Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis
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Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis Marco Francone 1 & Franco Iafrate 1 & Giorgio Maria Masci 1 & Simona Coco 1 & Francesco Cilia 1 & Lucia Manganaro 1 & Valeria Panebianco 1 & Chiara Andreoli 2 & Maria Chiara Colaiacomo 2 & Maria Antonella Zingaropoli 3 & Maria Rosa Ciardi 3 & Claudio Maria Mastroianni 3 & Francesco Pugliese 4 & Francesco Alessandri 4 & Ombretta Turriziani 5 & Paolo Ricci 1,2 & Carlo Catalano 1 Received: 7 April 2020 / Revised: 5 June 2020 / Accepted: 12 June 2020 # European Society of Radiology 2020
Abstract Objectives To correlate a CT-based semi-quantitative score of pulmonary involvement in COVID-19 pneumonia with clinical staging of disease and laboratory findings. We also aimed to investigate whether CT findings may be predictive of patients’ outcome. Methods From March 6 to March 22, 2020, 130 symptomatic SARS-CoV-2 patients were enrolled for this single-center analysis and chest CT examinations were retrospectively evaluated. A semi-quantitative CT score was calculated based on the extent of lobar involvement (0:0%; 1, < 5%; 2:5–25%; 3:26–50%; 4:51–75%; 5, > 75%; range 0–5; global score 0–25). Data were matched with clinical stages and laboratory findings. Survival curves and univariate and multivariate analyses were performed to evaluate the role of CT score as a predictor of patients’ outcome. Results Ground glass opacities were predominant in early-phase (≤ 7 days since symptoms’ onset), while crazy-paving pattern, consolidation, and fibrosis characterized late-phase disease (> 7 days). CT score was significantly higher in critical and severe than in mild stage (p < 0.0001), and among late-phase than early-phase patients (p < 0.0001). CT score was significantly correlated with CRP (p < 0.0001, r = 0.6204) and D-dimer (p < 0.0001, r = 0.6625) levels. A CT score of ≥ 18 was associated with an increased mortality risk and was found to be predictive of death both in univariate (HR, 8.33; 95% CI, 3.19–21.73; p < 0.0001) and multivariate analysis (HR, 3.74; 95% CI, 1.10–12.77; p = 0.0348). Conclusions Our preliminary data suggest the potential role of CT score for predicting the outcome of SARS-CoV-2 patients. CT score is highly correlated with laboratory findings and disease severity and might be beneficial to speed-up diagnostic workflow in symptomatic cases. Key Points • CT score is positively correlated with age, inflammatory biomarkers, severity of clinical categories, and disease phases. • A CT score ≥ 18 has shown to be highly predictive of patient’s mortality in short-term follow-up. • Our multivariate analysis demonstrated that CT parenchymal assessment may more accurately reflect short-term outcome, providing a direct visualization of anatomic injury compared with non-specific inflammatory biomarkers. Keywords Severe acute respiratory syndrome coronavirus 2 . COVID-19 . Pneumonia . Tomography, X-ray computed
Marco Francone and Franco Iafrate contributed equally to this work. * Franco Iafrate [email protected]
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