Chest CT scan assesses severity of COVID-19 disease and risk of death

Is that bad ?

In the context of COVID-19, chest computed tomography produces data that helps clinicians assess a patient’s risk of mortality, Dr Fatemeh Darvizeh of IRCCS San Raffaele Scientific Institute in Milan, Italy, told session participants. She and her colleagues found that two cardiovascular risk biomarkers were associated with disease severity in COVID-19 patients: sarcopenia and fatty liver disease.

“The high rate of morbidity and mortality associated with COVID-19 infection increases the need to identify non-clinical parameters that can early stratify the patient’s risk of death,” she said. “In this context, chest computed tomography – already widely used for the assessment of lung parenchyma – may provide additional information, allowing better risk stratification in individual patients.”

The Darvizeh group conducted a study that included 1,669 patients who underwent a contrast-free chest CT scan within 72 hours of hospital admission; the team collected clinical data such as patient demographics, co-morbidities, and lab test results from electronic medical records, and determined whether patients had received oxygen therapy or intensive care and s ‘they had died in hospital.

Investigators assessed CT chest examinations for well-ventilated lung volume, percentage of pneumonia involvement, coronary artery calcium score, paraverterbral muscle density as a marker of sarcopenia, bone density as a marker of osteoporosis and liver density as a marker for fatty liver disease. . Of the patient cohort, 66.1% were men and 63.8% had comorbidities; 68.1% had less than 50% lung damage from COVID-19 on CT scan, while 31.9% had more than 50% lung damage.

A quarter of the cohort died, the death rate being higher among men (28%) than among women (19%). Risk factors for COVID-19 mortality included advanced age, male sex, higher coronary artery calcium scores, higher degree of sarcopenia, fatty liver disease, and lower bone density. Involving the lungs by more than 50% more than tripled a patient’s chances of dying from COVID-19.

Overall, researchers found that sarcopenia and fatty liver on chest CT scan were associated with the severity and outcome of COVID-19 pneumonia.

“Chest CT scans performed for the diagnosis of COVID-19 pneumonia help identify new features in high-risk COVID patients,” Darvizeh said. “Accurate chest computed tomography scan is important not only for the assessment of lung parenchyma, but also [for assessing] risk of death of patients affected by COVID-19 upon admission to hospital. “

CT + cytokines = better prediction of severity

Presenter and third-year medical student Emma Klein of the Icahn School of Medicine at Mount Sinai in New York City shared the results of a study that found that adding plasma cytokine data to CT scan results thoracic chest improves assessment of COVID-19 disease severity and risk of death.

The team’s research included 152 patients with COVID-19 who underwent plasma cytokine assessment and a chest scan within five days of being admitted to hospital. The group assessed the predictive value of five models:

  • Cytokine data only
  • Qualitative CT data
  • Quantitative CT data
  • A combination of data included in the first three models
  • An “optimized” model that included data on cytokines, ground glass opacities, aerated lung ratio and age

Power of 5 models to predict COVID-19 severity and mortality by area under the curve (AUC)
Factor Cytokine model Qualitative CT model CT quantitative model Combined model Optimized model
Degree of disease severity 0.70 0.74 0.81 0.84 0.82
Death 0.70 0.61 0.66 0.75 0.78

The combined model was found to be the most effective in assessing the degree of severity of the disease, while the optimized model was the most effective in assessing the risk of mortality, according to the study authors.

“CT imaging alone and in combination with cytokines may be useful in predicting the outcome of COVID-19 patients,” Klein concluded.

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