Exploration of CT manifestations of different clinical types of novel coronavirus pneumonia.

BACKGROUND: To explore computed tomography (CT) characteristics of the 2019 novel coronavirus (COVID-19) pneumonia and explore variations among the different clinical types. METHODS: Clinical and CT imaging data of 43 patients diagnosed with COVID-19 in our hospital and the cooperative hospital between January 15-30, 2020 were collected (27 male and 16 female). Patients were classified as common type (26 cases, 60%), severe type (14 cases, 33%) or critical type (three cases, 7%) according to the new coronavirus pneumonia treatment scheme (sixth edition). Patient clinical data and CT images were analyzed and evaluated. RESULTS: Fever was the main symptom in common type COVID-19 cases (23/26, 88.46%). Both severe and critical type COVID-19 patients had fever and cough symptoms, and dyspnea was observed in all three critical COVID-19 patients. CT manifestations in the common type COVID-19 cohort were bilateral involvement (20/26, 71%), multiple lesions (14/26, 54%), ground-glass density shadow (17/26, 65%), and some cases were accompanied by local consolidation (9/26, 35%), which is consistent with early stage COVID-19 CT performance. CT manifestations in the severe and critical types involved both lungs. Severe COVID-19 cases predominantly consisted of multiple mixed-density lesions (10/14, 71%), and a few patients showed diffuse lung glass density shadows in both lungs (4/14, 29%), which is consistent with the progression stage COVID-19 CT performance. Critical COVID-19 cases exhibited mixed-density lesions, and two cases displayed "white lung", which is the CT manifestation at the severe COVID-19 stage. Only one critical COVID-19 patient had pleural effusion. CONCLUSIONS: The CT manifestations of COVID-19 are specific and there are variations between different clinical types. Thus, CT is an important clinical tool for early diagnosis and assessment of the severity of COVID-19.

Early predictive factors of progression from severe type to critical ill type in patients with Coronavirus Disease 2019: A retrospective cohort study.

BACKGROUND: The current worldwide pandemic of Coronavirus Disease 2019 (COVID-19) has posed a serious threat to global public health, and the mortality rate of critical ill patients remains high. The purpose of this study was to identify factors that early predict the progression of COVID-19 from severe to critical illness. METHODS: This retrospective cohort study included adult patients with severe or critical ill COVID-19 who were consecutively admitted to the Zhongfaxincheng campus of Tongji Hospital (Wuhan, China) from February 8 to 18, 2020. Baseline variables, data at hospital admission and during hospital stay, as well as clinical outcomes were collected from electronic medical records system. The primary endpoint was the development of critical illness. A multivariable logistic regression model was used to identify independent factors that were associated with the progression from severe to critical illness. RESULTS: A total of 138 patients were included in the analysis; of them 119 were diagnosed as severe cases and 16 as critical ill cases at hospital admission. During hospital stay, 19 more severe cases progressed to critical illness. For all enrolled patients, longer duration from diagnosis to admission (odds ratio [OR] 1.108, 95% CI 1.022-1.202; P = 0.013), pulse oxygen saturation at admission <93% (OR 5.775, 95% CI 1.257-26.535; P = 0.024), higher neutrophil count (OR 1.495, 95% CI 1.177-1.899; P = 0.001) and higher creatine kinase-MB level at admission (OR 2.449, 95% CI 1.089-5.511; P = 0.030) were associated with a higher risk, whereas higher lymphocyte count at admission (OR 0.149, 95% CI 0.026-0.852; P = 0.032) was associated with a lower risk of critical illness development. For the subgroup of severe cases at hospital admission, the above factors except creatine kinase-MB level were also found to have similar correlation with critical illness development. CONCLUSIONS: Higher neutrophil count and lower lymphocyte count at admission were early independent predictors of progression to critical illness in severe COVID-19 patients.