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      Prognostic value of CT integrated with clinical and laboratory data during the first peak of the COVID-19 pandemic in Northern Italy: A nomogram to predict unfavorable outcome

      research-article
      Author(s): a , b , a , c , c , d , d , d , a , a , b , e , e , *
      Publication date (Electronic):
      Journal: European Journal of Radiology
      Publisher: Elsevier B.V.
      Keywords: CT, computed tomography, COVID-19, Coronavirus Infectious Disease 2019, ED, Emergency Department, ICU, intensive care unit, PI score, Pulmonary Involvement score, PC score, Pulmonary Consolidation score, ROC, Receiver Operating Characteristic, OR, odds ratio, CI, confidence interval, AUC, area under the curve, SARS-CoV-2, severe acute respiratory syndrome coronavirus-2, RSNA, Radiological Society of North America, HIV, Human Immunodeficiency Virus, SaO2, Arterial saturation of oxygen, paO2, partial pressure of oxygen, pCO2, partial pressure of carbon dioxide, WBC, white blood cell, ALT, alanine aminotransferase, AST, aspartate aminotransferase, LDH, lactate dehydrogenase, PT, prothrombin time, PTT, partial thromboplastin time, CRP, C-reactive protein level, PCT, procalcitonin, BNP, atrial natriuretic peptide, TnT, troponin levels, SIMIT, Italian Society of Infectious and Tropical Diseases, A.I., Artificial Intelligence, COVID-19 prognostic parameters, Chest computed tomography, Quantitative visual analysis method, Integrated prognostic score, Clinical and laboratory data, Prognostic nomogram

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          Abstract

          Purpose

          To evaluate the prognostic role of chest computed tomography (CT), alone or in combination with clinical and laboratory parameters, in COVID-19 patients during the first peak of the pandemic.

          Methods

          A retrospective single-center study of 301 COVID-19 patients referred to our Emergency Department (ED) from February 25 to March 29, 2020. At presentation, patients underwent chest CT and clinical and laboratory examinations. Outcomes included discharge from the ED after improvement/recovery (positive outcome), or admission to the intensive care unit or death (poor prognosis). A visual quantitative analysis was formed using two scores: the Pulmonary Involvement (PI) score based on the extension of lung involvement, and the Pulmonary Consolidation (PC) score based on lung consolidation. The prognostic value of CT alone or integrated with other parameters was studied by logistic regression and ROC analysis.

          Results

          The impact of the CT PI score [≥15 vs. ≤ 6] on predicting poor prognosis (OR 5.71 95% CI 1.93-16.92, P = 0.002) was demonstrated; no significant association was found for the PC score. Chest CT had a prognostic role considering the PI score alone (AUC 0.722) and when evaluated with demographic characteristics, comorbidities, and laboratory data (AUC 0.841). We, therefore, developed a nomogram as an easy tool for immediate clinical application.

          Conclusions

          Visual analysis of CT gives useful information to physicians for prognostic evaluations, even in conditions of COVID-19 emergency. The predictive value is increased by evaluating CT in combination with clinical and laboratory data.

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Chaolin Huang, Yeming Wang, Xingwang Li … (2020)
          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            Clinical Characteristics of Coronavirus Disease 2019 in China

            Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)
            Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)
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              Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study

              Fei Zhou, Ting Yu, Ronghui Du … (2020)
              Summary Background Since December, 2019, Wuhan, China, has experienced an outbreak of coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological and clinical characteristics of patients with COVID-19 have been reported but risk factors for mortality and a detailed clinical course of illness, including viral shedding, have not been well described. Methods In this retrospective, multicentre cohort study, we included all adult inpatients (≥18 years old) with laboratory-confirmed COVID-19 from Jinyintan Hospital and Wuhan Pulmonary Hospital (Wuhan, China) who had been discharged or had died by Jan 31, 2020. Demographic, clinical, treatment, and laboratory data, including serial samples for viral RNA detection, were extracted from electronic medical records and compared between survivors and non-survivors. We used univariable and multivariable logistic regression methods to explore the risk factors associated with in-hospital death. Findings 191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03–1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61–12·23; p<0·0001), and d-dimer greater than 1 μg/mL (18·42, 2·64–128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0–24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days. Interpretation The potential risk factors of older age, high SOFA score, and d-dimer greater than 1 μg/mL could help clinicians to identify patients with poor prognosis at an early stage. Prolonged viral shedding provides the rationale for a strategy of isolation of infected patients and optimal antiviral interventions in the future. Funding Chinese Academy of Medical Sciences Innovation Fund for Medical Sciences; National Science Grant for Distinguished Young Scholars; National Key Research and Development Program of China; The Beijing Science and Technology Project; and Major Projects of National Science and Technology on New Drug Creation and Development.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Eur J Radiol
                Journal ID (iso-abbrev): Eur J Radiol
                Title: European Journal of Radiology
                Publisher: Elsevier B.V.
                ISSN (Print): 0720-048X
                ISSN (Electronic): 1872-7727
                Publication date PMC-release: 26 February 2021
                Publication date (Electronic): 26 February 2021
                Electronic Location Identifier: 109612
                Affiliations
                [a ]Department of Radiology, Humanitas Gavazzeni, Via Gavazzeni, 21, 24125, Bergamo, BG, Italy
                [b ]Department of Oncology, Humanitas Gavazzeni, Via Gavazzeni, 21, 24125, Bergamo, BG, Italy
                [c ]Department of Nuclear Medicine, Humanitas Gavazzeni, Via Gavazzeni, 21, 24125, Bergamo, BG, Italy
                [d ]Laboratory of Methodology for Clinical Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri, 2, 20156, Milano, Italy
                [e ]Humanitas Gavazzeni, Via Gavazzeni, 21, 24125, Bergamo, BG, Italy
                Author notes
                [* ]Corresponding author.
                Article
                Publisher Item ID: S0720-048X(21)00092-9 Publisher ID: 109612
                DOI: 10.1016/j.ejrad.2021.109612
                PMC ID: 7907738
                PubMed ID: 33662842
                SO-VID: 7c07f1a7-576b-44c6-8252-f0575cfe8df6
                Copyright © © 2021 Elsevier B.V. All rights reserved.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 12 December 2020
                Date revision received : 16 February 2021
                Date accepted : 20 February 2021
                Categories
                Subject: Article

                ScienceOpen disciplines: Radiology & Imaging
                Keywords: ct, computed tomography,covid-19, coronavirus infectious disease 2019,ed, emergency department,icu, intensive care unit,pi score, pulmonary involvement score,pc score, pulmonary consolidation score,roc, receiver operating characteristic,or, odds ratio,ci, confidence interval,auc, area under the curve,sars-cov-2, severe acute respiratory syndrome coronavirus-2,rsna, radiological society of north america,hiv, human immunodeficiency virus,sao2, arterial saturation of oxygen,pao2, partial pressure of oxygen,pco2, partial pressure of carbon dioxide,wbc, white blood cell,alt, alanine aminotransferase,ast, aspartate aminotransferase,ldh, lactate dehydrogenase,pt, prothrombin time,ptt, partial thromboplastin time,crp, c-reactive protein level,pct, procalcitonin,bnp, atrial natriuretic peptide,tnt, troponin levels,simit, italian society of infectious and tropical diseases,a.i., artificial intelligence,covid-19 prognostic parameters,chest computed tomography,quantitative visual analysis method,integrated prognostic score,clinical and laboratory data,prognostic nomogram
                Data availability:
                ScienceOpen disciplines: Radiology & Imaging
                Keywords: ct, computed tomography, covid-19, coronavirus infectious disease 2019, ed, emergency department, icu, intensive care unit, pi score, pulmonary involvement score, pc score, pulmonary consolidation score, roc, receiver operating characteristic, or, odds ratio, ci, confidence interval, auc, area under the curve, sars-cov-2, severe acute respiratory syndrome coronavirus-2, rsna, radiological society of north america, hiv, human immunodeficiency virus, sao2, arterial saturation of oxygen, pao2, partial pressure of oxygen, pco2, partial pressure of carbon dioxide, wbc, white blood cell, alt, alanine aminotransferase, ast, aspartate aminotransferase, ldh, lactate dehydrogenase, pt, prothrombin time, ptt, partial thromboplastin time, crp, c-reactive protein level, pct, procalcitonin, bnp, atrial natriuretic peptide, tnt, troponin levels, simit, italian society of infectious and tropical diseases, a.i., artificial intelligence, covid-19 prognostic parameters, chest computed tomography, quantitative visual analysis method, integrated prognostic score, clinical and laboratory data, prognostic nomogram

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