Alysson Roncally Silva Carvalho1,2,3, Alan Guimarães2, Thiego de Souza Oliveira Garcia4, Gabriel Madeira Werberich5, Victor Fraga Ceotto6, Fernando Augusto Bozza7,8, Rosana Souza Rodrigues5,7, Joana Sofia F Pinto9, Willian Rebouças Schmitt9, Walter Araujo Zin3, Manuela França9,10. 1. Cardiovascular R&D Centre (UnIC), Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal. 2. Laboratory of Pulmonary Engineering, Biomedical Engineering Program, Alberto Luiz Coimbra Institute of Post-Graduation and Research in Engineering, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. 3. Laboratory of Respiration Physiology, Carlos Chagas Filho Institute of Biophysics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. 4. Medical Faculty, Universidade Estácio de Sá, Rio de Janeiro, Brazil. 5. Department of Radiology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. 6. Hospital Niteroi D'Or, Niterói, Brazil. 7. D'Or Institute for Research and Education, Rio de Janeiro, Brazil. 8. National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil. 9. Radiology Department, Complexo Hospitalar Universitário do Porto, Porto, Portugal. 10. Instituto de Ciências Biomeìdicas Abel Salazar, Porto University, Porto, Portugal.
Abstract
BACKGROUND: COVID-19 pneumonia extension is assessed by computed tomography (CT) with the ratio between the volume of abnormal pulmonary opacities (PO) and CT-estimated lung volume (CTLV). CT-estimated lung weight (CTLW) also correlates with pneumonia severity. However, both CTLV and CTLW depend on demographic and anthropometric variables. PURPOSES: To estimate the extent and severity of COVID-19 pneumonia adjusting the volume and weight of abnormal PO to the predicted CTLV (pCTLV) and CTLW (pCTLW), respectively, and to evaluate their possible association with clinical and radiological outcomes. METHODS: Chest CT from 103 COVID-19 and 86 healthy subjects were examined retrospectively. In controls, predictive equations for estimating pCTLV and pCTLW were assessed. COVID-19 pneumonia extent and severity were then defined as the ratio between the volume and the weight of abnormal PO expressed as a percentage of the pCTLV and pCTLW, respectively. A ROC analysis was used to test differential diagnosis ability of the proposed method in COVID-19 and controls. The degree of pneumonia extent and severity was assessed with Z-scores relative to the average volume and weight of PO in controls. Accordingly, COVID-19 patients were classified as with limited, moderate and diffuse pneumonia extent and as with mild, moderate and severe pneumonia severity. RESULTS: In controls, CTLV could be predicted by sex and height (adjusted R 2 = 0.57; P < 0.001) while CTLW by age, sex, and height (adjusted R 2 = 0.6; P < 0.001). The cutoff of 20% (AUC = 0.91, 95%CI 0.88-0.93) for pneumonia extent and of 50% (AUC = 0.91, 95%CI 0.89-0.92) for pneumonia severity were obtained. Pneumonia extent were better correlated when expressed as a percentage of the pCTLV and pCTLW (r = 0.85, P < 0.001), respectively. COVID-19 patients with diffuse and severe pneumonia at admission presented significantly higher CRP concentration, intra-hospital mortality, ICU stay and ventilatory support necessity, than those with moderate and limited/mild pneumonia. Moreover, pneumonia severity, but not extent, was positively and moderately correlated with age (r = 0.46) and CRP concentration (r = 0.44). CONCLUSION: The proposed estimation of COVID-19 pneumonia extent and severity might be useful for clinical and radiological patient stratification.
BACKGROUND: COVID-19 pneumonia extension is assessed by computed tomography (CT) with the ratio between the volume of abnormal pulmonary opacities (PO) and CT-estimated lung volume (CTLV). CT-estimated lung weight (CTLW) also correlates with pneumonia severity. However, both CTLV and CTLW depend on demographic and anthropometric variables. PURPOSES: To estimate the extent and severity of COVID-19 pneumonia adjusting the volume and weight of abnormal PO to the predicted CTLV (pCTLV) and CTLW (pCTLW), respectively, and to evaluate their possible association with clinical and radiological outcomes. METHODS: Chest CT from 103 COVID-19 and 86 healthy subjects were examined retrospectively. In controls, predictive equations for estimating pCTLV and pCTLW were assessed. COVID-19 pneumonia extent and severity were then defined as the ratio between the volume and the weight of abnormal PO expressed as a percentage of the pCTLV and pCTLW, respectively. A ROC analysis was used to test differential diagnosis ability of the proposed method in COVID-19 and controls. The degree of pneumonia extent and severity was assessed with Z-scores relative to the average volume and weight of PO in controls. Accordingly, COVID-19 patients were classified as with limited, moderate and diffuse pneumonia extent and as with mild, moderate and severe pneumonia severity. RESULTS: In controls, CTLV could be predicted by sex and height (adjusted R 2 = 0.57; P < 0.001) while CTLW by age, sex, and height (adjusted R 2 = 0.6; P < 0.001). The cutoff of 20% (AUC = 0.91, 95%CI 0.88-0.93) for pneumonia extent and of 50% (AUC = 0.91, 95%CI 0.89-0.92) for pneumonia severity were obtained. Pneumonia extent were better correlated when expressed as a percentage of the pCTLV and pCTLW (r = 0.85, P < 0.001), respectively. COVID-19 patients with diffuse and severe pneumonia at admission presented significantly higher CRP concentration, intra-hospital mortality, ICU stay and ventilatory support necessity, than those with moderate and limited/mild pneumonia. Moreover, pneumonia severity, but not extent, was positively and moderately correlated with age (r = 0.46) and CRP concentration (r = 0.44). CONCLUSION: The proposed estimation of COVID-19 pneumonia extent and severity might be useful for clinical and radiological patient stratification.
Authors: Nicolò Patroniti; Giacomo Bellani; Elena Maggioni; Annamaria Manfio; Barbara Marcora; Antonio Pesenti Journal: Crit Care Med Date: 2005-11 Impact factor: 7.598
Authors: Andreas W Reske; Alexander P Reske; Till Heine; Peter M Spieth; Anna Rau; Matthias Seiwerts; Harald Busse; Udo Gottschaldt; Dierk Schreiter; Silvia Born; Marcelo Gama de Abreu; Christoph Josten; Hermann Wrigge; Marcelo B P Amato Journal: Crit Care Date: 2011-02-25 Impact factor: 9.097