The Clinical and Chest CT Features Associated With Severe and Critical COVID-19 Pneumonia

Abstract

Objective: The aim of this study was to investigate the clinical and computed tomography (CT) features associated with severe and critical coronavirus disease 2019 (COVID-19) pneumonia.

Materials and methods: Eighty-three patients with COVID-19 pneumonia including 25 severe/critical cases and 58 ordinary cases were enrolled. The chest CT images and clinical data of them were reviewed and compared. The risk factors associated with disease severity were analyzed.

Results: Compared with the ordinary patients, the severe/critical patients had older ages, higher incidence of comorbidities, cough, expectoration, chest pain, and dyspnea. The incidences of consolidation, linear opacities, crazy-paving pattern, and bronchial wall thickening in severe/critical patients were significantly higher than those of the ordinary patients. Besides, severe/critical patients showed higher incidences of lymph node enlargement, pericardial effusion, and pleural effusion than the ordinary patients. The CT scores of severe/critical patients were significantly higher than those of the ordinary patients (P < 0.001). Receiver operating characteristic curve showed that the sensitivity and specificity of CT score were 80.0% and 82.8%, respectively, for the discrimination of the 2 types. The clinical factors of age older than 50 years, comorbidities, dyspnea, chest pain, cough, expectoration, decreased lymphocytes, and increased inflammation indicators were risk factors for severe/critical COVID-19 pneumonia. Computed tomography findings of consolidation, linear opacities, crazy-paving pattern, bronchial wall thickening, high CT scores, and extrapulmonary lesions were features of severe/critical COVID-19 pneumonia.

Conclusions: There are significant differences in clinical symptoms, laboratory examinations, and CT manifestations between the ordinary patients and the severe/critical patients. Many factors are related to the severity of the disease, which can help clinicians to judge the severity of the patient and evaluate the prognosis.

FIGURE 1

Chest CT of a 44-year-old man with ordinary COVID-19 pneumonia (CT score = 5). A, An axial CT image showed multiple small regions of subpleural GGO with superimposed interlobular and intralobular septal thickening. B, 3D visualization of CT-VRT showed the extent of GGO with scattered pattern.

FIGURE 2

Chest CT findings of severe/critical COVID-19 pneumonia (CT score = 18), a 60-year-old man with dyspnea and pleural effusion. A, An axial CT image showed diffuse large regions of crazy-paving pattern (GGO with superimposed interlobular and intralobular septal thickening) with partial consolidation and bronchial wall thickening. B, 3D visualization of CT-VRT showed the diffuse extent of GGO and consolidation.