Can Chest Computed Tomography Findings of Symptomatic COVID-19 Patients Upon Admission Indicate Disease Prognosis and Clinical Outcome?

AIM: This study aimed to investigate whether initial chest Computed Tomography (CT) findings of COVID-19 patients could predict clinical outcomes, prognoses, and mortality rates associated with the infection. BACKGROUND: Published studies on chest CT in COVID-19 infection do not go beyond describing the characteristics of the current period. Comparative analysis of chest CT findings upon hospital admission among patients with different clinical outcomes is scarce. OBJECTIVE: We sought to retrospectively evaluate and compare clinical outcomes, prognoses, and mortality rates based upon the initial chest CT findings of 198 consecutive symptomatic patients with COVID-19 confirmed by Polymerase Chain Reaction (PCR). METHODS: Patients (N = 198) were divided into three groups according to their clinical outcomes as follows: group 1 (n = 62) included patients discharged from the service, group 2 (n= 60) included patients hospitalized in the intensive care unit, and group 3 (n = 76) included patients who died despite treatment. RESULTS: Predictors of poor prognosis and mortality with regard to chest CT findings included mediastinal lymphadenopathy, pleural effusion, and pericardial effusion, and clinical characteristics of age, dyspnea, and hypertension. The halo sign on chest CT was a good prognosis predictor in multivariate analysis. CONCLUSION: Some CT findings, such as discharge, intensive care unit hospitalization, and death as the worst consequence, significantly correlated with endpoints. These findings support the role of CT imaging for potentially predicting clinical outcomes of patients with COVID-19.

The radiological findings of COVID-19

Background/aim: Available information on the radiological findings of the 2019 novel coronavirus disease (COVID-19) is constantly updated. Ground glass opacities (GGOs) and consolidation with bilateral and peripheral distribution have been reported as the most common CT findings, but less typical features can also be identified. According to the reported studies, SARS-CoV-2 infection is not limited to the respiratory system, and it can also affect other organs. Renal dysfunction, gastrointestinal complications, liver dysfunction, cardiac manifestations, and neurological abnormalities are among the reported extrapulmonary features. This review aims to provide updated information for radiologists and all clinicians to better understand the radiological manifestations of COVID-19. Materials and methods: Radiological findings observed in SARS-CoV-2 virus infections were explored in detail in PubMed and Google Scholar databases. Results: The typical pulmonary manifestations of COVID-19 pneumonia were determined as GGOs and accompanying consolidations that primarily involve the periphery of the bilateral lower lobes. The most common extrapulmonary findings were increased resistance to flow in the kidneys, thickening of vascular walls, fatty liver, pancreas, and heart inflammation findings. However, these findings were not specific and significantly overlapped those caused by other viral diseases, and therefore alternative diagnoses should be considered in patients with negative diagnostic tests. Conclusion: Radiological imaging plays a supportive role in the care of patients with COVID-19. Both clinicians and radiologists need to know associated pulmonary and extrapulmonary findings and imaging features to help diagnose and manage the possible complications of the disease at an early stage. They should also be familiar with CT findings in patients with COVID-19 since the disease can be incidentally detected during imaging performed with other indications.

A comparison of computerized tomography findings of COVID-19 infection by gender and age groups.

OBJECTIVE: To compare the computed tomography (CT) imaging findings of coronavirus disease 2019 (COVID-19) by gender and age groups. METHODS: The patients with COVID-19 (n=1,024) were divided into nine age groups (0-9 years, 10-19 years, 20-29 years, 30-39 years, 40-49 years, 50-59 years, 60-69 years, 70-79 years, and 80 years and above). The CT findings were retrospectively analyzed according to the age groups and gender. RESULTS: Under 20 years of age, except for the ground-glass opacity and consolidation, no other finding was observed. Airway changes and crazy-paving pattern were more common over 80 years. While the tree-in-bud pattern was more common in the 20-29 age group than in other age groups, the halo sign was mostly seen at the age of 30-39 years. Unlike other groups, the thin reticular pattern was more common in patients aged 60-79 years. When the findings were compared by gender, the rates of centrilobular nodules (p=0.006), airway changes (p=0.004), and tree-in-bud pattern (p=0.050) were significantly higher in males than in females. CONCLUSION: The chest CT findings of COVID-19 show significant changes according to age and gender. The findings that are more common in elderly and male patients should be carefully evaluated in terms of the prognosis of the disease.

Evaluation of coagulation parameters: Coronavirus disease 2019 (COVID-19) between survivors and nonsurvivors.

OBJECTIVE: This study aims to investigate and compare the coagulation parameters of coronavirus disease 2019 (COVID-19) patients with mortal and nonmortal conditions. METHODS: In this study, 511 patients diagnosed with COVID-19 were included. Information about 31 deceased and 480 recovered COVID-19 patients was obtained from the hospital information management system and analyzed retrospectively. Whether there was a correlation between coagulation parameters between the mortal and nonmortal patients was analyzed. Descriptive analyses on general characteristics of the study population were performed. Visual (probability plots and histograms) and analytical methods (Kolmogorov-Smirnov and Shapiro-Wilk test) were used to test the normal distribution. Analyses were performed using the SPSS statistical software package. RESULTS: Out of 511 patients, 219 (42.9%) were females and 292 (57.1%) were males. There was no statistically significant difference between males and females in terms of mortality (p=0.521). In total, the median age was 67 (22). The median age was 74 (13) in the nonsurvivor group and 67 (22) in the survivor group, and the difference was statistically significant (p=0.007). The D-dimer, prothrombin time, international normalized ratio, neutrophil, and lymphocyte median age values with p-values, in the recovered and deceased patient groups were: 1070 (2129), 1990 (7513) µg FEU/L, p=0.005; 12.6 (2.10), 13.3 (2.1), p=0.014; 1.17 (0.21), 1.22 (0.19), p=0.028; 5.51 (6.15), 8.54 (7.05), p=0.001; and 0.99 (0.96), 0.64 (0.84), p=0.037, respectively, with statistically significant differences. CONCLUSIONS: As a result of this study, D-dimer, prothrombin time, and international normalized ratio increase were found to be associated with mortality. These parameters need to be closely monitored during the patient follow-up.

Correlation between venous blood gas indices and radiological involvements of COVID-19 patients at first admission to emergency department.

BACKGROUND: The purpose of this study was to investigate the relation between venous blood gas and chest computerized tomography findings and the clinical conditions of COVID-19 pneumonia. METHODS: A total of 309 patients admitted to the emergency department and subsequently confirmed COVID-19 cases was examined. Patients with pneumonia symptoms, chest computerized tomography scan, venous blood gas findings, and confirmed COVID-19 on reverse transcription-polymerase chain reaction (PCR) were consecutively enrolled. Multiple linear regression was used to predict computerized tomography and blood gas findings by clinical/laboratory data. RESULTS: The median age of patients was 51 (interquartile range 39-66), and 51.5% were male. The mortality rate at the end of follow-up was 18.8%. With respect to survival status of patients pCO2 and HCO3 levels and total computerized tomography score values were found to be higher in the surviving patients (p<0.001 and p=0.003, respectively), whereas pH and lactate levels were higher in patients who died (p=0.022 and p=0.001, respectively). With logistic regression analysis, total tomography score was found to be significantly effective on mortality (p<0.001). The diffuse and random involvement of the lungs had a significant effect on mortality (p<0.001, 95%CI 3.853-38.769, OR 12.222 and p=0.027; 95%CI 1.155-11.640, OR 3.667, respectively). With linear regression analysis, the effect of pH and lactate results were found to have a positive effect on total tomography score (p=0.003 and p<0.001, respectively), whereas pCO2 was found to have a negative effect (p=0.029). CONCLUSION: There was correlation between venous blood gas indices and radiologic scores in COVID-19 patients. Venous blood gas taken in emergency department can be a fast, applicable, minor-invasive, and complementary test in terms of diagnosing COVID-19 pneumonia and predicting the prognosis of disease.

Effects on mortality of early vs late administration of convalescent plasma in the treatment of Covid-19.

The pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first seen in the city of Wuhan, China, in December 2019 and then spread worldwide. On 24 March 2020, the U.S. Food and Drug Administration reported that the use of convalescent plasma (CP) containing antibodies against COVID-19 could be effective against infection. The aim of this study is to retrospectively investigate whether early CP transfusion treatment has an effect on recovery of clinical and laboratory parameters in patients diagnosed with severe COVID-19 who were admitted to the intensive care unit (ICU). The study included 141 consecutive patients who had laboratory confirmation of COVID-19 and were admitted to the ICU between 1 May and 30 September 2020. Of the 141 patients, 84 received CP in the first five days of hospitalization in the ICU (early group), and 57 received CP after the fifth day of hospitalization in the ICU (late group). There were no significant differences between the two groups in terms of age, gender, comorbidities and the severity of the disease (according to the evaluation of lung tomography). There was no difference between the two groups in terms of mechanical ventilator needed, inotrope support, and tracheostomy procedure during the ICU admission (p = 0.962, p = 0.680, and p = 0.927, respectively). Despite these limitations, the overriding result of our study is that it suggests that administration of CP either early or late in the treatment of COVID-19, had no effect on mortality.

The diagnostic process of cov&#305;d-19 in the emergency department: laboratory and &#305;maging methods

SUMMARY OBJECTIVES The 2019 Novel coronavirus disease puts a serious burden on the health system. Therefore, the detection of particularly serious patients at an early stage is extremely important in terms of controlling the outbreak and improving the prognosis. We investigated the role of inflammatory markers studied in patients suspected of COVID-19 at an emergency department in predicting PCR and CT results. METHODS This retrospective study was carried out with 133 patients who were admitted between 13 March and 1st April 2020 with suspicion of COVID-19. The patients were divided into four groups according to CT and RT-PCR results and evaluated. RESULTS Considering all patients, no specific findings were found in the hematological and biochemical values of patients in the laboratory analyses. Although all of the results remained within the reference range, there was a significant difference in white blood cell, neutrophil, platelet, and lymphocyte values when the groups were compared [p = 0.000;p = 0.004;p = 0.022;p = 0.023]. CONCLUSION Laboratory is not specific enough in the pre-diagnosis. In addition, this result does not alter with PCR or CT positivity. However, minimal changes observed in laboratory results may be partially guiding in patients in whom both PCR and CT are positive. RESUMO OBJETIVOS A nova doença de coronavírus de 2019 coloca um fardo sério para o sistema de saúde. Portanto, a detecção de pacientes especialmente graves em um estágio inicial é extremamente importante em termos de controle do surto e melhoria do prognóstico. Investigamos o papel dos marcadores inflamatórios estudados em pacientes suspeitos de COVID-19 no pronto-socorro na previsão de resultados de PCR e CT. MÉTODOS Este estudo retrospectivo foi realizado entre 133 pacientes que foram admitidos entre 13 de março e 1o de abril de 2020 com suspeita de COVID-19. Os pacientes foram divididos em quatro grupos de acordo com os resultados da TC e RT-PCR e avaliados. RESULTADOS Considerando todos os pacientes, não foram encontrados achados específicos nos valores hematológicos e bioquímicos dos pacientes em análises laboratoriais. Embora todos os resultados tenham permanecido dentro do intervalo de referência, houve uma diferença significativa nos valores de glóbulos brancos, neutrófilos, plaquetas e linfócitos quando os grupos foram comparados [p = 0,000;p = 0,004;p = 0,022;p = 0,023]. CONCLUSÃO O laboratório não é suficientemente específico no pré-diagnóstico. Além disso, este resultado não se altera com a positividade para PCR ou CT. No entanto, alterações mínimas observadas nos resultados laboratoriais podem ser parcialmente norteadoras em pacientes com PCR e CT positivos.

The predictive and diagnostic accuracy of long pentraxin-3 in COVID-19 pneumonia

Background/aim: The purpose of this study is to evaluate serum pentraxin-3 (PTX-3) levels in Sars-CoV-2 virus infection (COVID-19) patients and to investigate whether PTX-3 predicts the disease prognosis. Materials and methods: This study was conducted on 88 confirmed COVID-19 patients who were hospitalized due to symptomatic pneumonia between April 15 and August 15, 2020. The patients were divided into two groups as survived patients and non-survived patients. Both groups were compared according to demographic features, comorbid conditions and measurement of the PTX-3 and other laboratory parameters of the patients. Results: Of 88 patients with COVID-19, 59 (67%) were discharged with complete cure and 29 (33%) resulted in death. 46 (52.3%) of the patients were men. PTX-3 median value (IQR) was 3.66 ng/mL (0.9­27.9) in all patients, 3.3 ng/mL (0.9­27.9) in survivors and 3.91 ng/mL (1.9­23.2) in nonsurvivors which was significantly higher (P = 0.045). As a receiver operating characteristic curve analysis the cut-off value of PTX-3 for predicting mortality in patients was 3.73 with 65% sensitivity and 65% specificity (AUC: 0.646, 95% CI: 0.525­ 0.767, P = 0.045). Also, we found significant cut-off values with respect to D-dimer, D-dimer/PTX-3, high-sensitivity troponin, high- sensitivity troponin/PTX-3, lymphocyte, PTX-3/lymphocyte, procalcitonin, procalcitonin/PTX-3, CRP, and CRP/PTX-3 (P < 0.05). Conclusion: In this study, as far as we know, for the first time, we have shown PTX-3 as the new mortality biomarker for COVID-19 disease.

The diagnostic process of covid-19 in the emergency department: laboratory and imaging methods.

OBJECTIVES: The 2019 Novel coronavirus disease puts a serious burden on the health system. Therefore, the detection of particularly serious patients at an early stage is extremely important in terms of controlling the outbreak and improving the prognosis. We investigated the role of inflammatory markers studied in patients suspected of COVID-19 at an emergency department in predicting PCR and CT results. METHODS: This retrospective study was carried out with 133 patients who were admitted between 13 March and 1st April 2020 with suspicion of COVID-19. The patients were divided into four groups according to CT and RT-PCR results and evaluated. RESULTS: Considering all patients, no specific findings were found in the hematological and biochemical values of patients in the laboratory analyses. Although all of the results remained within the reference range, there was a significant difference in white blood cell, neutrophil, platelet, and lymphocyte values when the groups were compared [p = 0.000; p = 0.004; p = 0.022; p = 0.023]. CONCLUSION: Laboratory is not specific enough in the pre-diagnosis. In addition, this result does not alter with PCR or CT positivity. However, minimal changes observed in laboratory results may be partially guiding in patients in whom both PCR and CT are positive.