Prognostic value of initial chest CT findings for clinical outcomes in patients with COVID-19

Abstract

Rationale: To identify whether the initial chest computed tomography (CT) findings of patients with coronavirus disease 2019 (COVID-19) are helpful for predicting the clinical outcome. Methods: A total of 224 patients with laboratory-confirmed COVID-19 who underwent chest CT examination within the first day of admission were enrolled. CT findings, including the pattern and distribution of opacities, the number of lung lobes involved and the chest CT scores of lung involvement, were assessed. Independent predictors of adverse clinical outcomes were determined by multivariate regression analysis. Adverse outcome were defined as the need for mechanical ventilation or death. Results: Of 224 patients, 74 (33%) had adverse outcomes and 150 (67%) had good outcomes. There were higher frequencies of more than four lung zones involved (73% vs 32%), both central and peripheral distribution (57% vs 42%), consolidation (27% vs 17%), and air bronchogram (24% vs 13%) and higher initial chest CT scores (8.6±3.4 vs 5.4±2.1) (P < 0.05 for all) in the patients with poor outcomes. Multivariate analysis demonstrated that more than four lung zones (odds ratio [OR] 3.93; 95% confidence interval [CI]: 1.44 to 12.89), age above 65 (OR 3.65; 95% CI: 1.11 to 10.59), the presence of comorbidity (OR 5.21; 95% CI: 1.64 to 19.22) and dyspnea on admission (OR 3.19; 95% CI: 1.35 to 8.46) were independent predictors of poor outcome. Conclusions: Involvement of more than four lung zones and a higher CT score on the initial chest CT were significantly associated with adverse clinical outcome. Initial chest CT findings may be helpful for predicting clinical outcome in patients with COVID-19.

Keywords: COVID-19; CT; SARS-CoV-2; clinical outcomes.

Figure 1

Initial chest CT of a 76-year-old man who presented with fever, cough, and dyspnea for 4 days. Bilateral extensive irregular patchy ground glass opacities (GGOs), strip opacities, consolidation, some with air bronchogram, with both central and peripheral distributions were observed. Mechanical ventilation treatments were used at admission, and the patient died of respiratory failure after 10 days of hospitalization.

Figure 2

Initial chest CT of a 41-year-old man who presented with fever and cough for 3 days. Bilateral multiple patchy ground glass opacities (GGOs), with peripheral distribution were seen. The patient was discharged 6 days later after symptom improvement.

Figure 3

The involvement of more than four lung zones was identified as a cutoff with a sensitivity of 65% and a specificity of 78% for predicting poor prognosis. The area under the ROC (AUC) was 0.72 (95% confidence interval (CI): 0.59 to 0.85).