Visual lung damage CT score at hospital admission of COVID-19 patients and 30-day mortality

• Published in: European radiology 2021-11, Vol.31 (11), p.8354-8363
• Main Authors: Charpentier, Etienne, Soulat, Gilles, Fayol, Antoine, Hernigou, Anne, Livrozet, Marine, Grand, Teodor, Reverdito, Guillaume, al Haddad, Jad, Dang Tran, Kim Diep, Charpentier, Anne, Clement, Olivier, Hulot, Jean-Sebastien, Mousseaux, Elie
• Format: Article
• Language: English
• Subjects: Algorithms; Calcium-binding protein; Chest; Computed Tomography; Consolidation; Coronaviruses; COVID-19; Damage; Diagnostic Radiology; Evaluation; Health risks; Imaging; Internal Medicine; Interventional Radiology; Life Sciences; Lungs; Medicine; Medicine & Public Health; Mortality; Neuroradiology; Oxygen; Oxygen content; Oxygen saturation; Patients; Radiology; Respiration; Respiratory diseases; Respiratory rate; Risk analysis; Risk factors; Severe acute respiratory syndrome; Survival; Troponin; Troponin I; Ultrasound; Viral diseases
• ISSN: 0938-7994; 1432-1084
• DOI: 10.1007/s00330-021-07938-2

Objectives Chest CT has been widely used to screen and to evaluate the severity of COVID-19 disease in the early stages of infection without severe acute respiratory syndrome, but no prospective data are available to study the relationship between extent of lung damage and short-term mortality. The objective was to evaluate association between standardized simple visual lung damage CT score (vldCTs) at admission, which does not require any software, and 30-day mortality. Methods In a single-center prospective cohort of COVID-19 patients included during 4 weeks, the presence and extent of ground glass opacities(GGO), consolidation opacities, or both of them were visually assessed in each of the 5 lung lobes (score from 0 to 4 per lobe depending on the percentage and out of 20 per patient = vldCTs) after the first chest CT performed to detect COVID-19 pneumonia. Results Among 210 confirmed COVID-19 patients, the number of survivors and non-survivors was 162 (77%) and 48 (23%), respectively at 30 days. vldCTs was significantly higher in non-survivors, and the AUC of vldCTs to distinguish survivors and non-survivors was 0.72 (95%CI 0.628–0.807, p < 0.001); the best cut-off vldCTs value was 7. During follow-up, significant differences in discharges and 30-day mortality were observed between patients with vldCTs ≥ 7 versus vldCTs < 7: (98 [85.2%] vs 49 [51.6%]; p < 0.001 and 36 [37.9%] vs 12 [12.4%]; p < 0.001, respectively. The 30-day mortality increased if vldCTs ≥ 7 (HR, 3.16 (1.50–6.43); p = 0.001), independent of age, respiratory rate and oxygen saturation levels, and comorbidities at admission. Conclusions By using chest CT in COVID-19 patients, extensive lung damage can be visually assessed with a score related to 30-day mortality independent of conventional risk factors of the disease. Key Points • In non-selected COVID-19 patients included prospectively during 4 weeks, the extent of ground glass opacities(GGO) and consolidation opacities evaluated by a simple visual score was related to 30-day mortality independent of age, respiratory rate, oxygen saturation levels, comorbidities, and hs-troponin I level at admission. • This severity score should be incorporated into risk stratification algorithms and in structured chest CT reports requiring a standardized reading by radiologists in case of COVID-19.