Tomographic scale for the assessment of COVID-19 severity at the National Respiratory Diseases Institute

Introduction: The pandemic of SARS-CoV-2 (COVID-19) has caused high rates of morbidity and mortality. The use of adequate diagnostic methods to identify the evolution of this disease is necessary;computerized tomography (CT) is of the main tools by image, with sensitivity of 96-99%. Different studies have created scales to evaluate the extent and severity of lung disease from COVID-19, with a variability in the results. Objective: To evaluate the use of a tomographic scale (TS) to determine the severity of lung affectation in COVID-19. Material and methods: Analytical cross-sectional study including patients with confirmed diagnosis of COVID-19 and initial CT. ATS was used to evaluate the lung affectation, to identify pulmonary pattern and to establish the state of the disease. Statistical analysis consisted in descriptive and analytical statistics (ROC curve). Results: 151 patients, mean age 50 years. The predominant pulmonary pattern was «crazy paving» (46%), identified in the phase of progression. The area under the ROC curve was 0.831 (95% CI: 0.764-0.898), with a cut-off value of 16.5 to discriminate the severe from non-severe affectation, with sensitivity 84% and specificity 74%. Conclusion: The use of TS in initial CT showed an acceptable sensitivity to identify the severity of the disease.

Low muscle mass in COVID-19 critically-ill patients: Prognostic significance and surrogate markers for assessment.

INTRODUCTION: Low muscle mass is a common condition in the critically ill population and is associated with adverse clinical outcomes. The primary aim of this study was to analyze the prognostic significance of low muscle mass using computed tomography (CT) scans in COVID-19 critically ill patients. A second objective was to determine the accuracy and agreement in low muscle mass identification using diverse markers compared to CT as the gold standard. METHODS: This was a prospective cohort study of COVID-19 critically ill patients. Skeletal muscle area at the third lumbar vertebra was measured. Clinical outcomes (intensive care unit [ICU] and hospital length of stay [LOS], tracheostomy, days on mechanical ventilation [MV], and in-hospital mortality) were assessed. Phase angle, estimated fat-free mass index, calf circumference, and mid-upper arm circumference were measured as surrogate markers of muscle mass. RESULTS: Eighty-six patients were included (mean age ± SD: 48.6 ± 12.9; 74% males). Patients with low muscle mass (48%) had a higher rate of tracheostomy (50 vs 20%, p = 0.01), prolonged ICU (adjusted HR 0.53, 95%CI 0.30-0.92, p = 0.024) and hospital LOS (adjusted HR 0.50, 95% CI 0.29-0.86, p = 0.014). Bedside markers of muscle mass showed poor to fair agreement and accuracy compared to CT-assessed low muscle mass. CONCLUSION: Low muscle mass at admission was associated with prolonged length of ICU and hospital stays. Further studies are needed to establish targeted nutritional interventions to halt and correct the catabolic impact of COVID-19 in critically ill patients, based on standardized and reliable measurements of body composition.

CT findings in COVID-19 lung disease, initial experience at instituto nacional de enfermedades respiratorias ismael cosío villegas, ciudad de México

Introduction: The SARS-CoV-2 pandemic is a major public health problem worldwide, with high morbidity and mortality rates. Computed tomography (CT) is essential in the diagnostic process given its high sensitivity. Objective: To describe the tomographic findings in COVID-19 lung involvement. Material and methods: Analytical crosssectional study. Patients attended at the INER, CDMX, with a current operational definition of a suspected case for COVID-19, who had a specific RT-PCR test and chest CT in the initial evaluation. A descriptive and analytical analysis was performed using the Student’s χ2 and t tests. The Epi-Info version 7 program was used. Results: 56 patients were analyzed, with an average age of 51 years, 61% were male. 52% presented comorbidities, with diabetes mellitus being the most frequent. The symptoms that were mostly observed were fever, cough and headache. The tomographic pattern that predominated was mixed, with a subpleural and bilateral location. Conclusion: The pulmonary tomographic spectrum of the studied population was characterized by two main patterns: Mixed type (areas of ground glass consolidation) and crazy paving.