DOI QR코드

DOI QR Code

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)
  • 투고 : 2020.02.25
  • 심사 : 2020.03.20
  • 발행 : 2020.06.01

초록

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.

키워드

과제정보

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).

참고문헌

  1. Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med 2020;382:727-733  https://doi.org/10.1056/NEJMoa2001017
  2. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020 Feb 24 [Epub]. https://doi.org/10.1016/S2213-2600(20)30079-5 
  3. Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. [The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China]. Zhonghua Liu Xing Bing Xue Za Zhi 2020;41:145-151 
  4. Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, et al. Sensitivity of chest CT for COVID-19: comparison to RT-PCR. Radiology 2020 Feb 19 [Epub]. https://doi.org/10.1148/radiol.2020200432 
  5. Yoon SH, Lee KH, Kim JY, Lee YK, Ko H, Kim KH, et al. Chest radiographic and CT findings of the 2019 novel coronavirus disease (COVID-19): analysis of nine patients treated in Korea. Korean J Radiol 2020;21:494-500  https://doi.org/10.3348/kjr.2020.0132
  6. Pan Y, Guan H, Zhou S, Wang Y, Li Q, Zhu T, et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China. Eur Radiol 2020 Feb 13 [Epub]. https://doi.org/10.1007/s00330-020-06731-x 
  7. Bernheim A, Mei X, Huang M, Yang Y, Fayad ZA, Zhang N, et al. Chest CT findings in coronavirus disease-19 (COVID-19): relationship to duration of infection. Radiology 2020 Feb 20 [Epub]. https://doi.org/10.1148/radiol.2020200463 
  8. Song FX, Shi NN, Shan F, Zhang ZY, Shen J, Lu HZ, et al. Emerging 2019 novel coronavirus (2019-nCoV) pneumonia. Radiology 2020 Feb 6 [Epub]. https://doi.org/10.1148/radiol.2020200274 
  9. Zhang Y, Xu J, Li H, Cao B. A novel coronavirus (COVID-19) outbreak: a call for action. Chest 2020 Feb 19 [Epub]. https://doi.org/10.1016/j.chest.2020.02.014 
  10. Guan WJ, Ni ZY, Yu Hu, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of 2019 novel coronavirus infection in China. N Engl J Med 2020 Feb 28 [Epub]. http://doi.org/10.1056/NEJMoa2002032 
  11. Jin YH, Cai L, Cheng ZS, Cheng H, Deng T1, Fan YP, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Mil Med Res 2020;7:4 
  12. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 is suspected: interim guidance [Accessed March 13, 2020]. Available at: https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected 
  13. Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020;395:507-513  https://doi.org/10.1016/S0140-6736(20)30211-7
  14. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA 2020;323:1061-1069  https://doi.org/10.1001/jama.2020.1585
  15. Chung M, Bernheim A, Mei X, Zhang N, Huang M, Zeng X, et al. CT imaging features of 2019 novel coronavirus (2019-nCoV). Radiology 2020;295:202-207  https://doi.org/10.1148/radiol.2020200230
  16. Hwang DM, Chamberlain DW, Poutanen SM, Low DE, Asa SL, Butany J. Pulmonary pathology of severe acute respiratory syndrome in Toronto. Mod Pathol 2005;18:1-10  https://doi.org/10.1038/modpathol.3800247
  17. Tian S, Hu W, Niu L, Liu H, Xu H, Xiao SY. Pulmonary pathology of early-phase 2019 novel coronavirus (COVID-19) pneumonia in two patients with lung cancer. J Thorac Oncol 2020 Feb 28 [Epub]. https://doi.org/10.1016/j.jtho.2020.02.010 
  18. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C, et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020;8:420-422  https://doi.org/10.1016/S2213-2600(20)30076-X
  19. Zhang J, Zhou L, Yang Y, Peng W, Wang W, Chen X. Therapeutic and triage strategies for 2019 novel coronavirus disease in fever clinics. Lancet Respir Med 2020;8:e11-e12  https://doi.org/10.1016/S2213-2600(20)30071-0
  20. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506 https://doi.org/10.1016/S0140-6736(20)30183-5