positive predictive value 37.1%, negative predictive value 75.3%, in males, sensitivity 81.6%, positive predictive value 50, 6 and negative predictive value 86.6%.The sensitivities are different between the genders with p of 0.005 and specificity of 0.938, with age effect, starting at 45 years we have a p of 0.057 that decreases to 0.006 at 80 years for sensitivity and specificity. Conclusions The sensitivity and accuracy of CT scan in relation to PCR-RT was significant. Sensitivity increases with prevalence and in the older age group and in men.

Clinical manifestations and laboratory findings and mortality rate of kidney transplant recipients infected with COVID-19

Introduction: The emergence of a novel coronavirus (COVID-19) in late December 2019 and its rapid global spread has led World Health Organization (WHO) to introduce it as a very dangerous pandemic. People with underlying disease and a history of organ transplantation are at higher risk for COVID-19 disease compared with healthy people. Objectives: In the present study, clinical and laboratory manifestations in the patients with COVID-19 with a history of kidney transplantation has been investigated. Patients and Methods: This study conducted on 103 COVID-19-positive kidney transplant patients as a descriptive epidemiological study. Clinical and laboratory symptoms of hospitalized renal transplanted patients have been assessed. Statistical analysis of the collected data conducted using SPSS (Statistical Package for Social Sciences, version 22). Results: This study consisted of 103 COVID-19 patients with a history of kidney transplant, of which 64 males (62.1%) and 39 females (37.9%) with an average age of 48.5 ± 13.1 years. The most common clinical manifestations were headache (67%) and shortness of breath (66%). Elevated lactate dehydrogenase (LDH) levels, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) has been observed in 100%, 98.1% and 93.2% of patients, respectively. In 12.6% and 41.7% of patients, the degree of lung involvement was above 75% and 50%-75%, respectively. Moreover, 79.6% of patients has been discharged after improved, while 20.4% of patients died. Conclusion: We found, kidney transplantation may increase COVID-19-related mortality when compared to COVID-19-related mortality in the general population.

The effects of add-on therapy of Phyllanthus Emblica (Amla) on laboratory confirmed COVID-19 Cases: A randomized, double-blind, controlled trial

ObjectiveThis randomized, double-blind, controlled trial (RCT) aimed to evaluate the effect of Phyllanthus Emblica (Amla) as an add-on therapy on COVID-19_ related biomarkers and clinical outcomes in COVID-19 patients. MethodsIn this RCT, sixty-one patients were randomly assigned into two arms [the intervention (n=31) and control arms (n=30)]. The effect of Amla on diagnostic Reverse-transcription Polymerase Chain Reaction (RT-PCR) test results between the first and the last days of the study, the length of stay (LOS) in hospital, the percentage of lung involvement on CT scans, changes in the clinical symptoms, and the laboratory markers were assessed. ResultsThe two study groups had similar baseline demographics and characteristics in terms of medical history. The mean of LOS in the intervention arm (4.44 days) was significantly shorter than in the control arm (7.18 days, P < 0.001); RT-PCR results were not significantly different between the two arms (P = 0.07). All clinical variables decreased over time in the two groups (P < 0.001). However, the difference between the two groups in terms of fever (P = 0.004), severity of cough (P = 0.001), shortness of breath (P = 0.004), and myalgia (P = 0.005) were significant, but this intergroup comparison was not significant with regard to respiratory rate (P = 0.29), severity of chills (P = 0.06), sore throat (P = 0.22), and weakness (P = 0.12). Out of the eight evaluated para-clinical variables, three variables showed significant improvement in the intervention arm, including the mean increase in oxygen saturation (SpO2) level (P < 0.001), the reduction in the mean percentage of lung involvement on CT (P < 0.001), and the improvement in C-reactive protein test results (P < 0.001). ConclusionOrganic herbal Amla tea cannot significantly affect the RT-PCR results and or degree of lung involvement. Nevertheless, it showed an ameliorative effect on the severity of clinical signs and CRP levels. Also, Amla tea may shorten the recovery times of symptoms and LOS in COVID-19 patients.

Chest CT Characteristics are Strongly Predictive of Mortality in Patients with COVID-19 Pneumonia: A Multicentric Cohort Study

Rationale and ObjectivesThe novel coronavirus (COVID-19) has presented a significant and urgent threat to global health and there has been a need to identify prognostic factors in COVID-19 patients. The aim of this study was to determine whether chest computed tomography (CT) characteristics had any prognostic value in patients with COVID-19.Materials and MethodsA retrospective analysis of COVID-19 patients who underwent a chest CT-scan was performed in four medical centers. The prognostic value of chest CT results was assessed using a multivariable survival analysis with the Cox model. The characteristics included in the model were the degree of lung involvement, ground glass opacities, nodular consolidations, linear consolidations, a peripheral topography, a predominantly inferior lung involvement, pleural effusion, and crazy paving. The model was also adjusted on age, sex, and the center in which the patient was hospitalized. The primary endpoint was 30-day in-hospital mortality. A second model used a composite endpoint of admission to an intensive care unit or 30-day in-hospital mortality.ResultsA total of 515 patients with available follow-up information were included. Advanced age, a degree of pulmonary involvement ≥50% (Hazard Ratio 2.25 [95% CI: 1.378-3.671], p = 0.001), nodular consolidations and pleural effusions were associated with lower 30-day in-hospital survival rates. An exploratory subgroup analysis showed a 60.6% mortality rate in patients over 75 with ≥50% lung involvement on a CT-scan.ConclusionChest CT findings such as the percentage of pulmonary involvement ≥50%, pleural effusion and nodular consolidation were strongly associated with 30-day mortality in COVID-19 patients. CT examinations are essential for the assessment of severe COVID-19 patients and their results must be considered when making care management decisions.

Pulmonary Cystic Lesions in Patients with COVID-19 Infection: A Case Series

Computed Tomography has played a vital role in Coronavirus Disease 2019 (COVID-19) infection, caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) over the last two years. The typical features of COVID-19 on High Resolution Computed Tomography (HRCT) of chest including ground glass opacities and consolidation with a peripheral and lower lobar predilection have been very well documented in literature worldwide. However, thin-walled lucencies in the lung parenchyma called cysts is not very well documented. Authors thus present a case series comprising six SARS-CoV-2 Reverse Transcription-Polymerase Chain Reaction (RT-PCR) positive patients admitted to the hospital during the period 1st April 2021 to 31st May 2021 with lung cysts on HRCT. It was a retrospective study wherein details of the patients were drawn from the case record sheets and the clinical parameters along with HRCT chest findings were analysed, and correlations were drawn to study the cause, timing and significance of these cysts. In this study, the cysts were found to be thin-walled, varying in size from 5-20 mm in diameter and subpleural in distribution with no obvious lobar predilection.The immediately surrounding lung parenchyma showed features of maximal involvement by the atypical pneumonitis. All six cases had moderate to severe lung involvement entailing oxygen therapy. The high flow oxygen therapy and its duration along with degree of lung involvement, are important determinants of cystic degeneration. In the present case series, cystic changes were observed somewhere between day 15 to day 40 of the disease and thus a part of postacute fibrosis in COVID-19 infection.

CT Pulmonary Manifestations in Patients with Rheumatoid Arthritis: Visual scoring versus pulmonary function

Abstract Background Pulmonary involvement is the most common extra-articular manifestation of Rheumatoid arthritis. Aim of the Work To highlight the role of HRCT in detection and characterization of variable pulmonary manifestations that can be encountered in patients with Rheumatoid Arthritis trying to correlate the CT pulmonary manifestations with pulmonary functions using CT scoring system. Patients and Methods This was a retrospective study that included 32 patients who were diagnosed to have Rheumatoid Arthritis either outpatients or referred from the Rheumatology Department at Ain Shams University Hospitals to the Radiodiagnosis Department for HRCT chest examination. An acceptance from the ethical committee of Faculty of Medicine - Ain Shams University was obtained to use the data stored on PACs system with the patient’s consent was waived being a retrospective study. All patients underwent HRCT image analysis regarding the CT features and CT score for disease severity. Also, all patients did spirometery for pulmonary function assessment. Results Analyzing the data showed a female sex predominance (90.6%). 87% of the patients were diagnosed to have RA for more than 2 years duration. The most common respiratory symptom was dyspnea and the restrictive pattern was the commonest PFT finding. Ground glass pattern was the most common 78.1% followed by reticular pattern which was seen in 68.8% of patients. PFT and HRCT showed a positive correlation regarding the severity. Conclusion HRCT is a modality of choice for detection of pulmonary manifestation of rheumatoid arthritis patients with CT scoring can be used to assess the severity of disease and degree of lung involvement which is correlated with pulmonary function test.

The clinical presentations and outcomes in a cohort of hospitalized elderly COVID-19 Egyptian patients: A cross-sectional study

Background and aims: Elders at an increased risk of getting the novel COVID-19 infection. Materials and Methods: We analyzed the clinical presentations, laboratory and radiological investigations, and the patient’s outcome in fifty seniors aged 60 years and more who were hospitalized due to COVID-19 confirmed by RT-PCR essay of nasopharyngeal swabs in the period from December 2020 till March 2021. Results: The mean age was 68.2 ± 5.9 years (60% males and 40% females), 70% with comorbidities. Our patients exhibited a variety of clinical manifestations (constitutional, respiratory, gastrointestinal, and atypical) and hematological presentations with variable percentages. The mean period of hospital stay was15.05 days with 60% of the patients cured and 40% died (60% males, 40% females). The causes of death were septic shock (81.8%), ARDS (36.3%), AKI (18.2%), DIC (13.6), and encephalitis (9.1%). Using multivariant regression analysis and Roc curve analysis; levels of D-dimer >901ng/ml, interleukin-6 >13.5pg/ml, and >30% lung involvement were independent predictors of mortality after adjustment of other predictors. Conclusion: Elderly patients are susceptible to adverse outcomes of SARS Cov-2 infection. Unexpectedly, gastrointestinal manifestations were associated with mortality in seniors along with low oxygen saturation, and wheezy chest. After multivariant regression analysis only D-dimer, interleukin-6, and the degree of lung involvement in CT were independent predictors of mortality in seniors after adjustment of other predictors.

A nomogram for predicting brain metastasis in patients with de novo stage IV breast cancer.

BackgroundBrain metastasis (BM) is a very serious event in patients with breast cancer. The aim of this study was to establish a nomogram to predict the risk of BM in patients with de novo stage IV breast cancer.MethodsWe gathered female patients diagnosed with de novo stage IV breast cancer between 2010 and 2015 from the Surveillance, Epidemiology, and End Results (SEER) database. After randomly allocating the patients to the training set and verification set, we used univariate and multivariate logistic regression to analyze the relationship between BM and clinicopathological features. Finally, we developed a nomogram which was validated by the analysis of calibration curve and receiver operating characteristic curve.ResultsOf 7,154 patients with de novo stage IV breast cancer, 422 developed BM. Age, tumor size, subtype, and the degree of lung involvement were significantly correlated with BM. The nomogram had discriminatory ability with an area under curve (AUC) of 0.640 [95% confidence interval (CI): 0.607 to 0.673] in the training set, and 0.644 (95% CI: 0.595 to 0.693) in the validation set.ConclusionsOur study developed a nomogram to predict BM for de novo stage IV breast cancer, thus helping clinicians to identify patients at high-risk of BM and implement early preventive interventions to improve their prognoses.

CT quantitative analysis in patients with severe coronavirus disease 2019 and its correlation with laboratory examination results

OBJECTIVE: To quantitatively analyze the longitudinal changes of ground-glass opacity (GGO), consolidation and total lesion in patients infected with severe coronavirus disease 2019 (COVID-19), and its correlation with laboratory examination results. MATERIALS AND METHODS:All 76 computed tomography (CT) images and laboratory examination results from the admission to discharge of 15 patients confirmed with severe COVID-19 were reviewed, whereas the GGO volume ratio, consolidation volume ratio, and total lesion volume ratio in different stages were analyzed. The correlations of lesions volume ratio and laboratory examination results were investigated. RESULTS: Four stages were identified based on the degree of lung involvement from day 1 to day 28 after disease onset. GGO was the most common CT manifestation in the four stages. The peak of lung involvement was at around stage 2, and corresponding total lesion volume ratio, GGO volume ratio, and consolidation volume ratio were 17.48 (13.44−24.33), 12.11 (7.34−17.08), and 5.51 (2.58−8.58), respectively. Total lesion volume ratio was positively correlated with neutrophil percentage, C-reactive protein (CRP), high-sensitivity CRP (Hs-CRP), procalcitonin, lactate dehydrogenase (LD), and creatine kinase isoenzyme MB (CK-MB), but negatively correlated with lymphocyte count, lymphocyte percentage, arterial oxygen saturation, and arterial oxygen tension. Consolidation volume ratio was correlated with most above laboratory examination results except Hs-CRP, LD, and CK-MB. GGO, however, was only correlated with lymphocyte count. CONCLUSION: CT quantitative parameters could show longitudinal changes well. Total lesion volume ratio and consolidation volume ratio are well correlated with laboratory examination results, suggesting that CT quantitative parameters may be an effective tool to reflect the changes in the condition.

Clinical characteristics and chest CT imaging features of critically ill COVID-19 patients.

ObjectivesTo compare clinical, laboratory, and chest computed tomography (CT) findings in critically ill patients diagnosed with coronavirus disease 2019 (COVID-19) who survived and who died.MethodsThis retrospective study reviewed 60 critically ill patients (43 males and 17 females, mean age 64.4 ± 11.0 years) with COVID-19 pneumonia who were admitted to two different clinical centers. Their clinical and medical records were analyzed, and the chest CT images were assessed to determine the involvement of lobes and the distribution of lesions in the lungs between the patients who recovered from the illness and those who died.ResultsCompared with recovered patients (50/60, 83%), deceased patients (10/60, 17%) were older (mean age, 70.6 vs. 62.6 years, p = 0.044). C-reactive protein (CRP) (110.8 ± 26.3 mg/L vs 63.0 ± 50.4 mg/L, p < 0.001) and neutrophil-to-lymphocyte ratio (NLR) (18.7 ± 16.6 vs 8.4 ± 7.5, p = 0.030) were significantly elevated in the deceased as opposed to the recovered. Medial or parahilar area involvement was observed in all the deceased patients (10/10, 100%), when compared to only 54% (27/50) in the recovered. Ground-glass opacities (97%), crazy-paving pattern (92%), and air bronchogram (93%) were the most common radiological findings. There was significant difference in diabetes (p = 0.025) and emphysema (p = 0.013), and the odds ratio on a deceased patient having diabetes and emphysema was 6 times and 21 times the odds ratio on a recovered patient having diabetes and emphysema, respectively.ConclusionsOlder patients with comorbidities such as diabetes and emphysema, and higher CRP and NLRs with diffuse lung involvement were more likely to die of COVID-19.Key Points• Almost all patients critically ill with COVID-19 pneumonia had five lung lobes involved.• Medial or parahilar area involvement and degree of lung involvement were more serious in the deceased patients when compared with those who recovered from treatment.• Chronic lung disease, e.g., emphysema, diabetes, and higher serum CRP and NLR characterized patients who died of COVID-19.

Etiology, Risk Factors, and Biomarkers in Systemic Sclerosis with Interstitial Lung Disease.

Systemic sclerosis (SSc) is a complex, multiorgan, autoimmune disease. Lung fibrosis occurs in ∼80% of patients with SSc; 25% to 30% develop progressive interstitial lung disease (ILD). The pathogenesis of fibrosis in SSc-associated ILD (SSc-ILD) involves cellular injury, activation/differentiation of mesenchymal cells, and morphological/biological changes in epithelial/endothelial cells. Risk factors for progressive SSc-ILD include older age, male sex, degree of lung involvement on baseline high-resolution computed tomography imaging, reduced DlCO, and reduced FVC. SSc-ILD does not share the genetic risk architecture observed in idiopathic pulmonary fibrosis (IPF), with key risk factors yet to be identified. Presence of anti–Scl-70 antibodies and absence of anti-centromere antibodies indicate increased likelihood of progressive ILD. Elevated levels of serum Krebs von den Lungen-6 and C-reactive protein are both associated with SSc-ILD severity and predict SSc-ILD progression. A promising prognostic indicator is serum chemokine (C-C motif) ligand 18. SSc-ILD shares similarities with IPF, although clear differences exist. Histologically, a nonspecific interstitial pneumonia pattern is commonly observed in SSc-ILD, whereas IPF is defined by usual interstitial pneumonia. The course of SSc-ILD is variable, ranging from minor, stable disease to a progressive course, whereas all patients with IPF experience progression of disease. Although appropriately treated patients with SSc-ILD have better chances of stabilization and survival, a relentlessly progressive course, akin to IPF, is seen in a minority. Better understanding of cellular and molecular pathogenesis, genetic risk, and distinctive features of SSc-ILD and identification of robust prognostic biomarkers are needed for optimal disease management.