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Adverse Initial CT Findings Associated with Poor Prognosis of Coronavirus Disease

Authors
 YoungJun Chon  ;  Jin Young Kim  ;  Young Joo Suh  ;  Ji Yeon Lee  ;  Jae Seok Park  ;  Sung Min Moon  ;  Mu Sook Lee  ;  Jaehyuck Yi 
Citation
 JOURNAL OF KOREAN MEDICAL SCIENCE, Vol.35(34) : e316, 2020-08 
Journal Title
 JOURNAL OF KOREAN MEDICAL SCIENCE 
ISSN
 1011-8934 
Issue Date
2020-08
MeSH
Aged ; Aged, 80 and over ; Aging ; Betacoronavirus ; C-Reactive Protein / analysis ; Coronavirus Infections / diagnosis ; Coronavirus Infections / diagnostic imaging* ; Coronavirus Infections / mortality ; Coronavirus Infections / pathology* ; Female ; Humans ; Intensive Care Units ; Lung / diagnostic imaging* ; Lung / pathology* ; Male ; Middle Aged ; Pandemics ; Pleural Effusion / diagnostic imaging* ; Pleural Effusion / pathology* ; Pneumonia, Viral / diagnosis ; Pneumonia, Viral / diagnostic imaging* ; Pneumonia, Viral / mortality ; Pneumonia, Viral / pathology* ; Prognosis ; Retrospective Studies ; Severity of Illness Index ; Tomography, X-Ray Computed
Keywords
COVID-19 ; Computed Tomography ; Coronavirus ; Pneumonia
Abstract
Background: The predictors of poor prognosis in patients with coronavirus disease 2019 (COVID-19) using computed tomography (CT) have not been investigated in a large cohort. Therefore, the purpose of this study was to investigate the adverse initial CT features to predict poor prognosis in COVID-19. Methods: From February to April 2020, 281 COVID-19 patients who underwent CT at the time of admission were included. We divided the patients into the severe and non-severe disease groups. The severe group included patients with severe pneumonia or critical events. Intensive care unit admission or death were the critical events in this study. We compared the clinical and CT findings between the severe and non-severe groups and investigated the prognostic factors and critical events of the severe group using the regression analysis. Results: Among the 281 patients, 36 (12.8%) patients were in the severe group and 245 (87.2%) patients were in the non-severe group. Critical events occurred in 10 patients (3.6%). In the severe group, patients showed significantly more pneumonia with consolidation, crazy-paving appearance, pleural effusion, and higher CT scores than those in the non-severe group (all, P < 0.05). In the multivariate regression, pleural effusion (odds ratio [OR], 8.96; 95% confidence interval [CI], 1.81-44.42; P = 0.007), CT score > 5 (OR, 3.70; 95% CI, 1.44-9.53; P = 0.007), old age (> 77 years, OR, 9.96; 95% CI, 3.78-26.28; P < 0.001), and elevated C-reactive protein (OR, 4.15; 95% CI, 1.62-10.6; P = 0.003) were significant prognostic factors of severe disease. CT score > 5 (OR, 7.29; 95% CI, 1.37-38.68; P = 0.020), pleural effusion (OR, 5.67; 95% CI, 1.04-30.8; P = 0.045) and old age (OR, 8.6; 95% CI, 1.80-41.0; P = 0.007) were also significant predictors of critical events. Conclusion: Pleural effusion and the extent of pneumonia on initial CT scans are associated with poor prognosis in patients with COVID-19.
Files in This Item:
T202005148.pdf Download
DOI
10.3346/jkms.2020.35.e316
Appears in Collections:
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
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/180726
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