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Characteristics of COVID-19 Patients Who Progress to Pneumonia on Follow-Up Chest Radiograph: 236 Patients from a Single Isolated Cohort in Daegu, South Korea

 Ha Kyung Jung  ;  Jin Young Kim  ;  Mu Sook Lee  ;  Ji Yeon Lee  ;  Jae Seok Park  ;  Miri Hyun  ;  Hyun Ah Kim  ;  Yong Shik Kwon  ;  Sang Woong Choi  ;  Sung Min Moon  ;  Young Joo Suh 
 KOREAN JOURNAL OF RADIOLOGY, Vol.21(11) : 1265-1272, 2020-11 
Journal Title
Issue Date
Adult ; Age Factors ; Aged ; Betacoronavirus / isolation & purification ; C-Reactive Protein / analysis ; Coronavirus Infections / diagnosis* ; Coronavirus Infections / diagnostic imaging ; Coronavirus Infections / virology ; Female ; Humans ; L-Lactate Dehydrogenase / metabolism ; Lymphocyte Count ; Male ; Middle Aged ; Odds Ratio ; Pandemics ; Pneumonia, Viral / diagnosis* ; Pneumonia, Viral / diagnostic imaging ; Pneumonia, Viral / virology ; Republic of Korea ; Retrospective Studies ; Thorax / diagnostic imaging* ; Tomography, X-Ray Computed
C-reactive protein ; COVID-19 ; Coronavirus ; Lactate dehydrogenase ; Lymphopenia ; Pneumonia ; Radiography
Objective: We investigated the prevalence of pneumonia in novel coronavirus disease 2019 (COVID-19) patients using chest radiographs to identify the characteristics of those with initially negative chest radiographs, who were positive for pneumonia on follow-up. Materials and methods: Retrospective cohort data of 236 COVID-19 patients were reviewed. Chest radiography was performed on admission, with serial radiographs obtained until discharge. The 'positive conversion group' was defined as patients whose initial chest radiographs were negative but were positive for pneumonia during follow-up. Patients with initially positive chest radiographs were defined as the 'initial pneumonia group.' Patients with negative initial and follow-up chest radiographs were defined as the 'non-pneumonia group.' Clinical and laboratory findings were compared between groups, and predictors of positive conversion were investigated. Results: Among 236 patients, 108 (45.8%) were in the non-pneumonia group, 69 (29.2%) were in the initial pneumonia group, and 59 (25%) were in the positive conversion group. The patients in the 'initial pneumonia group' and 'positive conversion group' were older, had higher C-reactive protein (CRP) and lactate dehydrogenase levels, and lower absolute lymphocyte counts than those in the 'non-pneumonia group' (all p < 0.001). Among patients with negative initial chest radiographs, age ≥ 45 years (odds ratio [OR]: 3.93, 95% confidence interval [CI]: 1.76-8.75, p = 0.001), absolute lymphocyte count < 1500 cells/μL (OR: 2.25, 95% CI: 1.03-4.89, p = 0.041), and CRP > 0.5 mg/dL (OR: 3.91, 95% CI: 1.54-9.91, p = 0.004) were independent predictors for future development of pneumonia. Conclusion: More than a half of COVID-19 patients initially had normal chest radiographs; however, elderly patients (≥ 45 years of age) with abnormal laboratory findings (elevated CRP and low absolute lymphocyte counts) developed pneumonia on follow-up radiographs.
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1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Suh, Young Joo(서영주) ORCID logo https://orcid.org/0000-0002-2078-5832
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