Computed tomography findings of COVID-19 pneumonia in Intensive Care Unit-patients

Abstract

Background: In December 2019, a cluster of unknown etiology pneumonia cases occurred in Wuhan, China leading to identification of the responsible pathogen as SARS-coV-2. Since then, the coronavirus disease 2019 (COVID-19) has spread to the entire world. Computed Tomography (CT) is frequently used to assess severity and complications of COVID-19 pneumonia. The purpose of this study is to compare the CT patterns and clinical characteristics in intensive care unit (ICU) and non-ICU patients with COVID-19 pneumonia.
Design and Methods: This retrospective study included 218 consecutive patients (136 males; 82 females; mean age 63±15 years) with laboratory-confirmed SARS-coV-2. Patients were categorized in two different groups: (a) ICU patients and (b) non-ICU inpatients. We assessed the type and extent of pulmonary opacities on chest CT exams and recorded the information on comorbidities and laboratory values for all patients.
Results: Of the 218 patients, 23 (20 males: 3 females; mean age 60 years) required ICU admission, 195 (118 males: 77 females, mean age 64 years) were admitted to a clinical ward. Compared with non-ICU patients, ICU patients were predominantly males (60% versus 83% p=0.03), had more comorbidities, a positive CRP (p=0.04) and higher LDH values (p=0.008). ICU patients’ chest CT demonstrated higher incidence of consolidation (p=0.03), mixed lesions (p=0.01), bilateral opacities (p<0.01) and overall greater lung involvement by consolidation (p=0.02) and GGO (p=0.001).
Conclusions: CT imaging features of ICU patients affected by COVID-19 are significantly different compared with non-ICU patients. Identification of CT features could assist in a stratification of the disease severity and supportive treatment.

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References

Lu H, Stratton CW, Tang Y-W. Outbreak of pneumonia of unknown etiology in Wuhan, China: The mystery and the miracle. J Med Virol 2020;92:401-2. DOI: https://doi.org/10.1002/jmv.25678

Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel Coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323:1061-9. DOI: https://doi.org/10.1001/jama.2020.1585

Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506. DOI: https://doi.org/10.1016/S0140-6736(20)30183-5

Cau R, Bassareo P, Saba L. Cardiac involvement in COVID-19—Assessment with Echocardiography and cardiac magnetic resonance imaging. SN Compr Clin Med 2020. Online ahead of print. DOI: https://doi.org/10.1007/s42399-020-00344-7

Cau R, Bassareo PP, Mannelli L, et al. Imaging in COVID-19-related myocardial injury. Int J Cardiovasc Imaging 2020. Online ahead of print. DOI: https://doi.org/10.1007/s10554-020-02089-9

Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA 2020;323:1239-42. DOI: https://doi.org/10.1001/jama.2020.2648

Saba L, Gerosa C, Fanni D, et al. Molecular pathways triggered by COVID-19 in different organs: ACE2 receptor-expressing cells under attack? A review. Eur Rev Med Pharmacol Sci 2020;24:12609-22.

Corman VM, Landt O, Kaiser M, et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill 2020;25:2000045. DOI: https://doi.org/10.2807/1560-7917.ES.2020.25.3.2000045

Ng M-Y, Lee EYP, Yang J, et al. Imaging profile of the COVID-19 infection: Radiologic findings and literature review. Radiol Cardiothorac Imaging 2020;2:e200034. DOI: https://doi.org/10.1148/ryct.2020200034

Huang P, Liu T, Huang L, et al. Use of chest CT in combination with negative RT-PCR assay for the 2019 novel coronavirus but high clinical suspicion. Radiology 2020;295:22-3. DOI: https://doi.org/10.1148/radiol.2020200330

Xie X, Zhong Z, Zhao W, et al Chest CT for typical coronavirus disease 2019 (COVID-19) pneumonia: Relationship to negative RT-PCR testing. Radiology 2020;296:E41-5. DOI: https://doi.org/10.1148/radiol.2020200343

Phua J, Weng L, Ling L, et al. Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations. Lancet Respir Med 2020;8:506-17. DOI: https://doi.org/10.1016/S2213-2600(20)30161-2

Carlos WG, Dela Cruz CS, Cao B, et al. Novel Wuhan (2019-nCoV) coronavirus. Am J Respir Crit Care Med 2020;201:P7-8. DOI: https://doi.org/10.1164/rccm.2014P7

Vandroux D, Allyn J, Ferdynus C, et al. Mortality of critically ill patients with severe influenza starting four years after the 2009 pandemic. Infect Dis (Lond) 2019;51:831-7. DOI: https://doi.org/10.1080/23744235.2019.1668957

Gouda W, Yasin R. COVID-19 disease: CT pneumonia analysis prototype by using artificial intelligence, predicting the disease severity. Egypt J Radiol Nucl Med 2020;51:196. DOI: https://doi.org/10.1186/s43055-020-00309-9

Lyu P, Liu X, Zhang R, et al. The performance of chest CT in evaluating the clinical severity of COVID-19 pneumonia: Identifying critical cases based on CT characteristics. Invest Radiol 2020;55:412-21. DOI: https://doi.org/10.1097/RLI.0000000000000689

Wasilewski PG, Mruk B, Mazur S, et al. COVID-19 severity scoring systems in radiological imaging - a review. Polish J Radiol 2020;85:e361-8. DOI: https://doi.org/10.5114/pjr.2020.98009

Li K, Wu J, Wu F, et al. The clinical and chest CT features associated with severe and critical COVID-19 pneumonia. Invest Radiol 2020;55:327-31. DOI: https://doi.org/10.1097/RLI.0000000000000672

Lessmann N, Sánchez CI, Beenen L, et al. Automated assessment of COVID-19 reporting and data system and chest CT severity scores in patients suspected of having COVID-19 using artificial intelligence. Radiology 2021;298:e18-28. DOI: https://doi.org/10.1148/radiol.2020202439

Ruch Y, Kaeuffer C, Ohana M, et al. CT lung lesions as predictors of early death or ICU admission in COVID-19 patients. Clin Microbiol Infect 2020;26:1417.e5-8. DOI: https://doi.org/10.1016/j.cmi.2020.07.030

Hansell DM, Bankier AA, MacMahon H, et al. Fleischner Society: glossary of terms for thoracic imaging. Radiology 2008;246:697-722. DOI: https://doi.org/10.1148/radiol.2462070712

Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507-13. DOI: https://doi.org/10.1016/S0140-6736(20)30211-7

Jaillon S, Berthenet K, Garlanda C. Sexual dimorphism in innate immunity. Clin Rev Allergy Immunol 2019;56:308-21. DOI: https://doi.org/10.1007/s12016-017-8648-x

Bhatraju PK, Ghassemieh BJ, Nichols M, et al. Covid-19 in critically ill patients in the Seattle Region - Case series. N Engl J Med 2020;382:2012-22. DOI: https://doi.org/10.1056/NEJMoa2004500

Grasselli G, Zangrillo A, Zanella A, et al. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy. JAMA 2020;323:1574-81. DOI: https://doi.org/10.1001/jama.2020.5394

Guan W, Ni Z, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708-20. DOI: https://doi.org/10.1056/NEJMoa2002032

Grasselli G, Pesenti A, Cecconi M. Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: Early experience and forecast during an emergency response. JAMA 2020;323:1545-6. DOI: https://doi.org/10.1001/jama.2020.4031

Team CDCC-19 R. Preliminary estimates of the prevalence of selected underlying health conditions among patients with coronavirus disease 2019 - United States, February 12-March 28, 2020. MMWR Morb Mortal Wkly Rep 2020;69:382-6. DOI: https://doi.org/10.15585/mmwr.mm6913e2

Tal-Singer R, Crapo JD. COPD at the time of COVID-19: A COPD foundation perspective. Chronic Obstr Pulm Dis 2020;7:73-5. DOI: https://doi.org/10.15326/jcopdf.7.2.2020.0149

Wang L. C-reactive protein levels in the early stage of COVID-19. Med Mal Infect 2020;50:332-4. DOI: https://doi.org/10.1016/j.medmal.2020.03.007

Xu Z, Shi L, Wang Y, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020;8:420-2. DOI: https://doi.org/10.1016/S2213-2600(20)30076-X

Ajlan AM, Ahyad RA, Jamjoom LG, et al. Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: Chest CT findings. Am J Roentgenol 2014;203:782-7. DOI: https://doi.org/10.2214/AJR.14.13021

Wan Y-L, Tsay P-K, Cheung Y-C, et al. A correlation between the severity of lung lesions on radiographs and clinical findings in patients with severe acute respiratory syndrome. Korean J Radiol 2007;8:466-74. DOI: https://doi.org/10.3348/kjr.2007.8.6.466

Hani C, Trieu NH, Saab I, et al. COVID-19 pneumonia: A review of typical CT findings and differential diagnosis. Diagn Interv Imaging 2020;101:263-8. DOI: https://doi.org/10.1016/j.diii.2020.03.014

Li Y, Xia L. Coronavirus disease 2019 (COVID-19): Role of chest CT in diagnosis and management. Am J Roentgenol 2020;214:1280-6. DOI: https://doi.org/10.2214/AJR.20.22954

Fang Y, Zhang H, Xie J, et al. Sensitivity of chest CT for COVID-19: Comparison to RT-PCR. Radiology 2020;296:E115-7. DOI: https://doi.org/10.1148/radiol.2020200432

Engeler CE, Tashjian JH, Trenkner SW, Walsh JW. Ground-glass opacity of the lung parenchyma: a guide to analysis with high-resolution CT. Am J Roentgenol 1993;160:249-51. DOI: https://doi.org/10.2214/ajr.160.2.8424326

Guan CS, Lv Z Bin, Yan S, et al. Imaging features of coronavirus disease 2019 (COVID-19): Evaluation on thin-section CT. Acad Radiol 2020;27:609-13. DOI: https://doi.org/10.1016/j.acra.2020.03.002

Ye Z, Zhang Y, Wang Y, et al. Chest CT manifestations of new coronavirus disease 2019 (COVID-19): a pictorial review. Eur Radiol 2020;30:4381-9. DOI: https://doi.org/10.1007/s00330-020-06801-0

Pan F, Ye T, Sun P, et al. Time course of lung changes at chest CT during recovery from coronavirus disease 2019 (COVID-19). Radiology 2020;295:715-21. DOI: https://doi.org/10.1148/radiol.2020200370

Pan Y, Guan H, Zhou S, et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China. Eur Radiol 2020;30:3306-9. DOI: https://doi.org/10.1007/s00330-020-06731-x

Wu J, Feng LC, Xian XY, et al. [Novel coronavirus pneumonia (COVID-19) CT distribution and sign features].[Article in Chinese]. Zhonghua Jie He He Hu Xi Za Zhi 2020;43:321-6.

Bernheim A, Mei X, Huang M, et al. Chest CT findings in coronavirus disease-19 (COVID-19): Relationship to duration of infection. Radiology 2020;295:200463. DOI: https://doi.org/10.1148/radiol.2020200463

Yoon SH, Lee KH, Kim JY, et al. Chest radiographic and CT findings of the 2019 novel coronavirus disease (COVID-19): Analysis of nine patients treated in Korea. Korean J Radiol 2020;21:494-500. DOI: https://doi.org/10.3348/kjr.2020.0132

Sardanelli F, Cozzi A, Monfardini L, et al. Association of mediastinal lymphadenopathy with COVID-19 prognosis. Lancet Infect Dis 2020;20:1230-1. DOI: https://doi.org/10.1016/S1473-3099(20)30521-1

Faghihi Langroudi T, Khazaei M. Common imaging patterns of COVID-19 on spiral chest CT scan: a diagnostic approach for pulmonary involvement in ICU patients. J Cell Mol Anesth 2020;5:6-15.

Xiong Y, Sun D, Liu Y, et al. Clinical and high-resolution CT features of the COVID-19 infection: Comparison of the initial and follow-up changes. Invest Radiol 2020;55:332-9. DOI: https://doi.org/10.1097/RLI.0000000000000674

Emara DM, Naguib NN, Moustafa MA, et al. Typical and atypical CT chest imaging findings of novel coronavirus 19 (COVID-19) in correlation with clinical data: impact on the need to ICU admission, ventilation and mortality. Egypt J Radiol Nucl Med 2020;51:227. DOI: https://doi.org/10.1186/s43055-020-00339-3

Published
2021-04-19
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Original Articles
Keywords:
CT, COVID-19, severity score, ICU
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How to Cite
Cau, R., Falaschi, Z., Paschè, A., Danna, P., Arioli, R., Arru, C. D., Zagaria, D., Tricca, S., Suri, J. S., Karla, M. K., Carriero, A., & Saba, L. (2021). Computed tomography findings of COVID-19 pneumonia in Intensive Care Unit-patients. Journal of Public Health Research, 10(3). https://doi.org/10.4081/jphr.2021.2270