Estimating COVID-19 Pneumonia Extent and Severity From Chest Computed Tomography.

Autor:	Carvalho ARS; Cardiovascular R&D Centre (UnIC), Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.; Laboratory of Pulmonary Engineering, Biomedical Engineering Program, Alberto Luiz Coimbra Institute of Post-Graduation and Research in Engineering, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.; Laboratory of Respiration Physiology, Carlos Chagas Filho Institute of Biophysics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil., Guimarães A; Laboratory of Pulmonary Engineering, Biomedical Engineering Program, Alberto Luiz Coimbra Institute of Post-Graduation and Research in Engineering, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil., Garcia TSO; Medical Faculty, Universidade Estácio de Sá, Rio de Janeiro, Brazil., Madeira Werberich G; Department of Radiology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil., Ceotto VF; Hospital Niteroi D'Or, Niterói, Brazil., Bozza FA; D'Or Institute for Research and Education, Rio de Janeiro, Brazil.; National Institute of Infectious Disease, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil., Rodrigues RS; Department of Radiology, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.; D'Or Institute for Research and Education, Rio de Janeiro, Brazil., Pinto JSF; Radiology Department, Complexo Hospitalar Universitário do Porto, Porto, Portugal., Schmitt WR; Radiology Department, Complexo Hospitalar Universitário do Porto, Porto, Portugal., Zin WA; Laboratory of Respiration Physiology, Carlos Chagas Filho Institute of Biophysics, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil., França M; Radiology Department, Complexo Hospitalar Universitário do Porto, Porto, Portugal.; Instituto de Ciências Biomeìdicas Abel Salazar, Porto University, Porto, Portugal.
Jazyk:	angličtina
Zdroj:	Frontiers in physiology [Front Physiol] 2021 Feb 15; Vol. 12, pp. 617657. Date of Electronic Publication: 2021 Feb 15 (Print Publication: 2021).
DOI:	10.3389/fphys.2021.617657
Abstrakt:	Background: COVID-19 pneumonia extension is assessed by computed tomography (CT) with the ratio between the volume of abnormal pulmonary opacities (PO) and CT-estimated lung volume (CT LV ). CT-estimated lung weight (CT LW ) also correlates with pneumonia severity. However, both CT LV and CT LW depend on demographic and anthropometric variables. Purposes: To estimate the extent and severity of COVID-19 pneumonia adjusting the volume and weight of abnormal PO to the predicted CT LV (pCT LV ) and CT LW (pCT LW ), respectively, and to evaluate their possible association with clinical and radiological outcomes. Methods: Chest CT from 103 COVID-19 and 86 healthy subjects were examined retrospectively. In controls, predictive equations for estimating pCT LV and pCT LW were assessed. COVID-19 pneumonia extent and severity were then defined as the ratio between the volume and the weight of abnormal PO expressed as a percentage of the pCT LV and pCT LW , respectively. A ROC analysis was used to test differential diagnosis ability of the proposed method in COVID-19 and controls. The degree of pneumonia extent and severity was assessed with Z-scores relative to the average volume and weight of PO in controls. Accordingly, COVID-19 patients were classified as with limited, moderate and diffuse pneumonia extent and as with mild, moderate and severe pneumonia severity. Results: In controls, CT LV could be predicted by sex and height (adjusted R 2 = 0.57; P < 0.001) while CT LW by age, sex, and height (adjusted R 2 = 0.6; P < 0.001). The cutoff of 20% (AUC = 0.91, 95%CI 0.88-0.93) for pneumonia extent and of 50% (AUC = 0.91, 95%CI 0.89-0.92) for pneumonia severity were obtained. Pneumonia extent were better correlated when expressed as a percentage of the pCT LV and pCT LW ( r = 0.85, P < 0.001), respectively. COVID-19 patients with diffuse and severe pneumonia at admission presented significantly higher CRP concentration, intra-hospital mortality, ICU stay and ventilatory support necessity, than those with moderate and limited/mild pneumonia. Moreover, pneumonia severity, but not extent, was positively and moderately correlated with age ( r = 0.46) and CRP concentration ( r = 0.44). Conclusion: The proposed estimation of COVID-19 pneumonia extent and severity might be useful for clinical and radiological patient stratification. Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. (Copyright © 2021 Carvalho, Guimarães, Garcia, Madeira Werberich, Ceotto, Bozza, Rodrigues, Pinto, Schmitt, Zin and França.)
Databáze:	MEDLINE
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