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Stratifying the early radiologic trajectory in dyspneic patients with COVID-19 pneumonia

Authors
 Jin Young Kim  ;  Keum Ji Jung  ;  Seung-Jin Yoo  ;  Soon Ho Yoon 
Citation
 PLOS ONE, Vol.16(10) : e0259010, 2021-10 
Journal Title
PLOS ONE
Issue Date
2021-10
MeSH
Aged ; Aged, 80 and over ; COVID-19* / diagnostic imaging ; COVID-19* / mortality ; Dyspnea* / diagnostic imaging ; Dyspnea* / mortality ; Female ; Humans ; Intensive Care Units* ; Male ; Middle Aged ; Retrospective Studies ; Risk Factors ; SARS-CoV-2* ; Tomography, X-Ray Computed*
Abstract
Objective: This study aimed to stratify the early pneumonia trajectory on chest radiographs and compare patient characteristics in dyspneic patients with coronavirus disease 2019 (COVID-19).

Materials and methods: We retrospectively included 139 COVID-19 patients with dyspnea (87 men, 62.7±16.3 years) and serial chest radiographs from January to September 2020. Radiographic pneumonia extent was quantified as a percentage using a previously-developed deep learning algorithm. A group-based trajectory model was used to categorize the pneumonia trajectory after symptom onset during hospitalization. Clinical findings, and outcomes were compared, and Cox regression was performed for survival analysis.

Results: Radiographic pneumonia trajectories were categorized into four groups. Group 1 (n = 83, 59.7%) had negligible pneumonia, and group 2 (n = 29, 20.9%) had mild pneumonia. Group 3 (n = 13, 9.4%) and group 4 (n = 14, 10.1%) showed similar considerable pneumonia extents at baseline, but group 3 had decreasing pneumonia extent at 1-2 weeks, while group 4 had increasing pneumonia extent. Intensive care unit admission and mortality were significantly more frequent in groups 3 and 4 than in groups 1 and 2 (P < .05). Groups 3 and 4 shared similar clinical and laboratory findings, but thrombocytopenia (<150×103/μL) was exclusively observed in group 4 (P = .016). When compared to groups 1 and 2, group 4 (hazard ratio, 63.3; 95% confidence interval, 7.9-504.9) had a two-fold higher risk for mortality than group 3 (hazard ratio, 31.2; 95% confidence interval, 3.5-280.2), and this elevated risk was maintained after adjusting confounders.

Conclusion: Monitoring the early radiologic trajectory beyond baseline further prognosticated at-risk COVID-19 patients, who potentially had thrombo-inflammatory responses.
Files in This Item:
T202125726.pdf Download
DOI
10.1371/journal.pone.0259010
Appears in Collections:
4. Graduate School of Public Health (보건대학원) > Graduate School of Public Health (보건대학원) > 1. Journal Papers
Yonsei Authors
Jung, Keum Ji(정금지) ORCID logo https://orcid.org/0000-0003-4993-0666
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/188170
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