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Clinical and radiological changes of hospitalised patients with COVID-19 pneumonia from disease onset to acute exacerbation: a multicentre paired cohort study.
Eur Radiol. 2020 Oct; 30(10):5702-5708.ER

Abstract

OBJECTIVES

To analyse clinical and radiological changes from disease onset to exacerbation in coronavirus infectious disease-19 (COVID-19) patients.

METHODS

We reviewed clinical histories of 276 patients with confirmed COVID-19 pneumonia and extracted data on patients who met the diagnostic criteria for COVID-19 severe/fatal pneumonia and had an acute exacerbation starting with mild or common pneumonia.

RESULTS

Twenty-four patients were included. Of these, 8% were smokers, 54% had been to Wuhan, and 46% had comorbidities. Before acute exacerbation, elevated lactate dehydrogenase (232.9 ± 88.7) was present, and chest CT scans showed the number of involved lobes was 4 (2-5) and total CT score was 6 (2-8). Following acute exacerbation, patients were likely to have more clinical symptoms (p < 0.01) and abnormal laboratory changes (p < 0.01). The number of involved lobes and CT score after an exacerbation significantly increased to 5 (5-5) and 12 (9-14), respectively. Receiver operating characteristic (ROC) curve showed that, when the cutoff value of CT score was 5, the sensitivity and specificity for severe pneumonia were 90% and 70%, respectively. CT findings of ground glass opacity with consolidations (91.7%), bilateral distribution (100.0%), and multifocal lesion (100.0%) were features in found in patients after exacerbation.

CONCLUSIONS

There are significant changes in clinical, laboratory, and CT findings in patients from disease onset to exacerbation. An increase in the number of involved lobes or an increased CT score from the baseline may predict poor clinical outcomes. Combining an assessment of CT changes with clinical and laboratory changes could help clinical teams evaluate the prognosis.

KEY POINTS

• The common chest CT signs of COVID-19 pneumonia after exacerbation were ground glass opacity (GGO) with consolidation, bilateral distribution, and multifocal lesions. • An increase in number of involved lobes or an increased CT score from the baseline may predict a poor clinical outcome. • Worsened symptoms and abnormal laboratory results are also associated with poor prognosis.

Authors+Show Affiliations

Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, China.Department of Oncology, Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, China.Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, China.Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, China.Department of Radiology, The First Hospital of Changsha, Changsha, 410011, Hunan Province, China.Department of Radiology, The Central Hospital of Xiangtan, Xiangtan, 410011, Hunan Province, China.Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, China.Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, China.Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, China.Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, China. chenxiangyu@csu.edu.cn.Department of Radiology, The Second Xiangya Hospital, Central South University, Changsha, 410011, Hunan Province, China. xiaoenhua64@csu.edu.cn. Molecular Imaging Research Center, Central South University, Changsha, 410008, Hunan Province, China. xiaoenhua64@csu.edu.cn.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

32385648

Citation

Liu, Jiayi, et al. "Clinical and Radiological Changes of Hospitalised Patients With COVID-19 Pneumonia From Disease Onset to Acute Exacerbation: a Multicentre Paired Cohort Study." European Radiology, vol. 30, no. 10, 2020, pp. 5702-5708.
Liu J, Chen T, Yang H, et al. Clinical and radiological changes of hospitalised patients with COVID-19 pneumonia from disease onset to acute exacerbation: a multicentre paired cohort study. Eur Radiol. 2020;30(10):5702-5708.
Liu, J., Chen, T., Yang, H., Cai, Y., Yu, Q., Chen, J., Chen, Z., Shang, Q. L., Ma, C., Chen, X., & Xiao, E. (2020). Clinical and radiological changes of hospitalised patients with COVID-19 pneumonia from disease onset to acute exacerbation: a multicentre paired cohort study. European Radiology, 30(10), 5702-5708. https://doi.org/10.1007/s00330-020-06916-4
Liu J, et al. Clinical and Radiological Changes of Hospitalised Patients With COVID-19 Pneumonia From Disease Onset to Acute Exacerbation: a Multicentre Paired Cohort Study. Eur Radiol. 2020;30(10):5702-5708. PubMed PMID: 32385648.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical and radiological changes of hospitalised patients with COVID-19 pneumonia from disease onset to acute exacerbation: a multicentre paired cohort study. AU - Liu,Jiayi, AU - Chen,Taili, AU - Yang,Haitao, AU - Cai,Yeyu, AU - Yu,Qizhi, AU - Chen,Juan, AU - Chen,Zhu, AU - Shang,Quan-Liang, AU - Ma,Cong, AU - Chen,Xiangyu, AU - Xiao,Enhua, Y1 - 2020/05/08/ PY - 2020/02/25/received PY - 2020/04/23/accepted PY - 2020/04/17/revised PY - 2020/5/10/pubmed PY - 2020/9/15/medline PY - 2020/5/10/entrez KW - COVID-19 KW - Pneumonia KW - Tomography, X-ray computed SP - 5702 EP - 5708 JF - European radiology JO - Eur Radiol VL - 30 IS - 10 N2 - OBJECTIVES: To analyse clinical and radiological changes from disease onset to exacerbation in coronavirus infectious disease-19 (COVID-19) patients. METHODS: We reviewed clinical histories of 276 patients with confirmed COVID-19 pneumonia and extracted data on patients who met the diagnostic criteria for COVID-19 severe/fatal pneumonia and had an acute exacerbation starting with mild or common pneumonia. RESULTS: Twenty-four patients were included. Of these, 8% were smokers, 54% had been to Wuhan, and 46% had comorbidities. Before acute exacerbation, elevated lactate dehydrogenase (232.9 ± 88.7) was present, and chest CT scans showed the number of involved lobes was 4 (2-5) and total CT score was 6 (2-8). Following acute exacerbation, patients were likely to have more clinical symptoms (p < 0.01) and abnormal laboratory changes (p < 0.01). The number of involved lobes and CT score after an exacerbation significantly increased to 5 (5-5) and 12 (9-14), respectively. Receiver operating characteristic (ROC) curve showed that, when the cutoff value of CT score was 5, the sensitivity and specificity for severe pneumonia were 90% and 70%, respectively. CT findings of ground glass opacity with consolidations (91.7%), bilateral distribution (100.0%), and multifocal lesion (100.0%) were features in found in patients after exacerbation. CONCLUSIONS: There are significant changes in clinical, laboratory, and CT findings in patients from disease onset to exacerbation. An increase in the number of involved lobes or an increased CT score from the baseline may predict poor clinical outcomes. Combining an assessment of CT changes with clinical and laboratory changes could help clinical teams evaluate the prognosis. KEY POINTS: • The common chest CT signs of COVID-19 pneumonia after exacerbation were ground glass opacity (GGO) with consolidation, bilateral distribution, and multifocal lesions. • An increase in number of involved lobes or an increased CT score from the baseline may predict a poor clinical outcome. • Worsened symptoms and abnormal laboratory results are also associated with poor prognosis. SN - 1432-1084 UR - https://www.unboundmedicine.com/medline/citation/32385648/Clinical_and_radiological_changes_of_hospitalised_patients_with_COVID_19_pneumonia_from_disease_onset_to_acute_exacerbation:_a_multicentre_paired_cohort_study_ L2 - https://dx.doi.org/10.1007/s00330-020-06916-4 DB - PRIME DP - Unbound Medicine ER -