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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
Fonseca, Eduardo Kaiser Ururahy Nunes; Assunção Júnior, Antonildes Nascimento; Araujo-Filho, Jose de Arimateia Batista; Ferreira, Lorena Carneiro; Loureiro, Bruna Melo Coelho; Strabelli, Daniel Giunchetti; Farias, Lucas de Pádua Gomes de; Chate, Rodrigo Caruso; Cerri, Giovanni Guido; Sawamura, Marcio Valente Yamada; Nomura, Cesar Higa.
  • Fonseca, Eduardo Kaiser Ururahy Nunes; Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas HCFMUSP. Sao Paulo. BR
  • Assunção Júnior, Antonildes Nascimento; Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas HCFMUSP. Sao Paulo. BR
  • Araujo-Filho, Jose de Arimateia Batista; Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas HCFMUSP. Sao Paulo. BR
  • Ferreira, Lorena Carneiro; Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas HCFMUSP. Sao Paulo. BR
  • Loureiro, Bruna Melo Coelho; Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas HCFMUSP. Sao Paulo. BR
  • Strabelli, Daniel Giunchetti; Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas HCFMUSP. Sao Paulo. BR
  • Farias, Lucas de Pádua Gomes de; Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas HCFMUSP. Sao Paulo. BR
  • Chate, Rodrigo Caruso; Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas HCFMUSP. Sao Paulo. BR
  • Cerri, Giovanni Guido; Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas HCFMUSP. Sao Paulo. BR
  • Sawamura, Marcio Valente Yamada; s.af
  • Nomura, Cesar Higa; Universidade de Sao Paulo. Faculdade de Medicina. Hospital das Clinicas HCFMUSP. Sao Paulo. BR
Clinics ; 76: e3503, 2021. tab, graf
Article in English | LILACS | ID: biblio-1350628
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 ≥50% 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 <50%, p<0.001). An LLB of ≥50% 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 ≥50% remained at a higher risk at 30-day mortality (adjusted hazard ratio 2.17, 95% confidence interval 1.47-3.18, p<0.001).

CONCLUSION:

Even after accounting for dynamic CT changes in patients with both clinical and imaging findings consistent with COVID-19, an LLB of ≥50% might be associated with a higher risk of mortality.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: COVID-19 Type of study: Observational study / Prognostic study / Risk factors Limits: Adult / Aged / Humans Country/Region as subject: South America / Brazil Language: English Journal: Clinics Journal subject: Medicine Year: 2021 Type: Article Affiliation country: Brazil Institution/Affiliation country: Universidade de Sao Paulo/BR

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Full text: Available Index: LILACS (Americas) Main subject: COVID-19 Type of study: Observational study / Prognostic study / Risk factors Limits: Adult / Aged / Humans Country/Region as subject: South America / Brazil Language: English Journal: Clinics Journal subject: Medicine Year: 2021 Type: Article Affiliation country: Brazil Institution/Affiliation country: Universidade de Sao Paulo/BR