Quantitative Burden of COVID-19 Pneumonia at Chest CT Predicts Adverse Outcomes: A Post Hoc Analysis of a Prospective International Registry
Kajetan Grodecki, Andrew Lin, Sebastien Cadet, Priscilla McElhinney, Aryabod Razipour, Cato Chan, Barry D. Pressman, Peter Julien, Pál Maurovich‐Horvat, Nicola Gaibazzi, Udit Thakur, Maria Elisabetta Mancini, Cecilia Agalbato, Roberto Menè, Gianfranco Parati, Franco Cernigliaro, Nitesh Nerlekar, Camilla Torlasco, Gianluca Pontone, Piotr J. Slomka, Damini Dey
Abstract
Purpose To examine the independent and incremental value of CT-derived quantitative burden and attenuation of coronavirus disease 2019 (COVID-19) pneumonia for the prediction of clinical deterioration or death. Materials and Methods This was a retrospective analysis of a prospective international registry of consecutive patients with laboratory-confirmed COVID-19 and chest CT imaging, admitted to four centers between January 10 and May 6, 2020. Total burden (expressed as a percentage) and mean attenuation of ground-glass opacities (GGO) and consolidation were quantified from CT using semiautomated research software. The primary outcome was clinical deterioration (intensive care unit admission, invasive mechanical ventilation, or vasopressor therapy) or in-hospital death. Logistic regression was performed to assess the predictive value of clinical and CT parameters for the primary outcome. Results The final population consisted of 120 patients (mean age, 64 years ± 16 [standard deviation], 78 men), of whom 39 (32.5%) experienced clinical deterioration or death. In multivariable regression of clinical and CT parameters, consolidation burden (odds ratio [OR], 3.4; 95% CI: 1.7, 6.9 per doubling; P = .001) and increasing GGO attenuation (OR, 3.2; 95% CI: 1.3, 8.3 per standard deviation, P = .02) were independent predictors of deterioration or death; as was C-reactive protein (OR, 2.1; 95% CI: 1.3, 3.4 per doubling; P = .004), history of heart failure (OR 1.3; 95% CI: 1.1, 1.6, P = .01), and chronic lung disease (OR, 1.3; 95% CI: 1.0, 1.6; P = .02). Quantitative CT measures added incremental predictive value beyond a model with only clinical parameters (area under the curve, 0.93 vs 0.82, P = .006). The optimal prognostic cutoffs for burden of COVID-19 pneumonia as determined by the Youden index were consolidation of greater than or equal to 1.8% and GGO of greater than or equal to 13.5%. Conclusion Quantitative burden of consolidation or GGO at chest CT independently predicted clinical deterioration or death in patients with COVID-19 pneumonia. CT-derived measures have incremental prognostic value over and above clinical parameters and may be useful for risk stratifying patients with COVID-19. Supplemental material is available for this article. Keywords: Adults, CT, Infection, Lung, Thorax © RSNA, 2020