Prediction of lethal outcomes in COVID-19 cases based on the results chest computed tomography
https://doi.org/10.21292/2075-1230-2020-98-6-7-14
Abstract
The objective: to predict lethal outcomes in patients with COVID-19 based on the result of chest computed tomography (chest CT) using a semi-quantitative visual scale of the pulmonary parenchyma lesion.
Subjects and methods. Inclusion criteria: patients who underwent chest CT from March 2 to May 1, 2020, inclusively, upon referral of a general practitioner due to suspected community-acquired pneumonia caused by COVID-19. Chest CT was performed in 48 medical organizations providing primary medical care to the adult population in Moscow. Exclusion criteria: patients whose chest CT was not assessed by CT 0-4 score; patients who were not confirmed as COVID-19 positive.
In the Russian Federation, CT 0-4 score is recommended to be used for assessment of the extent of lung parenchyma lesion in cases with suspected COVID-19.
Data on fatal outcomes were received on May 4, 2020 inclusive.
Results: data of 13,003 patients from the Unified Radiological Information Service were retrospectively included in the study according to inclusion and exclusion criteria. The test aimed to detect a trend of directional changes in the proportion of deceased patients among various categories using CT 0-4 score demonstrated a statistically significant result (p < 0.0001). The chance of a lethal outcome increases directionally from CT-0 to CT-4. The test for deviations from the linear trend also provided p < 0.0001, i.e. when moving to higher scores (CT-3 and CT-4), there was an accelerated increase in the risk of death. Analysis of overall survival using the Cox regression model showed that the assessed factors (age and CT 0-4 score) were statistically significantly associated with the time to death from COVID-19 (p < 0.05). The risk of death increased with age, on average, 8.6% for every 5 years (95% CI 0.8-17.0%). When transferring from one category of CT to the next one, the risk increased by 38% on the average (95% CI 17.1-62.6%). There was no statistically significant association of gender factor with overall survival (p = 0.408).
The visual score of CT 0-4 recommended for use in the Russian Federation to assess lung parenchyma lesions according to chest CT data, is a predictor of a lethal outcome in patients with COVID-19. CT 0-4 score is convenient for practical use.
About the Authors
S. P. MorozovRussian Federation
Sergey P. Morozov, Doctor of Medical Sciences, Professor, Director.
28, Bd. 1, Srednaya Kalitnikovskaya St., Moscow, 109029.
Phone: +7 (495) 276-04-36.
V. A. Gombolevskiy
Russian Federation
Viktor A. Gombolevskiy, Candidate of Medical Sciences, Head of Department for Radiology Quality Enhancement.
28, Bd. 1, Srednaya Kalitnikovskaya St., Moscow, 109029.
Phone: +7 (495) 276-04-36.
V. Yu. Cherninа
Russian Federation
Valeriya Yu. Chernina, Junior Researcher of Department for Radiology Quality Enhancement.
28, Bd. 1, Srednaya Kalitnikovskaya St., Moscow, 109029.
Phone: +7 (495) 276-04-36.
I. A. Blokhin
Russian Federation
Ivan A. Blokhin, Junior Researcher of Department for Radiology Quality Enhancement.
28, Bd. 1, Srednaya Kalitnikovskaya St., Moscow, 109029.
Phone: +7 (495) 276-04-36.
O. A. Mokienko
Russian Federation
Olesya A. Mokienko, Candidate of Medical Sciences, Academic Secretary.
28, Bd. 1, Srednaya Kalitnikovskaya St., Moscow, 109029.
Phone: +7 (495) 276-04-36.
A. V. Vlаdzimirskiy
Russian Federation
Anton V. Vladzimirskiy, Doctor of Medical Sciences, Deputy Director for Research.
28, Bd. 1, Srednaya Kalitnikovskaya St., Moscow, 109029.
Phone: +7 (495) 276-04-36.
A. S. Belevskiy
Russian Federation
Andrey S. Belevskiy, Doctor of Medical Sciences, Professor, Chief Expert in Pulmonology of Moscow Health Department, Head of Pulmonology Department.
1, Ostrovityanova St., Moscow, 117997
Phone: +7 (495) 434-36-90.
D. N. Protsenko
Russian Federation
Denis N. Protsenko, Candidate of Medical Sciences, Associate Professor, Chief Expert in Anesthesiology and Intensive Care of Moscow Health Department, Head Physician.
7, Kasatkina St., Moscow, 129301.
Phone: +7 (495) 686-80-50.
M. A. Lysenko
Russian Federation
Maryana A. Lysenko, Doctor of Medical Sciences, Head Physician.
11, Sosnovaya St., Moscow, 123182.
Phone: +7 (499) 196-37-49.
O. V. Zayrаtyants
Russian Federation
Oleg V. Zayratyants, Doctor of Medical Sciences, Professor, Head of Pathological Anatomy Department.
20, Build. 1, Delegatskaya St., Moscow, 127473.
E. L. Nikonov
Russian Federation
Evgeniy L. Nikonov, Administration and Coordination Department of Moscow Health Department, Head.
43, Oruzheyny Lane, Moscow, 127006.
Phone: +7 (499) 145-75-29.
References
1. Morozov S.P., Protsenko D.N., Smetanina S.V., Аndreychenko А.E., Аmbrosi O.E., Balanyuk H.А., Vladzimirskiy А.V., Vetsheva N.N., Gombolevskiy V.А., Epifanova S.V., Ledikhova N.V., Lobanov M.N., Pavlov N.А., Panina E.V., Polischuk N.S., Riden T.V., Sokolina I.А., Turavilova E.V., Fedorov S.S., Chernina V. Yu., Shulkin I.M. Luchevaya diagnostika koronavirusnoy bolezni (COVID-19): organizatsiya, metodologiya, interpretatsiya rezultatov: preprint no TSDT – 2020 – II. Versiya 2 ot 17.04.2020. Seriya Luchshie praktiki luchevoy i instrumentalnoy diagnostiki. [Radiation diagnosis of coronavirus disease (COVID-19): organization, methodology, interpretation of results: preprint No. CDT – 2020 – II. Version 2 from 17.04.2020. Series on best practices of radiation and instrumental diagnostics]. Issue 65, Moscow, GBUZ NPKTS DiT DZM Publ., 2020, 78 p.
2. Sinitsyn V.E., Tyurin I.E., Mitkov V.V. Vremennye metodicheskie rekomendatsii Rossiyskogo obschestva rentgenologov i radiologov (RORR) i Rossiyskoy assotsiatsii spetsialistov ultrazvukovoy diagnostike v meditsine (RАSUDM) Metody luchevoy diagnostiki pnevmonii pri novoy koronavirusnoy infektsii pri COVID-19. Rossiyskoe obschestvo rentgenologov i radiologov (RORR), Rossiyskaya assotsiatsiya spetsialistov ultrazvukovoy diagnostiki v meditsine (RАSUDM). [Provisional guidelines of the Russian Society of Radiologists and Radiologists (RORR) and the Russian Association of Ultrasound Diagnostics in Medicine (RASUDM) on Methods of Radiation Diagnostics of Pneumonia with a New Coronavirus Infection of COVID-19. Russian Society of Radiologists and Radiologists (RORR), Russian Association of Ultrasound Diagnostic Specialists in Medicine (RASUDM)]. 2020.
3. Colombi D., Bodini F.C., Petrini M., Maffi G., Morelli N., Milanese G., Silva M., Sverzellati N., Michieletti E. Well-aerated Lung on Admitting Chest CT to Predict Adverse Outcome in COVID-19 Pneumonia. Radiology, 2020, Apr. 17:201433. doi:10.1148/radiol.2020201433.
4. Du R.H., Liang L.R., Yang C.Q., Wang W., Cao T.Z., Li M., Guo G.Y., Du J., Zheng C.L., Zhu Q. and Hu M. Predictors of mortality for patients with COVID-19 pneumonia caused by SARS-CoV-2: a prospective cohort study. Eur. Respir. J., 2020, vol. 55, no. 5, 2000524, Published 2020 May 7. doi:10.1183/13993003.00524-2020.
5. Li K., Fang Y., Li W., Pan C., Qin P., Zhong Y., Liu X., Huang M., Liao Y., Li S. CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19). Eur. Radiol., 2020, Mar 25. doi: 10.1007/s00330-020-06817-6.
6. Li X., Xu S., Yu M., Wang K., Tao Y., Zhou Y., Shi J., Zhou M., Wu B., Yang Z., Zhang C. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan [published online ahead of print, 2020 Apr 12]. J. Allergy Clin. Immunol., 2020, S0091-6749(20)30495-4. doi:10.1016/j.jaci.2020.04.006.
7. Silverstein W.K., Stroud L., Cleghorn G.E., Leis J.A. First imported case of 2019 novel coronavirus in Canada, presenting as mild pneumonia. Lancet, 2020, Feb. 29, vol. 395 (10225):734. doi: 10.1016/S0140-6736(20)30370-6.
8. Sverzellati N., Milanese G., Milone F., Balbi M., Ledda R.E., Silva M. Integrated Radiologic Algorithm for COVID-19 Pandemic. J. Thorac. Imaging, 2020, Apr. 7, doi: 10.1097/RTI.0000000000000516.
9. Wynants L., Van Calster B., Bonten M.M., Collins G.S., Debray T.P., De Vos M., Haller M.C., Heinze G., Moons K.G., Riley R.D., Schuit E. Prediction models for diagnosis and prognosis of covid-19 infection: systematic review and critical appraisal. BMJ, 2020, 369:m1328. Published 2020 Apr 7. doi:10.1136/bmj.m1328.
10. Yoon S.H., Lee K.H., Kim J.Y., Lee Y.K., Ko H., Kim K.H., Park C.M., Kim Y.H. Chest Radiographic and CT Findings of the 2019 Novel Coronavirus Disease (COVID-19): analysis of nine patients treated in Korea. Korean J. Radiol., 2020, Apr. vol. 21, no. 4, pp. 494-500. doi: 10.3348/kjr.2020.0132.
11. Yuan M., Yin W., Tao Z., Tan W., Hu Y. Association of radiologic findings with mortality of patients infected with 2019 novel coronavirus in Wuhan, China. PLoS One, 2020, no. 15, pp. e0230548. doi:10.1371/journal. pone.0230548.
12. Zhang R., Ouyang H., Fu L., Wang S., Han J., Huang K., Jia M., Song Q., Fu Z. CT features of SARS-CoV-2 pneumonia according to clinical presentation: a retrospective analysis of 120 consecutive patients from Wuhan city [published online ahead of print, 2020 Apr 11]. Eur. Radiol., 2020, no. 10.1007/s00330-020-06854-1.
Review
For citations:
Morozov S.P., Gombolevskiy V.A., Cherninа V.Yu., Blokhin I.A., Mokienko O.A., Vlаdzimirskiy A.V., Belevskiy A.S., Protsenko D.N., Lysenko M.A., Zayrаtyants O.V., Nikonov E.L. Prediction of lethal outcomes in COVID-19 cases based on the results chest computed tomography. Tuberculosis and Lung Diseases. 2020;98(6):7-14. (In Russ.) https://doi.org/10.21292/2075-1230-2020-98-6-7-14