Voxel-level forecast system for lesion development in patients with COVID-19 (preprint)

The global spread of COVID-19 seriously endangers human health and even lives. By predicting patients' individualized disease development and further performing intervention in time, we may rationalize scarce medical resources and reduce mortality. Based on 1337 multi- stage ([≥]3) high-resolution chest computed tomography (CT) images of 417 infected patients from three centers in the epidemic area, we proposed a random forest + cellular automata (RF+CA) model to forecast voxel-level lesion development of patients with COVID-19. The model showed a promising prediction performance (Dice similarity coefficient [DSC] = 71.1%, Kappa coefficient = 0.612, Figure of Merit [FoM] = 0.257, positional accuracy [PA] = 3.63) on the multicenter dataset. Using this model, multiple driving factors for the development of lesions were determined, such as distance to various interstitials in the lung, distance to the pleura, etc. The driving processes of these driving factors were further dissected and explained in depth from the perspective of pathophysiology, to explore the mechanism of individualized development of COVID-19 disease. The complete codes of the forecast system are available at https://github.com/keyunj/VVForecast_covid19.

Epidemiological,clinical and radiological findings in medical staff with COVID-19 in Wuhan, China: a single-centered, retrospective cohort study (preprint)

Backgrounds In December 2019, a pneumonia associated with the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) emerged in Wuhan city, China. As of 20 Feb 2020, a total of 2,055 medical staff infected with SARS-Cov-2 in China had been reported. The predominant cause of the infection and the failure of protection among medical staff remains unclear. We sought to explore the epidemiological, clinical characteristics and prognosis of novel coronavirus-infected medical staff.Methods Medical staff who infected with SARS-Cov-2 and admitted to Union Hospital, Wuhan between 16 Jan, 2020 to 25 Feb, 2020 were included retrospectively. Epidemiological, clinical and radiological data were compared by occupation and analyzed with the Kaplan-Meier and Cox regression methods.Results A total of 101 medical staff (32 males and 69 females; median age: 33 years old) were included in this study and 74% were nurses. None had an exposure to Huanan seafood wholesale market or wildlife. A small proportion of the cohort had contact with specimens (3%) as well as patients infected with SARS-Cov-2 in fever clinics (15%) and isolation wards (3%). 80% of medical staff showed abnormal IL-6 levels and 33% had lymphocytopenia. Chest CT mainly manifested as bilateral (62%), septal/subpleural (77%) and ground­glass opacities (48%). The major differences between doctors and nurses manifested in laboratory indicators. As of the last observed date, no patient was transferred to intensive care unit or died, and 98 (97%) had been discharged. Fever (HR=0.57; 95% CI 0.36-0.90) and IL-6 levels greater than >2.9 pg/ml (HR=0.50; 95% CI 0.30-0.86) on admission were unfavorable factors for discharge.Conclusions Our findings suggested that the infection of medical staff mainly occurred at the early stages of SARS-CoV-2 epidemic in Wuhan, and only a small proportion of infection had an exact mode. Meanwhile, medical staff infected with COVID-19 have relatively milder symptoms and favorable clinical course than other ordinary patients, which may be partly due to their medical expertise, younger age and less underlying diseases. The potential risk factors of presence of fever and IL-6 levels greater than >2.9 pg/ml could help to identify medical staff with poor prognosis at an early stage.

Prognostic Value of Baseline Clinical and HRCT Findings in 101 Patients with Severe COVID-19 in Wuhan, China (preprint)

Background It has been reported that patients with severe Coronavirus disease 2019 (COVID-19) had high mortality rate, but the information about prognostic factors for these patients is unknown. The aim of this study was to assess the prognostic value of baseline clinical and high resolution CT (HRCT) findings in patients with severe COVID-19.Methods In this retrospective, two-center study, we included two groups of inpatients with severe COVID-19 who had been discharged or had died in Jin Yin-tan hospital and Wuhan union hospital between January 5, 2020, and February 22, 2020. Cases were confirmed by real-time polymerase chain reaction. Demographic, clinical, laboratory data, and HRCT data were collected and compared between discharged and deceased patients. Univariable and multivariable logistic regression models were used to assess predictors of mortality risk in these patients.Results 101 patients were included in this study, of whom 66 were discharged and 35 died in the hospital. The mean age was 56.6 ± 15.1 years and 67 (66.3%)were men. Of the 101 patients, hypertension (38, 37.6%), cardiovascular disease (21,20.8%), diabetes (18,17.8%), and chronic pulmonary disease (16,15.8%) were the most common coexisting conditions. The multivariable regression analysis showed older age (OR:1.142, 95%CI:1.059–1.231, p༜0.001), acute respiratory distress syndrome (ARDS) (OR:10.142, 95%CI:1.611–63.853, p = 0.014), reduced lymphocyte count (OR:0.004, 95%CI: 0.001–0.306, p = 0.013), and elevated HRCT score (OR:1.276, 95%CI:1.002–1.625, p = 0.049) to be independent predictors of mortality risk on admission in severe COVID-19 patients.Conclusions These initial data indicate that older age, ARDS, lymphocytopenia and elevated HRCT score on admission were strong predictors of mortality risk in severe COVID-19 patients.

CT appearance of new coronavirus pneumonia in subclinical period and short-term changes / 中华放射学杂志

Objective@#To explore the characteristics and short-term changes of high resolutionCT (HRCT) in subclinical stage of new coronavirus pneumonia (NCP).@*Methods@#TheHRCT images of 17 NCP patients in subclinical stage were analyzed retrospectively in Union Hospital of Tongji Medical College, Huazhong University of science and technology and Wuhan JinyintanHospital from January 15 to January 31, 2020. There were 4 males and 13 females, aged from 25.0 to 51.0 (39.8±7.5) years, who were closely contacted with NCP patients. The follow-up CT examination was performed 3 to 6 days after the initial CT examination in all patients. Six patients were treated using anti-virus, anti-inflammation andsymptomatic therapy, while the orther 11 patients were untreated. The CT imaging signs of subclinical and short-term follow-up were analyzed, and the CT image changes of short-term follow-up was summarized.@*Results@#Thelesions of 17 NCP patients were mainly located at the lower lobes of both lungs (9 cases at the left lower lobe and 10 cases at the right lower lobe in the subclinical stage, 9 casesat the left lower lobe and 11casesat the right lower lobe in the short-term follow-up). The number of lung segments involved increased from 46 in the subclinical stage to 90 in the short-term follow-up. In the subclinical stage, most of the lesions were multiple (13 cases), while in the short-term follow-up, the number of multiple cases decreased (7 cases), focal (6 cases) and diffuse distribution(4 cases) increased. The lesions were mainly distributed under the pleura (13 cases) or along the bronchovascular bundle (10 cases). In the short-term follow-up, 1 case progressed from subpleural to subpleural and along the bronchovascular bundle. There were 3 main types of lesions, including ground glass nodule, ground glass opacity and crazy-paving pattern. In the subclinical stage and short-term follow-up, ground glass nodules were seen in all the 17 cases. In the short-termfollow-up, ground glass nodules decreased in 4 cases and crazy-paving pattern increased in 4 cases. In 6 patients after treatment, 3 cases were changed from multiple to single ground glass nodule, 3 cases showed multiple ground glass opacity reduced. Therange of lesions in 11 patients without treatment enlarged.@*Conclusion@#TheHRCT features of the NCP patients in subcilincal stagehave some charicteristics, such as small ground glass nodule, ground glass opacity along the subpleural or along the bronchovascular bundle, and the great changescan be seen in the short-term follow-up.