Intestinal ischemic manifestations of SARS-CoV-2: Results from the ABDOCOVID multicentre study.

BACKGROUND: Intestinal ischemia has been described in case reports of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (coronavirus disease 19, COVID-19). AIM: To define the clinical and histological, characteristics, as well as the outcome of ischemic gastrointestinal manifestations of SARS-CoV-2 infection. METHODS: A structured retrospective collection was promoted among three tertiary referral centres during the first wave of the pandemic in northern Italy. Clinical, radiological, endoscopic and histological data of patients hospitalized for COVID-19 between March 1st and May 30th were reviewed. The diagnosis was established by consecutive analysis of all abdominal computed tomography (CT) scans performed. RESULTS: Among 2929 patients, 21 (0.7%) showed gastrointestinal ischemic manifestations either as presenting symptom or during hospitalization. Abdominal CT showed bowel distention in 6 patients while signs of colitis/enteritis in 12. Three patients presented thrombosis of main abdominal veins. Endoscopy, when feasible, confirmed the diagnosis (6 patients). Surgical resection was necessary in 4/21 patients. Histological tissue examination showed distinctive features of endothelial inflammation in the small bowel and colon. Median hospital stay was 9 d with a mortality rate of 39%. CONCLUSION: Gastrointestinal ischemia represents a rare manifestation of COVID-19. A high index of suspicion should lead to investigate this complication by CT scan, in the attempt to reduce its high mortality rate. Histology shows atypical feature of ischemia with important endotheliitis, probably linked to thrombotic microangiopathies.

Artificial Intelligence in Predicting Clinical Outcome in COVID-19 Patients from Clinical, Biochemical and a Qualitative Chest X-Ray Scoring System

Purpose: To determine the performance of a chest radiograph (CXR) severity scoring system combined with clinical and laboratory data in predicting the outcome of COVID-19 patients. Materials and Methods: We retrospectively enrolled 301 patients who had reverse transcriptase-polymerase chain reaction (RT-PCR) positive results for COVID-19. CXRs, clinical and laboratory data were collected. A CXR severity scoring system based on a qualitative evaluation by two expert thoracic radiologists was defined. Based on the clinical outcome, the patients were divided into two classes: moderate/mild (patients who did not die or were not intubated) and severe (patients who were intubated and/or died). ROC curve analysis was applied to identify the cut-off point maximizing the Youden index in the prediction of the outcome. Clinical and laboratory data were analyzed through Boruta and Random Forest classifiers. Results: The agreement between the two radiologist scores was substantial (kappa = 0.76). A radiological score ≥ 9 predicted a severe class: sensitivity = 0.67, specificity = 0.58, accuracy = 0.61, PPV = 0.40, NPV = 0.81, F1 score = 0.50, AUC = 0.65. Such performance was improved to sensitivity = 0.80, specificity = 0.86, accuracy = 0.84, PPV = 0.73, NPV = 0.90, F1 score = 0.76, AUC= 0.82, combining two clinical variables (oxygen saturation [SpO2]), the ratio of arterial oxygen partial pressure to fractional inspired oxygen [P/F ratio] and three laboratory test results (C-reactive protein, lymphocytes [%], hemoglobin). Conclusion: Our CXR severity score assigned by the two radiologists, who read the CXRs combined with some specific clinical data and laboratory results, has the potential role in predicting the outcome of COVID-19 patients.

Preparation of a radiology department in an Italian hospital dedicated to COVID-19 patients.

Preparedness for the ongoing coronavirus disease 2019 (COVID-19) and its spread in Italy called for setting up of adequately equipped and dedicated health facilities to manage sick patients while protecting healthcare workers, uninfected patients, and the community. In our country, in a short time span, the demand for critical care beds exceeded supply. A new sequestered hospital completely dedicated to intensive care (IC) for isolated COVID-19 patients needed to be designed, constructed, and deployed. Along with this new initiative, the new concept of "Pandemic Radiology Unit" was implemented as a practical solution to the emerging crisis, born out of a critical and urgent acute need. The present article describes logistics, planning, and practical design issues for such a pandemic radiology and critical care unit (e.g., space, infection control, safety of healthcare workers, etc.) adopted in the IC Hospital Unit for the care and management of COVID-19 patients.