Clinical characteristics and chest CT imaging features of critically ill COVID-19 patients

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.

Keywords: Comorbidity; Computed tomography; Coronavirus infections; Pneumonia; X-ray.

Fig. 1

Lesion distribution in the lung fields of critically ill patients with COVID-19. a A 53-year-old male critically ill COVID-19 patient whose symptoms improved and was discharged from the hospital after treatment. CT shows the lesions infiltrating the peripheral and intermediate lung fields, with a lung involvement degree of 26–50% and lesion consolidation degree of 1–25%. b A 77-year-old female critically ill patient with COVID-19 who eventually died. Peripheral, intermediate, and medial areas were seen to be simultaneously involved on CT, with lung involvement and lesion consolidation degrees of 51–75%

Fig. 2

A 52-year-old male critically ill patient with COVID-19 who recovered after treatment. Multiple pure GGO lesions were seen in the peripheral and intermediate lung fields (arrows) on the CT image. GGO, ground-glass opacities

Fig. 3

Crazy-paving pattern in a 65-year-old female critically ill COVID-19 patient in the recovery group. A typical crazy-paving pattern is visualized on the CT image

Fig. 4

Air bronchogram appearance in a 73-year-old male critically ill COVID-19 patient in the recovery group. Multiple bronchogram signs are seen in the GGO and consolidation lesions (arrows). GGO, ground-glass opacities

Fig. 5

A 77-year-old male critically ill COVID-19 patient who recovered after treatment. GGO (arrows in a) and linear opacities (arrowheads in b) are presented in the same patient on the CT images. GGO, ground-glass opacities

Fig. 6

GGO with different margins in a 78-year-old male critically ill COVID-19 patient in the recovery group. a GGO with blurred margin. b GGO with clear margin. GGO, ground-glass opacities