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Background: A major role of CT in COVID-19 pneumonia is to assess disease severity and progress. In this study, we aimed to assess the validity, reliability, and survival outcomes of simple chest computed tomography (CT) score in the evaluation of the severity of lung involvement in coronavirus disease 2019 (COVID-19) compared with the current chest CT score. Results: This retrospective analysis included 213 patients (121 men and 92 women;mean age, 46 ± 15.6 years;range, 1–85 years). The ROC curve was used to compare the validity of both scores. Interreader agreement (IRA) for both scores was calculated using Cohen’s kappa statistic. The survival analysis of both scores was investigated using the Kaplan–Meier survival analysis. The simple score showed a comparable validity with the current score (AUC = 0.89 and 0.90, respectively;p = 0.61). The ROC analysis demonstrated that a simple score of > 3 and a current score of > 12 were potential predictors of death with sensitivity values of 81.8% and 86.4% and specificity values of 96.3% and 93.7%, respectively. The simple score showed a higher IRA compared with the current score (κ = 0.645 and 0.458, respectively). Both scores were comparable for predicting survival outcomes. Conclusion: The simple score was non-inferior for predicting survival outcome, compared with the current chest CT score. Furthermore, we suggest that the simple score should be used as it is simpler and more consistent.
ABSTRACT
Background: This study aimed to investigate the chest computed tomography (CT) characteristics and laboratory findings in patients with confirmed COVID-19 pneumonia and to evaluate their relationship with clinical outcome. This retrospective study assessed 164 consecutive CT chests of COVID-19 patients during April 2020. The chest CT and laboratory data were analyzed. The primary endpoint was patient survival either died or survived. The relationship between CT and laboratory findings was correlated to patient outcome. Results: The study group included 164 patients (86 male, 78 women;average age, 44.3 ± 16.5 years) whose RT-PCR were positive for COVID-19. Only 120 (73.2%) patients had pulmonary manifestations. Ground glass opacities of peripheral distribution and multifocal affection were the major CT finding in COVID-19 patients. Univariate analysis revealed that CT severity score, D-dimer level, age, total leucocytic count, and absolute lymphocytic count were predictive for death. Conclusion: CT has an emerging role in the diagnosis of COVID-19 pneumonia and in assessing disease severity. CT severity score, D-dimer, total leucocytic count, and absolute lymphocytic count significantly predict patient survival.
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Introduction: AKI in patients with COVID-19 may be due to ATI from hemodynamic instability or inflammatory responses. We present two cases of CSG and ATI in patients admitted for COVID-19 Case Description: Case 1 25-year-old black obese female admitted with fever, cough, dyspnea and serum creatinine of 1.4 mg/dL, discharged next day with home quarantine. Re-admitted 26 days later due to nausea, fatigue, and bilateral foot swelling. Serum creatinine 28 mg/dl and urine protein to creatinine ratio (uPCR) of 10.4 g/g Case 2 42-year-old black female with hypertension, diabetes mellitus admitted with fever, dyspnea, cough, and diarrhea. Patient found to have diabetic ketoacidosis, serum creatinine 12.7 mg/dl. She developed deep vein thrombosis and pulmonary embolism and uPCR 15.4 g/g. She was started on hemodialysis Kidney biopsy showed global and segmental capillary collapse with a variable degree of sclerosis and severe renal tubules injury. Electron microscopy showed spherical structures in the podocytes, endothelial cells, and tubular epithelium similar to Coronavirus particles Discussion: Our experience above is part of a growing literature describing the direct visualization of SARS-CoV-2 in causing ATI and CSG. Pathogenetic pathways remain to be elucidated.
ABSTRACT
Background: HD units are clustered close contact environments where prolonged and repeated exposure to blood borne pathogens occurs. Weeks into the CoVID-19 pandemic, wide disparities in rates of death and exposure of staff and patients amongst HD units in the same zip code of an epicenter in New York regions emerged. Methods: Random HD units surveyed as to when and what infection control measures they implemented. Direct input into RedCap and SAS 9.0 analysis of the data conducted. Results: 15 HD units (average census 18-240) responded. Survey compiled exposure rates from 3/1/20 - 4/30/20. The 1st reported case of CoVID-19 by a facility was 3/2/20. Most facilities reported outbreaks (4-30 cases per facility) by 3/21/20. Missed HD sessions due to CoVID varied from 2-100, hospital stays for such patients varied from 2-20 days and death rates from 0-15 per facility. 4 of 15 facilities reported deaths of family members of exposed patients and impediments in logistics of single person transportation forcing carpooling. Home dialysis programs reported minimal deaths and exposures. 20% of facilities had no infection preventionist and 26% no patient educator. Reported waiting area cleaning and hand sanitizer refill rates ranged from 1-5 times per day. 20% of the facilities have < 6 feet distance between patients. Implementation of infection control practices such as wearing of masks by patients varied widely amongst units. Some started March 1st-March 16th, some later due to mixed messages of its importance. Lack of personal protective equipment (PPE)(in 13% of facilities), staff, and housekeeping shortages (6.7-13.3%) compounded the problems. Positive CoVID results had 1-10 staff members infected per facility with sick call rates from 7-30 days, and no staff death. 46% of the HD units don't belong to the CDC coalition. Conclusions: Maintenance of strict hand hygiene, proper air flow, repeated environmental surface cleansing, availability of PPE, and patient and staff education remain the corner stone in preventing infections from spreading. Lack of leadership support and failing to share best practices between dialysis units in the US remains prohibitive but must be encouraged and standardized.