Clinical characteristics and chest CT imaging features of critically ill COVID-19 patients
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Clinical characteristics and chest CT imaging features of critically ill COVID-19 patients Nan Zhang 1 & Xunhua Xu 2 & Ling-Yan Zhou 3 & Gang Chen 2 & Yu Li 1 & Huiming Yin 4 & Zhonghua Sun 5 Received: 6 March 2020 / Revised: 5 May 2020 / Accepted: 14 May 2020 # European Society of Radiology 2020
Abstract Objectives To compare clinical, laboratory, and chest computed tomography (CT) findings in critically ill patients diagnosed with coronavirus disease 2019 (COVID-19) who survived and who died. Methods This retrospective study reviewed 60 critically ill patients (43 males and 17 females, mean age 64.4 ± 11.0 years) with COVID-19 pneumonia who were admitted to two different clinical centers. Their clinical and medical records were analyzed, and the chest CT images were assessed to determine the involvement of lobes and the distribution of lesions in the lungs between the patients who recovered from the illness and those who died. Results Compared with recovered patients (50/60, 83%), deceased patients (10/60, 17%) were older (mean age, 70.6 vs. 62.6 years, p = 0.044). C-reactive protein (CRP) (110.8 ± 26.3 mg/L vs 63.0 ± 50.4 mg/L, p < 0.001) and neutrophil-tolymphocyte ratio (NLR) (18.7 ± 16.6 vs 8.4 ± 7.5, p = 0.030) were significantly elevated in the deceased as opposed to the recovered. Medial or parahilar area involvement was observed in all the deceased patients (10/10, 100%), when compared to only 54% (27/50) in the recovered. Ground-glass opacities (97%), crazy-paving pattern (92%), and air bronchogram (93%) were the most common radiological findings. There was significant difference in diabetes (p = 0.025) and emphysema (p = 0.013), and the odds ratio on a deceased patient having diabetes and emphysema was 6 times and 21 times the odds ratio on a recovered patient having diabetes and emphysema, respectively. Conclusions Older patients with comorbidities such as diabetes and emphysema, and higher CRP and NLRs with diffuse lung involvement were more likely to die of COVID-19. Key Points • Almost all patients critically ill with COVID-19 pneumonia had five lung lobes involved. • Medial or parahilar area involvement and degree of lung involvement were more serious in the deceased patients when compared with those who recovered from treatment. • Chronic lung disease, e.g., emphysema, diabetes, and higher serum CRP and NLR characterized patients who died of COVID-19. Keywords Coronavirus infections . Pneumonia . Comorbidity . Computed tomography . X-ray
Dr Nan Zhang and Dr Xunhua Xu contributed equally as co-first authors to this work. * Yu Li [email protected]
2
Department of Radiology, China Resources & WISCO General Hospital, Wuhan, Hubei Province, China
* Huiming Yin [email protected]
3
Department of Radiology, Second Hospital of Wuhan Iron and Steel Company, Wuhan, Hubei Province, China
* Zhonghua Sun [email protected]
4
The First Affiliated Hospital of Hunan University of Medicine, Huaihua, Hunan Province, China
5
Discipline of Medical Radiation Sciences, Curtin University, Perth, Austr
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