Clinical and radiological imaging as prognostic predictors in COVID-19 patients

• Published in: Egyptian journal of radiology and nuclear medicine 2021-04, Vol.52 (1), p.100-13
• Main Authors: Metwally, Maha Ibrahim, Basha, Mohammad Abd Alkhalik, Zaitoun, Mohamed M. A, Abdalla, Housseini Mohamed, Nofal, Hanaa Abu Elazayem, Hendawy, Hamdy, Manajrah, Esaraa
• Format: Article
• Language: English
• Subjects: Age groups; chest CT; China; Coronaviruses; COVID-19; CT imaging; Egypt; Epidemics; Fatal outcome; Health aspects; Infection; Laboratories; Lymphatic system; Medical imaging; Medical research; Medicine, Experimental; Middle age; Novel coronavirus; Observational studies; Oxygen saturation; Pleural effusion; Population; Severe acute respiratory syndrome coronavirus 2; Severity
• ISSN: 0378-603X; 2090-4762
• DOI: 10.1186/s43055-021-00470-9

Background Since the announcement of COVID-19 as a pandemic infection, several studies have been performed to discuss the clinical picture, laboratory finding, and imaging features of this disease. The aim of this study is to demarcate the imaging features of novel coronavirus infected pneumonia (NCIP) in different age groups and outline the relation between radiological aspect, including CT severity, and clinical aspect, including age, oxygen saturation, and fatal outcome. We implemented a prospective observational study enrolled 299 laboratory-confirmed COVID-19 patients (169 males and 130 females; age range = 2-91 years; mean age = 38.4 ± 17.2). All patients were submitted to chest CT with multi-planar reconstruction. The imaging features of NCIP in different age groups were described. The relations between CT severity and age, oxygen saturation, and fatal outcome were evaluated. Results The most predominant CT features were bilateral (75.4%), posterior (66.3%), pleural-based (93.5%), lower lobe involvement (89.8%), and ground-glass opacity (94.7%). ROC curve analysis revealed that the optimal cutoff age that was highly exposed to moderate and severe stages of NCIP was 38 years old (AUC = 0.77, p < 0.001). NCIP was noted in 42.6% below 40-year-old age group compared to 84% above 40-year-old age group. The CT severity was significantly related to age and fatal outcome (p < 0.001). Anterior, centrilobular, hilar, apical, and middle lobe involvements had a significant relation to below 90% oxygen saturation. A significant negative correlation was found between CT severity and oxygen saturation (r = - 0.49, p < 0.001). Crazy-paving pattern, anterior aspect, hilar, centrilobular involvement, and moderate and severe stages had a statistically significant relation to higher mortality. Conclusion The current study confirmed the value of CT as a prognostic predictor in NCIP through demonstration of the strong relation between CT severity and age, oxygen saturation, and the fatal outcome. In the era of COVID-19 pandemic, this study is considered to be an extension to other studies discussing chest CT features of COVID-19 in different age groups with demarcation of the relation of chest CT severity to different pattern and distribution of NCIP, age, oxygen saturation, and mortality rate.