ABSTRACT
The aim of this study was to evaluate factors affecting the recurrence of positive RT-PCR results. By performing a retrospective analysis, we evaluated the clinical data of recurrent positive coronavirus disease 2019 (COVID-19) patients in multiple medical institutions in Wuhan. We recruited COVID-19 patients who were hospitalized from January 1 to March 10, 2020, in three tertiary hospitals in Wuhan, met the discharge criteria and received at least one additional nucleic acid test before leaving the hospital. According to the RT-PCR results, patients were split into a recurrent positive group (RPos group) and a nonrecurrent positive group (non-RPos group). Clinical characteristics, therapeutic schedules and antibody titers were compared between the two groups. AI-assisted chest high-resolution computed tomography (HRCT) technology was applied to investigate pulmonary inflammatory exudation and compare the extent of lung areas with different densities. This study involved 122 COVID-19 patients. There were no significant differences in age, sex, preexisting diseases, clinical symptoms, clinical classification, course of disease, therapeutic schedules or serum-specific antibodies between the two groups. A higher proportion of patients who showed pulmonary inflammatory exudation on HRCT scans were recurrent positive at the time of discharge than other patients (81.6% vs 13.7%, P < 0.01). In addition, the degree of pulmonary fibrosis was higher in the RPos group than in the non-RPos group (P < 0.05). Subpleural exudation at the peripheral edge of the lung and extensive pulmonary fibrosis at the time of discharge represent risk factors for the recurrence of COVID-19.
ABSTRACT
Background: COVID-19 patients showed certain characteristic features of multiple signs in bilateral lungs. Some patients only had a single pulmonary lobe lesion, which has not been reported previously. Single pulmonary lobe lesions are easily missed or misdiagnosed if they do not receive enough attention. Objective: To study the imaging manifestations, clinical features and outcomes of patients with COVID-19 with only one single pulmonary lobe lesion. Methods: Patient clinical data were collected only from patients with confirmed SARS-CoV-2 infection by RT-PCR, which was confined to only single lobe lesions on chest CT imaging findings at the onset. Which lobe was frequently involved, the imaging manifestations, clinical features and outcomes were also analyzed. Result: From January 1, 2020, to March 14, 2020, a total of 367 inpatients were diagnosed with COVID-19, in which 50 (13.6%) patients were confirmed with only one single pulmonary lobe lesion. The most frequently involved lobe was the right lower lobe (18 patients, 36%, highest). Lesions in the lower lobe easily spread to all lobes of the bilateral lungs (P<0.001, χ2=10.264), especially the left lower lobe, and were less frequent in the right upper lobe. During hospitalization, 2 (4%) patients were admitted to the ICU, 2 (4%) patients died, and 28 (56%) patients developed lesions in other lobes within 6.32±3.71 days. Conclusions: The general pattern of COVID-19 imaging with localized nodules may also cause severe respiratory symptoms of bilateral lung disease, serious complications, or even death in patients with multiple lobe lesions or bilateral lung lesions, which should not be underestimated.