Lung lesion burden found on chest ct as a prognostic marker in hospitalized patients with high clinical suspicion of covid-19 pneumonia: A Brazilian experience

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Abstract

OBJECTIVE: To investigate the relationship between lung lesion burden (LLB) found on chest computed tomography (CT) and 30-day mortality in hospitalized patients with high clinical suspicion of coronavirus disease 2019 (COVID-19), accounting for tomographic dynamic changes. METHODS: Patients hospitalized with high clinical suspicion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a dedicated and reference hospital for COVID-19, having undergone at least one RT-PCR test, regardless of the result, and with one CT compatible with COVID-19, were retrospectively studied. Clinical and laboratory data upon admission were assessed, and LLB found on CT was semi-quantitatively evaluated through visual analysis. The primary outcome was 30-day mortality after admission. Secondary outcomes, including the intensive care unit (ICU) admission, mechanical ventilation used, and length of stay (LOS), were assessed. RESULTS: A total of 457 patients with a mean age of 57±15 years were included. Among these, 58% presented with positive RT-PCR result for COVID-19. The median time from symptom onset to RT-PCR was 8 days [interquartile range 6–11 days]. An initial LLB of X50% using CT was found in 201 patients (44%), which was associated with an increased crude at 30-day mortality (31% vs. 15% in patients with LLB of o50%, po0.001). An LLB of X50% was also associated with an increase in the ICU admission, the need for mechanical ventilation, and a prolonged LOS after adjusting for baseline covariates and accounting for the CT findings as a time-varying covariate; hence, patients with an LLB of X50% remained at a higher risk at 30-day mortality (adjusted hazard ratio 2.17, 95% confidence interval 1.47–3.18, po0.001). CONCLUSION: Even after accounting for dynamic CT changes in patients with both clinical and imaging findings consistent with COVID-19, an LLB of X50% might be associated with a higher risk of mortality.

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Fonseca, E. K. U. N., Júnior, A. N. A., Araujo-Filho, J. de A. B., Ferreira, L. C., Loureiro, B. M. C., Strabelli, D. G., … Nomura, C. H. (2021). Lung lesion burden found on chest ct as a prognostic marker in hospitalized patients with high clinical suspicion of covid-19 pneumonia: A Brazilian experience. Clinics, 76. https://doi.org/10.6061/clinics/2021/e3503

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