Korean Journal of Radiology

The Korean Society of Radiology (대한영상의학회)
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Association between Initial Chest CT or Clinical Features and Clinical Course in Patients with Coronavirus Disease 2019 Pneumonia

  • Zhe Liu (Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University) ;
  • Chao Jin (Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University) ;
  • Carol C. Wu (Department of Diagnostic Radiology, University of Texas M.D. Anderson Cancer Center) ;
  • Ting Liang (Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University) ;
  • Huifang Zhao (Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University) ;
  • Yan Wang (Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University) ;
  • Zekun Wang (Department of Radiology, the Eighth Hospital of Xi'an) ;
  • Fen Li (Department of Radiology, the Eighth Hospital of Xi'an) ;
  • Jie Zhou (Department of Radiology, Xi'an Chest Hospital) ;
  • Shubo Cai (Department of Radiology, Xi'an Chest Hospital) ;
  • Lingxia Zeng (Department of Epidemiology and Health Statistics, School of Public Health, Xi'an Jiaotong University Health Science Center) ;
  • Jian Yang (Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University)
  • Received : 2020.02.25
  • Accepted : 2020.03.20
  • Published : 2020.06.01
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Abstract

Objective: To identify the initial chest computed tomography (CT) findings and clinical characteristics associated with the course of coronavirus disease 2019 (COVID-19) pneumonia. Materials and Methods: Baseline CT scans and clinical and laboratory data of 72 patients admitted with COVID-19 pneumonia (39 men, 46.2 ± 15.9 years) were retrospectively analyzed. Baseline CT findings including lobar distribution, presence of ground glass opacities, consolidation, linear opacities, and lung severity score were evaluated. The outcome event was recovery with hospital discharge. The time from symptom onset to discharge or the end of follow-up (for those remained hospitalized) was recorded. Data were censored in events such as death or discharge without recovery. Multivariable Cox proportional hazard regression was used to explore the association between initial CT, clinical or laboratory findings, and discharge with recovery, whereby hazard ratio (HR) values < 1 indicated a lower rate of discharge at four weeks and longer time until discharge. Results: Thirty-two patients recovered and were discharged during the study period with a median length of admission of 16 days (range, 9 to 25 days), while the rest remained hospitalized at the end of this study (median, 17.5 days; range, 4 to 27 days). None died during the study period. After controlling for age, onset time, lesion characteristics, number of lung lobes affected, and bilateral involvement, the lung severity score on baseline CT (> 4 vs. ≤ 4 [reference]: adjusted HR = 0.41 [95% confidence interval, CI = 0.18-0.92], p = 0.031) and initial lymphocyte count (reduced vs. normal or elevated [reference]: adjusted HR = 0.14 [95% CI = 0.03-0.60], p = 0.008) were two significant independent factors that influenced recovery and discharge. Conclusion: Lung severity score > 4 and reduced lymphocyte count at initial evaluation were independently associated with a significantly lower rate of recovery and discharge and extended hospitalization in patients admitted for COVID-19 pneumonia.

Keywords

Acknowledgement

This study was funded by National Natural Science Foundation of China (No. 81171317, 81971581, 51706178), Innovation Capability Support Program of Shaanxi (2019TD-018), National Key Research and Development Program of China (2016YFC0100300), the 2011 New Century Excellent Talent Support Plan of the Ministry of Education, China (NCET-11-0438).

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