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Clinical characteristics and chest CT imaging features of critically ill COVID-19 patients.
Eur Radiol. 2020 Nov; 30(11):6151-6160.ER

Abstract

OBJECTIVES

To 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.

METHODS

This 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.

RESULTS

Compared 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.

CONCLUSIONS

Older 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.

Authors+Show Affiliations

Department of Radiology, Capital Medical University, Beijing Anzhen Hospital, 2nd Anzhen Road, Chaoyang District, Beijing, China.Department of Radiology, China Resources & WISCO General Hospital, Wuhan, Hubei Province, China.Department of Radiology, Second Hospital of Wuhan Iron and Steel Company, Wuhan, Hubei Province, China.Department of Radiology, China Resources & WISCO General Hospital, Wuhan, Hubei Province, China.Department of Radiology, Capital Medical University, Beijing Anzhen Hospital, 2nd Anzhen Road, Chaoyang District, Beijing, China. 1523115105@qq.com.The First Affiliated Hospital of Hunan University of Medicine, Huaihua, Hunan Province, China. 1976841746@qq.com.Discipline of Medical Radiation Sciences, Curtin University, Perth, Australia. z.sun@curtin.edu.au.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

32474629

Citation

Zhang, Nan, et al. "Clinical Characteristics and Chest CT Imaging Features of Critically Ill COVID-19 Patients." European Radiology, vol. 30, no. 11, 2020, pp. 6151-6160.
Zhang N, Xu X, Zhou LY, et al. Clinical characteristics and chest CT imaging features of critically ill COVID-19 patients. Eur Radiol. 2020;30(11):6151-6160.
Zhang, N., Xu, X., Zhou, L. Y., Chen, G., Li, Y., Yin, H., & Sun, Z. (2020). Clinical characteristics and chest CT imaging features of critically ill COVID-19 patients. European Radiology, 30(11), 6151-6160. https://doi.org/10.1007/s00330-020-06955-x
Zhang N, et al. Clinical Characteristics and Chest CT Imaging Features of Critically Ill COVID-19 Patients. Eur Radiol. 2020;30(11):6151-6160. PubMed PMID: 32474629.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clinical characteristics and chest CT imaging features of critically ill COVID-19 patients. AU - Zhang,Nan, AU - Xu,Xunhua, AU - Zhou,Ling-Yan, AU - Chen,Gang, AU - Li,Yu, AU - Yin,Huiming, AU - Sun,Zhonghua, Y1 - 2020/05/30/ PY - 2020/03/06/received PY - 2020/05/14/accepted PY - 2020/05/05/revised PY - 2020/6/1/pubmed PY - 2020/10/29/medline PY - 2020/6/1/entrez KW - Comorbidity KW - Computed tomography KW - Coronavirus infections KW - Pneumonia KW - X-ray SP - 6151 EP - 6160 JF - European radiology JO - Eur Radiol VL - 30 IS - 11 N2 - OBJECTIVES: To 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. METHODS: This 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. RESULTS: Compared 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. CONCLUSIONS: Older 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. SN - 1432-1084 UR - https://www.unboundmedicine.com/medline/citation/32474629/Clinical_characteristics_and_chest_CT_imaging_features_of_critically_ill_COVID_19_patients_ L2 - https://dx.doi.org/10.1007/s00330-020-06955-x DB - PRIME DP - Unbound Medicine ER -