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Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis.
Eur Radiol. 2020 Jul 04 [Online ahead of print]ER

Abstract

OBJECTIVES

To correlate a CT-based semi-quantitative score of pulmonary involvement in COVID-19 pneumonia with clinical staging of disease and laboratory findings. We also aimed to investigate whether CT findings may be predictive of patients' outcome.

METHODS

From March 6 to March 22, 2020, 130 symptomatic SARS-CoV-2 patients were enrolled for this single-center analysis and chest CT examinations were retrospectively evaluated. A semi-quantitative CT score was calculated based on the extent of lobar involvement (0:0%; 1, < 5%; 2:5-25%; 3:26-50%; 4:51-75%; 5, > 75%; range 0-5; global score 0-25). Data were matched with clinical stages and laboratory findings. Survival curves and univariate and multivariate analyses were performed to evaluate the role of CT score as a predictor of patients' outcome.

RESULTS

Ground glass opacities were predominant in early-phase (≤ 7 days since symptoms' onset), while crazy-paving pattern, consolidation, and fibrosis characterized late-phase disease (> 7 days). CT score was significantly higher in critical and severe than in mild stage (p < 0.0001), and among late-phase than early-phase patients (p < 0.0001). CT score was significantly correlated with CRP (p < 0.0001, r = 0.6204) and D-dimer (p < 0.0001, r = 0.6625) levels. A CT score of ≥ 18 was associated with an increased mortality risk and was found to be predictive of death both in univariate (HR, 8.33; 95% CI, 3.19-21.73; p < 0.0001) and multivariate analysis (HR, 3.74; 95% CI, 1.10-12.77; p = 0.0348).

CONCLUSIONS

Our preliminary data suggest the potential role of CT score for predicting the outcome of SARS-CoV-2 patients. CT score is highly correlated with laboratory findings and disease severity and might be beneficial to speed-up diagnostic workflow in symptomatic cases.

KEY POINTS

• CT score is positively correlated with age, inflammatory biomarkers, severity of clinical categories, and disease phases. • A CT score ≥ 18 has shown to be highly predictive of patient's mortality in short-term follow-up. • Our multivariate analysis demonstrated that CT parenchymal assessment may more accurately reflect short-term outcome, providing a direct visualization of anatomic injury compared with non-specific inflammatory biomarkers.

Authors+Show Affiliations

Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy. francoiafrate@gmail.com.Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.Unit of Emergency Radiology, Policlinico Umberto I, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.Unit of Emergency Radiology, Policlinico Umberto I, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.Department of Anaesthesiology Critical Care Medicine and Pain Therapy, Policlinico Umberto I, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy.Department of Anaesthesiology Critical Care Medicine and Pain Therapy, Policlinico Umberto I, Sapienza University, Viale Regina Elena 324, 00161, Rome, Italy.Department of Molecular Medicine, Sapienza University of Rome, Viale dell'Università 31, 00185, Rome, Italy.Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy. Unit of Emergency Radiology, Policlinico Umberto I, Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.Department of Radiological, Oncological and Pathological Sciences, Policlinico Umberto I, Sapienza University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32623505

Citation

Francone, Marco, et al. "Chest CT Score in COVID-19 Patients: Correlation With Disease Severity and Short-term Prognosis." European Radiology, 2020.
Francone M, Iafrate F, Masci GM, et al. Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis. Eur Radiol. 2020.
Francone, M., Iafrate, F., Masci, G. M., Coco, S., Cilia, F., Manganaro, L., Panebianco, V., Andreoli, C., Colaiacomo, M. C., Zingaropoli, M. A., Ciardi, M. R., Mastroianni, C. M., Pugliese, F., Alessandri, F., Turriziani, O., Ricci, P., & Catalano, C. (2020). Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis. European Radiology. https://doi.org/10.1007/s00330-020-07033-y
Francone M, et al. Chest CT Score in COVID-19 Patients: Correlation With Disease Severity and Short-term Prognosis. Eur Radiol. 2020 Jul 4; PubMed PMID: 32623505.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis. AU - Francone,Marco, AU - Iafrate,Franco, AU - Masci,Giorgio Maria, AU - Coco,Simona, AU - Cilia,Francesco, AU - Manganaro,Lucia, AU - Panebianco,Valeria, AU - Andreoli,Chiara, AU - Colaiacomo,Maria Chiara, AU - Zingaropoli,Maria Antonella, AU - Ciardi,Maria Rosa, AU - Mastroianni,Claudio Maria, AU - Pugliese,Francesco, AU - Alessandri,Francesco, AU - Turriziani,Ombretta, AU - Ricci,Paolo, AU - Catalano,Carlo, Y1 - 2020/07/04/ PY - 2020/04/07/received PY - 2020/06/12/accepted PY - 2020/06/05/revised PY - 2020/7/6/entrez PY - 2020/7/6/pubmed PY - 2020/7/6/medline KW - COVID-19 KW - Pneumonia KW - Severe acute respiratory syndrome coronavirus 2 KW - Tomography, X-ray computed JF - European radiology JO - Eur Radiol N2 - OBJECTIVES: To correlate a CT-based semi-quantitative score of pulmonary involvement in COVID-19 pneumonia with clinical staging of disease and laboratory findings. We also aimed to investigate whether CT findings may be predictive of patients' outcome. METHODS: From March 6 to March 22, 2020, 130 symptomatic SARS-CoV-2 patients were enrolled for this single-center analysis and chest CT examinations were retrospectively evaluated. A semi-quantitative CT score was calculated based on the extent of lobar involvement (0:0%; 1, < 5%; 2:5-25%; 3:26-50%; 4:51-75%; 5, > 75%; range 0-5; global score 0-25). Data were matched with clinical stages and laboratory findings. Survival curves and univariate and multivariate analyses were performed to evaluate the role of CT score as a predictor of patients' outcome. RESULTS: Ground glass opacities were predominant in early-phase (≤ 7 days since symptoms' onset), while crazy-paving pattern, consolidation, and fibrosis characterized late-phase disease (> 7 days). CT score was significantly higher in critical and severe than in mild stage (p < 0.0001), and among late-phase than early-phase patients (p < 0.0001). CT score was significantly correlated with CRP (p < 0.0001, r = 0.6204) and D-dimer (p < 0.0001, r = 0.6625) levels. A CT score of ≥ 18 was associated with an increased mortality risk and was found to be predictive of death both in univariate (HR, 8.33; 95% CI, 3.19-21.73; p < 0.0001) and multivariate analysis (HR, 3.74; 95% CI, 1.10-12.77; p = 0.0348). CONCLUSIONS: Our preliminary data suggest the potential role of CT score for predicting the outcome of SARS-CoV-2 patients. CT score is highly correlated with laboratory findings and disease severity and might be beneficial to speed-up diagnostic workflow in symptomatic cases. KEY POINTS: • CT score is positively correlated with age, inflammatory biomarkers, severity of clinical categories, and disease phases. • A CT score ≥ 18 has shown to be highly predictive of patient's mortality in short-term follow-up. • Our multivariate analysis demonstrated that CT parenchymal assessment may more accurately reflect short-term outcome, providing a direct visualization of anatomic injury compared with non-specific inflammatory biomarkers. SN - 1432-1084 UR - https://www.unboundmedicine.com/medline/citation/32623505/Chest_CT_score_in_COVID-19_patients:_correlation_with_disease_severity_and_short-term_prognosis L2 - https://dx.doi.org/10.1007/s00330-020-07033-y DB - PRIME DP - Unbound Medicine ER -
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