[Analysis of chest imaging features of novel coronavirus pneumonia, bacterial pneumonia and viral pneumonia].

OBJECTIVE: To investigate and summarize the chest CT imaging features of patients with novel coronavirus pneumonia (COVID-19), bacterial pneumonia and other viral pneumonia. METHODS: Chest CT data of 102 patients with pulmonary infection due to different etiologies were retrospectively analyzed, including 36 patients with COVID-19 admitted to Hainan Provincial People's Hospital and the Second Affiliated Hospital of Hainan Medical University from December 2019 to March 2020, 16 patients with other viral pneumonia admitted to Hainan Provincial People's Hospital from January 2018 to February 2020, and 50 patients with bacterial pneumonia admitted to Haikou Affiliated Hospital of Central South University Xiangya School of Medicine from April 2018 to May 2020. Two senior radiologists and two senior intensive care physicians were participated to evaluated the extent of lesions involvement and imaging features of the first chest CT after the onset of the disease. RESULTS: Bilateral pulmonary lesions were more common in patients with COVID-19 and other viral pneumonia, and the incidence was significantly higher than that of bacterial pneumonia (91.6%, 75.0% vs. 26.0%, P < 0.05). Compared with other viral pneumonia and COVID-19, bacterial pneumonia was mainly characterized by single-lung and multi-lobed lesion (62.0% vs. 18.8%, 5.6%, P < 0.05), accompanied by pleural effusion and lymph node enlargement. The proportion of ground-glass opacity in the lung tissues of patients with COVID-19 was 97.2%, that of patients with other viral pneumonia was 56.2%, and that of patients with bacterial pneumonia was only 2.0% (P < 0.05). The incidence rate of lung tissue consolidation (25.0%, 12.5%), air bronchial sign (13.9%, 6.2%) and pleural effusion (16.7%, 37.5%) in patients with COVID-19 and other viral pneumonia were significantly lower than those in patients with bacterial pneumonia (62.0%, 32.0%, 60.0%, all P < 0.05), paving stone sign (22.2%, 37.5%), fine mesh sign (38.9%, 31.2%), halo sign (11.1%, 25.0%), ground-glass opacity with interlobular septal thickening (30.6%, 37.5%), bilateral patchy pattern/rope shadow (80.6%, 50.0%) etc. were significantly higher than those of bacterial pneumonia (2.0%, 4.0%, 2.0%, 0%, 22.0%, all P < 0.05). The incidence of local patchy shadow in patients with COVID-19 was only 8.3%, significantly lower than that in patients with other viral pneumonia and bacterial pneumonia (8.3% vs. 68.8%, 50.0%, P < 0.05). There was no significant difference in the incidence of peripheral vascular shadow thickening in patients with COVID-19, other viral pneumonia and bacterial pneumonia (27.8%, 12.5%, 30.0%, P > 0.05). CONCLUSIONS: The probability of ground-glass opacity, paving stone and grid shadow in chest CT of patients with COVID-19 was significantly higher than those of bacterial pneumonia, and it was more common in the lower lungs and lateral dorsal segment. In other patients with viral pneumonia, ground-glass opacity was distributed in both upper and lower lungs. Bacterial pneumonia is usually characterized by single lung consolidation, distributed in lobules or large lobes and accompanied by pleural effusion.

Study on the clinical features and prognosis of second and third generations of COVID-19.

Background: There have been no studies examining differences in clinical manifestations and prognosis between second and third generation coronavirus disease 2019 (COVID-19) patients. Our object was to analyze the epidemiological data and correlation between clinical types and COVID-19 generations. Methods: Older than 18 years COVID-19 patients who met two of the three items listed in COVID-19 Diagnosis Protocol were enrolled and divided into two groups based on epidemiological history. Clinical characteristics (age, gender, body mass index, course), disease severity, laboratory results (platelets, white blood cells, lymphocytes, inflammatory biomarkers, alanine aminotransferase, lactate dehydrogenase, creatine kinase, myoglobin, troponin, D-dimer blood biochemical indexes), clinical types were analyzed. Two groups were compared by chi-square test, group means were compared by t test, correlation between COVID-19 generations and clinical severity and clinical types were examined by Spearman correlation analysis. Results: There were no significant differences in gender composition (P=0.488), A-DROP scores (P=0.079) nor BMI (P=0.532) between the two generations. The number of second generation patients over 60 years was significantly greater than that in third generation (P<0.001). Creatine kinase levels of third generation patients were significantly higher than those of second generation patients at admission (P=0.009) and during hospitalization (P=0.023). The troponin levels of third generation patients were significantly higher than those of second generation patients at admission (P=0.020). At discharged, the creatine kinase and troponin levels were not significantly different between the two generations. Rate of severe (P=0.130) and critical cases (P=0.314) in second generation COVID-19 patients was not significantly different from that of third generation patients. Age (ρ=0.224, P<0.001), duration (ρ=0.317, P<0.001), transmission generation (ρ=0.269, P<0.001), serum creatine kinase (ρ=0.240, P<0.001), troponin (ρ=0.296, P<0.001), C-reaction protein (ρ=0.278, P<0.001), procalcitonin levels (ρ=0.221, P=0.001), lymphocyte count (ρ=-0.245, P<0.001), and platelet count (ρ=-0.265, P<0.001) of COVID-19 patients were significantly s correlated with clinical types. Conclusions: Increased virulence may occur in specific tissues and organs during intergenerational transmission of COVID-19 virus. COVID-19 virus virulence in different regions is different. The clinical prognosis of COVID-19 patients is closely related to age, course, transmission generations, and some laboratory indicators. Transmission generation, regional differences, and laboratory indicators may have certain potential value in predicting prognosis and treatment.