Tomography and Prognostic Indices in the State of the Art of Evaluation in Hospitalized Patients with COVID-19 Pneumonia
Abstract
:1. Introduction
2. Materials and Methods
2.1. Model Development
2.2. Computed Tomography
2.3. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Critical Illness | ||||
---|---|---|---|---|
Variable | Total (n = 109) | No (n = 77) | Yes (n = 32) | p |
Age, years | 53.88 ± 13.51 * | 52.02 ± 13.21 * | 57.90 ± 13.37 * | 0.02 † |
Male gender (%) | 69 (63.3) | 46 (59.74) | 23 (71.88) | 0.23 ‡ |
Smoking (%) | 22 (20.18) | 18 (23.38) | 4 (12.50) | 0.19 |
AdmissionMeasurements (Range) | ||||
Symptom onset-hospitalization, days | 6 (3–9) | 6 (3–9) | 7 (2–9.5) | 0.94 § |
Respiratory rate, breaths/min | 20 (18–26) | 19 (18–22) | 25 (22.5–32) | 0.001 |
Heart rate, beats/min | 93 (80–105) | 90 (80–104) | 95.5 (82.5–110) | 0.17 |
Temperature, °C | 36.6 (36–37.3) | 36.5 (36–37.2) | 37 (36.3–37.8) | 0.08 |
MAP, mean (SD), mmhg | 91.96 ± 13.24 * | 92.27 ± 11.86 * | 91.21 ± 16.28 * | 0.70 † |
Symptoms, Number and (%) | ||||
Fever | 93 (85.32) | 66 (85.71) | 27 (84.38) | 0.53 ¶ |
Shortness of breath | 81 (74.31) | 56 (72.73) | 25 (78.12) | 0.85 † |
Dry cough | 93 (85.32) | 64 (83.12) | 29 (90.62) | 0.24 ¶ |
Headache | 53 (48.62) | 38 (49.15) | 15 (46.88) | 0.81 † |
Sore throat | 56 (51.38) | 39 (50.65) | 17 (53.12) | 0.81 |
Myalgia/arthralgia | 77 (70.64) | 55 (71.43) | 22 (68.75) | 0.78 |
Diarrhea | 20 (18.35) | 14 (18.18) | 6 (18.75) | 0.94 |
Comorbidities, Number and (%) | ||||
Number of Comorbidities | ||||
0 | 35 (32.11) | 27 (35.06) | 8 (25) | 0.30 |
1 | 34 (24.68) | 19 (25.00) | 15 (46.88) | 0.02 |
2 | 23 (21.10) | 18 (23.38) | 5 (15.62) | 0.02 |
3 | 9 (8.26) | 9 (11.69) | 0 | 0.03 |
4 | 5 (4.59) | 3 (3.9) | 2 (6.25) | 0.46 |
5 | 3 (2.75) | 1 (1.30) | 2 (6.25) | 0.20 |
Obesity | 27 (24.77) | 17 (22.08) | 10 (31.25) | 0.31 † |
Hypertension | 52 (47.71) | 37 (48.05) | 15 (46.88) | 0.91 |
Diabetes | 31 (28.44) | 20 (25.97) | 11 (34.38) | 0.37 |
Dyslipidemia | 30 (27.52) | 21 (27.27) | 9 (28.12) | 0.92 |
Cardiovascular disease | 16 (14.68) | 10 (12.99) | 6 (18.75) | 0.30 ¶ |
COPD | 2 (1.83) | 2 (2.60) | 0 | 0.49 |
Cerebrovascular disease | 3 (2.75) | 0 | 3 (9.38) | 0.02 |
Malignancy | 1 (0.92) | 1 (1.30) | 0 | 0.70 |
Chronic kidney disease | 10 (9.17) | 8 (10.39) | 2 (6.25) | 0.39 |
Critical Illness | ||||
---|---|---|---|---|
Variable | Total (n = 109) | No (n = 77) | Yes (n = 32) | p |
PaO2, mmHg | 63.5 (51.5–80.5) | 68 (55.5–85) | 51.5 (46–64) | 0.00 § |
FiO2, (%) | 41 (29−50) | 33 (21–41) | 60 (41–60) | 0.001 |
Horowitz Index (P/F ratio) | 166.6 ± 97.08 * | 221.95± 92.14 * | 96.56 ± 47.21 * | 0.001 † |
Hemoglobin, g/L (range) | 14.6 (13.6–15.5) | 14.6 (13.8–15.6) | 14.5 (13.2–15.5) | 0.68 § |
Hematocrit, (%) | 44 (41–47.4) | 44 (41.5–47.4) | 44 (44–47.4) | 0.98 |
Platelet count, ×103/L (range) | 221 (160–274) | 211 (156–266) | 238.5 (167.5–316) | 0.14 |
Neutrophil cell count, ×103/L | 6.3 (4–9.7) | 4.7 (3.3–8.0) | 9.3 (6.2–13.6) | 0.001 |
Lymphocyte count, ×103/L | 0.9 (0.6–1.3) | 1 (0.7–1.4) | 0.8 (0.5–1.0) | 0.001 |
Neutrophil–lymphocyte ratio | 6.3 (3.6–12.5) | 5.12 (2.8–9.38) | 11.04 (7.75–21.41) | 0.001 |
Sodium, mmol/L (range) | 135 (132.4–137) | 135 (133–137) | 134 (130.4–136.6) | 0.13 |
Potassium, mmol/L (range) | 4.11 (3.78–4.58) | 4 (3.6–4.4) | 4.38 (3.97–4.87) | 0.02 |
Calcium, mg/dL (range) | 8.3 (7.9–8.8) | 8.37 (8.11–8.96) | 8.2 (7.7–8.56) | 0.01 |
Glucose, mg/dL (range) | 119 (105.8–174.8) | 113 (103–148) | 136.4 (115.4–226) | 0.001 |
Creatinine, mg/dL (range) | 0.96 (0.75–1.3) | 0.85 (0.72–1.1) | 1.25 (0.8–1.9) | 0.001 |
Blood urea nitrogen, mg/dL | 17.8 (12.1–27.4) | 16(11–20.6) | 27 (19.2–46.7) | 0.001 |
eGFR, mL/min/1.73 m2 | 82.3 ± 38.5 * | 86.7 ± 38.21 * | 57.37 ± 35.93 * | 0.001 † |
C-reactive protein, mg/L | 81 (27.5–192) | 51.8 (17.2–118.6) | 186 (99.5–278) | 0.001 § |
D-dimer level, μg/mL (range) | 0.35 (0.22–0.75) | 0.29 (0.2–0.75) | 0.51 (0.27–0.82) | 0.09 |
hsTnl, pg/mL (range) | 9.5 (5.1–32.9) | 7.9 (4.9–15.4) | 22.6 (10.7–114) | 0.001 |
NT-proBNP, pg/mL (range) | 202 (87–1145) | 175 (63–605) | 737 (220–2103) | 0.001 |
Creatine kinase, U/L (range) | 108 (47.6–196.4) | 82 (44.4–194) | 141.5 (80.4–217.7) | 0.12 |
CK-MB fraction, U/L (range) | 1.59 (0.83–4.7) | 1.5 (0.7–4.8) | 2.1 (1.1–3.6) | 0.77 |
Ferritin, ng/mL (range) | 481.7 (249–894.4) | 457 (196.3–840) | 629.7 (320.9–1290) | 0.02 |
Fibrinogen, g/L (range) | 4.96 (3.87–6) | 4.6 (3.7–5.5) | 5.74 (5–7) | 0.001 |
Alkaline phosphatase, U/L | 81.5 (65–113) | 79.7 (61.9–102.8) | 97.35 (76.1–125.5) | 0.02 |
LDH, U/L (range) | 310 (222–440) | 274 (203.7–371) | 394 (264–473.1) | 0.001 |
AST, U/L (range) | 37.6 (20.9–49.9) | 35.8 (21.7–54.7) | 37.6 (25–56.8) | 0.64 |
ALT, U/L (range) | 31.5 (21–49.9) | 33.2 (20.9–53.9) | 28.9 (21.6–44.8) | 0.37 |
Direct bilirubin, mg/dL | 0.16 (0.11–0.23) | 0.14 (0.11–0.22) | 0.19 (0.11–0.26) | 0.12 |
Total bilirubin, mg/dL | 0.66 (0.47–0.97) | 0.67 (0.47–0.93) | 0.65 (0.47–1.05) | 0.89 |
Albumin, g/L (range) | 3.53 ± 0.59 * | 3.68 ± 0.57 * | 3.11 ± 0.41 * | 0.56 † |
INR (range) | 1.11 (1.02–1.2) | 1.1 (1–1.2) | 1.16 (1.06–1.23) | 0.12 |
Variable | Total (n = 109) | Critical Illness | p | Death Total 19 (17) | |
---|---|---|---|---|---|
No (n = 77) | Yes (n = 32) | ||||
CURB 65 | |||||
0 | 39 | 34 (44) | 5 (16) | 0.009 | 1 (2.5) |
1 | 35 | 30 (39) | 5 (16) | 0.02 | 5 (14) |
2 | 29 | 11 (14) | 18 (56) | 0.0001 | 9 (31) |
3 | 3 | 1 (1) | 2 (6) | 0.20 | 2 (67) |
4 | 3 | 1 (1) | 2 (6) | 0.20 | 2 (67) |
COVID-GRAM | |||||
Riesgo bajo <1.7% | 4 (4) | 4 (5) | 0 | 0.3 | 0 |
Riesgo intermedio (1.7–40.4%) | 75 | 60 (78) | 15 (47) | 0.002 | 10 (13) |
Riesgo alto >40.4% | 30 | 13 (17) | 17 (53) | 0.0003 | 9 (30) |
NEWS 2 score | |||||
Low risk (0–4) | 37 (34) | 36 (47) | 1 (3) | 0.0001 | 1 (3) |
Moderate risk (5–6) | 19 (17) | 18 (23) | 1 (3) | 0.01 | 0 |
High risk (>7) | 52 (48) | 22 (29) | 30 (94) | 0.0001 | 18 (35) |
Berlin criteria | |||||
Without risk | 24 (21) | 24 (31) | 0 | 0.0001 | 0 |
Mild | 3 (3) | 2 (3) | 1 (3) | NS | 0 |
Moderate: | 61 (56) | 47 (61) | 14 (44) | NS | 8 |
Severe: | 21 (19) | 4 (5) | 17 (53) | 0.0001 | 11 |
Rox index | |||||
Minor risk for intubation | 74 (68) | 77 | 30 | 0.08 | 1 |
High risk for intubation | 33 (30) | 0 | 2 | 0.08 | 1 |
Padua Score | |||||
≤4 points low risk | 11 | 10 | 1 | NS | 0 |
≥4 points high risk | 98 | 67 | 31 | NS | 19 |
Q (CSI) index | |||||
≤3 Low (4%) | 23 (21) | 23 (30) | 0 | 0.0002 | 0 |
4–6 Low-intermediate (30%) | 22 (20) | 17 (22) | 5 (16) | 0.6 | 3 (14) |
7–9 High-intermediate (44%) | 16 (15) | 14 (18) | 2 (6) | 0.14 | 1 (6) |
10–12 High (57%) | 48 (44) | 23 (30) | 25 (78) | 0.0001 | 15 (94) |
Score C4 | |||||
Low | 17 (16) | 17 (22) | 0 | 0.0002 | 0 |
Intermedium risk | 36 (33) | 31 (40) | 5 (16) | 0.01 | 3 (8) |
High | 48 (44) | 27 (35) | 21 (66) | 0.005 | 12 (25) |
Very High | 12 (7) | 2 (3) | 6 (19 | 0.007 | 4 (33) |
Critical Illness | ||||
---|---|---|---|---|
Chest CT Findings, No. (%) | Total (n = 109) | No (n = 77) | Yes (n = 32) | p |
GGO | 98 (89.9) | 67 (87) | 31 (96.8) | 0.10 ¶ |
Consolidation | 61 (55.9) | 36 (46.7) | 25 (78.12) | 0.001 ‡ |
Crazy paving pattern | 6 (7.5) | 3 (5.4) | 3 (12) | 0.27 ¶ |
Linear pattern | 41 (37.6) | 27 (35) | 14 (43.7) | 0.39 ‡ |
Lymphadenopathy | 32 (29.36) | 19 (24.6) | 13 (40.62) | 0.09 |
Pleural effusion | 22 (20.18) | 7 (9) | 15 (46.8) | 0.001 |
Pericardial effusion | 17 (15.6) | 5 (6.49) | 12 (37.5) | 0.001 ¶ |
Pulmonary fibrosis | 3 (2.78) | 1 (1.32) | 2 (6.25) | 0.20 |
Pneumothorax | 1 (0.92) | 1 (1.3) | 0 | 0.70 |
Steatosis | 23 (21.3) | 18 (23.6) | 5 (15.62) | 0.25 ‡ |
Emphysema | 2 (1.83) | 0 | 2 (6.25) | 0.08 ¶ |
CO-RADS, No. (%) | ||||
CO-RADS 0 | 0 | 0 | 0 | 0 |
CO-RADS 1 | 7 (6.42) | 6 (7.79) | 1 (3.12) | 0.33 |
CO-RADS 2 | 0 | 0 | 0 | |
CO-RADS 3 | 7 (6.42) | 5 (6.49) | 2 (6.25) | 0.66 |
CO-RADS 4 | 18 (16.51) | 14 (18.18) | 4 (12.50) | 0.46 ‡ |
CO-RADS 5 | 54 (49.5) | 36 (46.75) | 18 (56.25) | 0.36 |
CO-RADS 6 | 23 (21.10) | 16 (20.78) | 7 (21.88) | 0.89 |
Distribution, No. (%) | ||||
Peripheral distribution | 55 (50.46) | 43 (55.84) | 12 (37.50) | 0.08 |
Central distribution | 22 (20.18) | 11 (14.29) | 11 (34.38) | 0.01 |
Peripheral and central distribution | 20 (18.35) | 12 (15.58) | 8 (25) | 0.24 |
None | 12 (11.01) | 11 (14.29) | 1 (3.12) | 0.08 ¶ |
CT score, Mean (SD) | ||||
Left upper lobe | 2.33 (1.48) | 1.96 (1.29) | 3.25 (1.54) | 0.001 † |
Left lower lobe | 3.12 (1.69) | 2.78 (1.61) | 3.93 (1.61) | 0.00 |
Right upper lobe | 2.36 (1.52) | 1.97 (1.33) | 3.32 (1.55) | 0.00 |
Middle lobe | 2.33 (1.55) | 1.90 (1.37) | 3.38 (1.47) | 0.00 |
Right lower lobe | 3.03 (1.57) | 2.68 (1.56) | 3.90 (1.22) | 0.00 |
Total, severity score | 14 (8–19) * | 11 (7–16) * | 20 (16–23) * | 0.0001 § |
Univariate Analysis | Multivariate Analysis | |||
---|---|---|---|---|
Variables | OR (95 % CI) | p | OR (95 % CI) | p |
Age, years | 1.03 | 0.02 | 0.14 | |
Laboratories findings | ||||
PaO2, mmHg | 0.96 | 0.00 | 0.96 | 0.05 |
FiO2, % | 1.11 | 0.00 | 1.11 | 0.001 |
Neutrophil cell count, x103/L | 1.23 | 0.00 | 0.33 | |
Neutrophil–lymphocyte ratio | 2.19 | 0.00 | 1.94 | 0.001 |
Potassium, mmol/L | 2.02 | 0.01 | 0.86 | |
Calcium, mg/dL | 0.43 | 0.01 | 0.53 | |
eGFR, ml/min/1.73 m2 | 0.98 | 0.01 | 0.17 | |
Fibrinogen, g/L | 1.10 | 0.01 | 0.18 | |
Chest CT findings | ||||
Consolidation | 4.06 | 0.00 | 0.11 | |
Pleural effusion | 8.82 | 0.00 | 0.06 | |
CT score ≥18 | 13.82 | 0.00 | 5.13 | 0.01 |
Risk clinical Scores | ||||
High risk COVID-GRAM | 5.57 | 0.00 | 0.07 | |
High risk qCSI | 5.83 | 0.00 | 0.07 |
AU-ROC | Sensitivity | Specificity | Positive LR | Negative LR | OR | PPV | NPV | |
---|---|---|---|---|---|---|---|---|
NLR severe | 0.64 | 34.4 | 94.8 | 6.62 | 0.69 | 9.56 | 73.9 | 77.7 |
CT score ≥ 18 | 0.78 | 71.9 | 84.4 | 4.61 | 0.33 | 13.8 | 66.4 | 87.5 |
High risk COVID-GRAM | 0.68 | 53.1 | 83.1 | 3.15 | 0.56 | 5.58 | 57.4 | 80.5 |
High risk qCSI | 0.68 | 84.4 | 51.9 | 1.76 | 0.30 | 5.84 | 42.9 | 88.6 |
Combination of clinical scores and TSS * | ||||||||
NLR severe plus TSS | 0.77 | 57.1 | 98.4 | 36 | 0.43 | 82.7 | 93.9 | 84.3 |
High risk COVIDGRAM plus CT score ≥ 18 | 0.83 | 72.2 | 94.8 | 14 | 0.29 | 47.7 | 85.7 | 88.8 |
High risk qCSI plus CT Score total | 0.85 | 90.9 | 80.4 | 4.65 | 0.11 | 41.1 | 66.6 | 95.4 |
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Críales-Vera, S.; Saucedo-Orozco, H.; Iturralde-Torres, P.; Martínez-Mota, G.; Dávila-Medina, E.; Guarner-Lans, V.; Manzano-Pech, L.; Pérez-Torres, I.; Soto, M.E. Tomography and Prognostic Indices in the State of the Art of Evaluation in Hospitalized Patients with COVID-19 Pneumonia. Pathogens 2022, 11, 1281. https://0-doi-org.brum.beds.ac.uk/10.3390/pathogens11111281
Críales-Vera S, Saucedo-Orozco H, Iturralde-Torres P, Martínez-Mota G, Dávila-Medina E, Guarner-Lans V, Manzano-Pech L, Pérez-Torres I, Soto ME. Tomography and Prognostic Indices in the State of the Art of Evaluation in Hospitalized Patients with COVID-19 Pneumonia. Pathogens. 2022; 11(11):1281. https://0-doi-org.brum.beds.ac.uk/10.3390/pathogens11111281
Chicago/Turabian StyleCríales-Vera, Sergio, Huitzilihuitl Saucedo-Orozco, Pedro Iturralde-Torres, Gustavo Martínez-Mota, Estefanía Dávila-Medina, Verónica Guarner-Lans, Linaloe Manzano-Pech, Israel Pérez-Torres, and María Elena Soto. 2022. "Tomography and Prognostic Indices in the State of the Art of Evaluation in Hospitalized Patients with COVID-19 Pneumonia" Pathogens 11, no. 11: 1281. https://0-doi-org.brum.beds.ac.uk/10.3390/pathogens11111281