Correlation of important prognostic factors and CT scores in invasive and non-invasive ventilation of COVID-19 patients.

BACKGROUND: Intensive care workers received the largest share of the COVID-19 pandemic, which caused nightmares to the whole world. In COVID-19 pneumonia cases which had high mortality rates, many prognostic factors and laboratory examinations were tried to evaluate the clinical severity quickly and accurately.This study was planned to investigate a correlation between the initially ventilation strategy and major prognostic parameters and CT scores in patients admitted to intensive care unit (ICU). METHODS: In our study, we reviewed 50 consecutive non-invasive mv and 50 consecutive invasive mv treatment of COVID-19 pneumonia patients between March 23, 2020,and May 23, 2020, in the ICUs of our hospital. Patients who were divided into twogroups (non-invasive mechanical ventilation [NIMV] and invasive mechanical ventilation [IMV]) as an initial ventilation strategy according to clinical severity and P/F ratios were evaluated comparatively; demographic data, admission and lowest P/F ratios, admission and highest SOFA scores, comorbidity status, scores on CT at diagnosis, length of ICU stays, hospitalization periods, and mortality rates were examined. RESULTS: About 85% of all patients were 46 years and older. No significant difference was found in terms of gender and comorbidity status. The lowest P/F ratio was significantly lower in IMV group. The admission and highest SOFA values were higher in the IMV group. There was no significant difference between the CT scores and the number of lobes involved. The mortality rate in the IMV group was significantly higher. CONCLUSION: Patients who started treatment with NIMV had relatively low poor prognostic factors, their mortality was lower. However, the total CT score at diagnosis was expected to be higher in those who were performed IMV, no significant difference was found in our study. We concluded that the severity classification of the patients cannot be made according to CT scores. CT results should be evaluated as a whole according to the patient's clinic, predisposing factors, and response to treatment.

Mediastinal lymphadenopathy may predict 30-day mortality in patients with COVID-19.

PURPOSE: There is scarce data on the impact of the presence of mediastinal lymphadenopathy on the prognosis of coronavirus-disease 2019 (COVID-19). We aimed to investigate whether its presence is associated with increased risk for 30-day mortality in a large group of patients with COVID-19. METHOD: In this retrospective cross-sectional study, 650 adult laboratory-confirmed hospitalized COVID-19 patients were included. Patients with comorbidities that may cause enlarged mediastinal lymphadenopathy were excluded. Demographics, clinical characteristics, vital and laboratory findings, and outcome were obtained from electronic medical records. Computed tomography scans were evaluated by two blinded radiologists. Univariate and multivariate logistic regression analyses were performed to determine independent predictive factors of 30-day mortality. RESULTS: Patients with enlarged mediastinal lymphadenopathy (n = 60, 9.2%) were older and more likely to have at least one comorbidity than patients without enlarged mediastinal lymphadenopathy (p = 0.03, p = 0.003). There were more deaths in patients with enlarged mediastinal lymphadenopathy than in those without (11/60 vs 45/590, p = 0.01). Older age (OR:3.74, 95% CI: 2.06-6.79; p < 0.001), presence of consolidation pattern (OR:1.93, 95% CI: 1.09-3.40; p = 0.02) and enlarged mediastinal lymphadenopathy (OR:2.38, 95% CI:1.13-4.98; p = 0.02) were independently associated with 30-day mortality. CONCLUSION: In this large group of hospitalized patients with COVID-19, we found that in addition to older age and consolidation pattern on CT scan, enlarged mediastinal lymphadenopathy were independently associated with increased mortality. Mediastinal evaluation should be performed in all patients with COVID-19.

Clinical characteristics of adult patients hospitalized with laboratory-confirmed COVID-19 pneumonia.

BACKGROUND: The clinical spectrum of COVID-19 has a great variation from asymptomatic infection to acute respiratory distress syndrome and eventually death. The mortality rates vary across the countries probably due to the heterogeneity in study characteristics and patient cohorts as well as treatment strategies. Therefore, we aimed to summarize the clinical characteristics and outcomes of adult patients hospitalized with laboratory-confirmed COVID-19 pneumonia in Istanbul, Turkey. METHODS: A total of 722 adult patients with laboratory-confirmed COVID-19 pneumonia were analyzed in this single-center retrospective study between March 15 and May 1, 2020. RESULTS: A total of 722 laboratory-confirmed patients with COVID-19 pneumonia were included in the study. There were 235 (32.5%) elderly patients and 487 (67.5%) non-elderly patients. The most common comorbidities were hypertension (251 [34.8%]), diabetes mellitus (198 [27.4%]), and ischemic heart disease (66 [9.1%]). The most common symptoms were cough (512 [70.9%]), followed by fever (226 [31.3%]), and shortness of breath (201 [27.8%]). Lymphocytopenia was present in 29.7% of the patients, leukopenia in 12.2%, and elevated CRP in 48.8%. By the end of May 20, 648 (89.7%) patients had been discharged and 60 (8.5%) patients had died. According to our study, while our overall mortality rate was 8.5%, this rate was 14.5% in elderly patients, and the difference was significant. CONCLUSIONS: This case series provides characteristics and outcomes of sequentially adult patients hospitalized with laboratory-confirmed COVID-19 pneumonia in Turkey.

Diagnosis of the coronavirus disease 2019 with chest computed tomography: A retrospective inter-observer agreement study between radiologists and clinicians

Background:Effective triage and early detection are very important for the control and treatment of coronavirus disease 2019. For this purpose, reverse transcription polymerase chain reaction and chest computed tomography are used in emergency departments.Objective:The aim of the study was to examine the diagnostic performance of computed tomography and to compare the inter-observer agreement among radiologists and between clinicians, in a coronavirus disease 2019 pneumonia high-prevalence area.Methods:After exclusions, 534 patients were retrospectively included in this study. Reverse transcription polymerase chain reaction was considered as gold standard for diagnosis. All computed tomography images were independently reviewed by two radiologists who were blinded to reverse transcription polymerase chain reaction results and other clinical information. Each computed tomography scan was scored in four categories as typical, intermediate, atypical, and negative, regarding coronavirus disease 2019 pneumonia according to Radiological Society of North America guideline. As for the evaluation of the diagnostic performance, typical and intermediate appearances were accepted as positive for coronavirus disease 2019. In addition, the computed tomography scans were scored by two clinicians as coronavirus disease 2019 positive and negative.Results:The study group included 534 patients after the exclusion criteria. As a result of the repeated reverse transcription polymerase chain reaction tests, 396 (74%) patients were diagnosed with coronavirus disease 2019, 138 (26%) patients had a negative result and were evaluated as a control group. When the reverse transcription polymerase chain reaction results were referenced as the gold standard;the accuracy rates of radiologists and clinicians (R1, R2, C1, and C2) in the diagnosis of coronavirus disease 2019 were 78%, 79%, 73%, and 71%, their sensitivity rates were 83%, 83%, 74%, and 75%, and the negative predictive values were 57%, 58%, 49%, and 46%, respectively. Inter-observer agreements among the reviewers ranged from good to excellent.Conclusions:Radiological Society of North America guideline related to coronavirus disease 2019 has excellent inter-observer agreement among chest radiologists. In this study, radiologists and clinicians have presented similar and good diagnostic performances in the evaluation of coronavirus disease 2019?suspected patients with chest computed tomography in high-epidemic area.

COVID-19 Pulmonary Infection with Pneumothorax in a Young Patient.

Coronavirus disease (COVID-19), first reported in December 2019 in Wuhan, China, has spread all over the world in a short time and was declared as a pandemic by the World Health Organization (WHO). During COVID-19 pandemic, chest computed tomography (CT) imaging has become an important tool with high sensitivity for diagnosis due to the low positive rate of the real-time reverse-transcriptase polymerase chain reaction (RT-PCR). Furthermore, the chest CT has played an important role in the diagnosis of underlying pulmonary lesions. In this case report, we present a patient who was admitted to the emergency department with fever, cough and left shoulder pain, and was subsequently diagnosed with both COVID-19 and pneumothorax following chest CT and RT-PCR test. Key Words: COVID-19, Coronavirus, Pneumothorax, Tomography.