Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 22
Filter
1.
Diagnostics ; 12(8):1848, 2022.
Article in English | MDPI | ID: covidwho-1969133

ABSTRACT

Prone positioning is frequently used for non-intubated hypoxemic patients with COVID-19, although conclusive evidence is still lacking. The aim of the present study was to investigate whether baseline CT-scans could predict the improvement in oxygenation in COVID-19 related Acute respira-tory syndrome (ARDS) patients when pronated. Methods: A retrospective study of COVID-19 patients who underwent non-invasive ventilation (NIV) and prone positioning was conducted. Results: Forty-five patients were included. On average, 50% of the overall lung volume was affected by the disease, as observed in the CT-scans, with ground glass opacities (GGOs) and consolidations accounting for 44% and 4%, respectively. The abnormalities were mainly posterior, as demonstrated by posterior/anterior distribution ratios of 1.5 and 4.4 for GGO and consolidation, respectively. The median PaO2/FiO2 ratio during NIV in a supine position (SP1) was 140 [IQR 108–169], which improved by 67% (+98) during prone positioning, on average. Once supine positioning was resumed (SP2), the improvement in oxygenation was maintained in 28 patients (62% of the overall population, categorized as 'responders';). We found no significant differences between responders and non-responders in terms of the extent (p = 0.92) and the distribution of parenchymal abnormalities seen in the baseline CT (p = 0.526). Conclusion: Despite the lack of a priori estimation of the sample size, considering the absence of any trends in the differences and correlations, we can reasonably conclude that the baseline chest CT-scan does not predict a gas-exchange response in awake prone-positioned patients with COVID-19 related ARDS. Physicians dealing with this category of patients should not rely on the imaging at presentation when evaluating whether to pronate patients.

3.
Diagnostics (Basel) ; 12(5)2022 May 10.
Article in English | MEDLINE | ID: covidwho-1869506

ABSTRACT

Radiology plays a crucial role for the diagnosis and management of COVID-19 patients during the different stages of the disease, allowing for early detection of manifestations and complications of COVID-19 in the different organs. Lungs are the most common organs involved by SARS-CoV-2 and chest computed tomography (CT) represents a reliable imaging-based tool in acute, subacute, and chronic settings for diagnosis, prognosis, and management of lung disease and the evaluation of acute and chronic complications. Cardiac involvement can be evaluated by using cardiac computed tomography angiography (CCTA), considered as the best choice to solve the differential diagnosis between the most common cardiac conditions: acute coronary syndrome, myocarditis, and cardiac dysrhythmia. By using compressive ultrasound it's possible to study the peripheral arteries and veins and to exclude the deep vein thrombosis, directly linked to the onset of pulmonary embolism. Moreover, CT and especially MRI can help to evaluate the gastrointestinal involvement and assess hepatic function, pancreas involvement, and exclude causes of lymphocytopenia, thrombocytopenia, and leukopenia, typical of COVID-19 patients. Finally, radiology plays a crucial role in the early identification of renal damage in COVID-19 patients, by using both CT and US. This narrative review aims to provide a comprehensive radiological analysis of commonly involved organs in patients with COVID-19 disease.

4.
Panminerva Med ; 2022 Feb 22.
Article in English | MEDLINE | ID: covidwho-1702913

ABSTRACT

BACKGROUND: An aspect of COVID-19 baffling physicians is the presentation of patients with acute respiratory failure, but normal mental faculties and no perception of dyspnea (i.e. "silent hypoxemia"). The aim of this study was to investigate the frequency, characteristics, and outcome of COVID-19 patients with silent hypoxemic status and comparing them with a symptomatic severity-matched group. METHODS: This is a retrospective monocentric observational study involving all patients with PCR confirmed SARS-CoV-2 pneumonia, admitted at Papa Giovanni XXIII Hospital, Bergamo (Italy) from Emergency Department due to acute respiratory failure, during the first Italian pandemic peak (February-April 2020). RESULTS: Overall 28-day mortality in 1,316 patients was 26.9%. Patients who did not report dyspnea at admission (N 469, 35.6%) had a lower 28-day mortality (22.6 vs. 29.3%, p=0.009). The severity matching analysis (i.e. PaO2/FiO2 and imaging) led to the identification of two groups of 254 patients that did not differ for sex prevalence, age, BMI, smoking history, comorbidities, and PaCO2 at admission. The use of CPAP during the first 24 hours, such as the need of endotracheal intubation (ETI) during the overall admission were significantly lower in matched patients with silent hypoxemia, whereas 28-day mortality resulted similar (p=0.21). CONCLUSIONS: Lack of dyspnea is common in patients suffering from severe COVID-19 pneumonia leading to respiratory failure, since up to a third of them could be asymptomatic on admission. Dyspnea per se correlates with pneumonia severity, and prognosis. However, dyspnea loses its predictive relevance once other findings to evaluate pneumonia severity are available such as PaO2/FiO2 and imaging. Silent hypoxemic patients are less likely to receive CPAP during the first 24 hours and ETI during the hospitalization, in spite of a comparable mortality to the dyspneic ones.

5.
Eur J Radiol ; 149: 110188, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1664888

ABSTRACT

SARS-CoV-2 infection, responsible for COVID-19 outbreak, can cause cardiac complications, worsening outcome and prognosis. In particular, it can exacerbate any underlying cardiovascular condition, leading to atherosclerosis and increased plaque vulnerability, which may cause acute coronary syndrome. We review current knowledge on the mechanisms by which SARS-CoV-2 can trigger endothelial/myocardial damage and cause plaque formation, instability and deterioration. The aim of this review is to evaluate current non-invasive diagnostic techniques for coronary arteries evaluation in COVID-19 patients, such as coronary CT angiography and atherosclerotic plaque imaging, and their clinical implications. We also discuss the role of artificial intelligence, deep learning and radiomics in the context of coronary imaging in COVID-19 patients.


Subject(s)
COVID-19 , Coronary Artery Disease , Plaque, Atherosclerotic , Artificial Intelligence , Coronary Angiography/methods , Coronary Artery Disease/diagnostic imaging , Coronary Vessels , Humans , Plaque, Atherosclerotic/diagnostic imaging , SARS-CoV-2
6.
J Ultrasound ; 2022 Jan 09.
Article in English | MEDLINE | ID: covidwho-1616312

ABSTRACT

PURPOSE: To evaluate the usefulness of compressive ultrasound (CUS) for the diagnosis of deep vein thrombosis (DVT) in patients with SARS-CoV-2-related infection. METHODS: 112 hospitalized patients with confirmed SARS-CoV-2 infection were retrospectively enrolled. CUS was performed within 2 days of admission and consisted in the assessment of the proximal and distal deep venous systems. Lack of compressibility, or direct identification of an endoluminal thrombus, were the criteria used for the diagnosis of DVT. Pulmonary embolism (PE) events were investigated at computed tomography pulmonary angiography (CTPA) within 5 days of follow-up. Logistic binary regression was computed to determine which clinical and radiological parameters were independently associated with PE onset. RESULTS: Overall, the incidence of DVT in our cohort was about 43%. The most common district involved was the left lower limb (68.7%) in comparison with the right one (58.3%) while the upper limbs were less frequently involved (4.2% the right one and 2.1% the left one, respectively). On both sides, the distal tract of the popliteal vein was the most common involved (50% right side and 45.8% left side). The presence of DVT in the distal tract of the right popliteal vein (OR = 2.444 95%CIs 1.084-16.624, p = 0.038), in the distal tract of the left popliteal vein (OR = 4.201 95%CIs 1.484-11.885, p = 0.007), and D-dimer values (OR = 2.122 95%CIs 1.030-5.495, p = 0.003) were independently associated with the onset on PE within 5 days. CONCLUSIONS: CUS should be considered a useful tool to discriminate which category of patients can develop PE within 5 days from admission.

8.
Eur Radiol ; 31(5): 2726-2736, 2021 May.
Article in English | MEDLINE | ID: covidwho-1384395

ABSTRACT

OBJECTIVES: To evaluate a semi-automated segmentation and ventilated lung quantification on chest computed tomography (CT) to assess lung involvement in patients affected by SARS-CoV-2. Results were compared with clinical and functional parameters and outcomes. METHODS: All images underwent quantitative analyses with a dedicated workstation using a semi-automatic lung segmentation software to compute ventilated lung volume (VLV), Ground-glass opacity (GGO) volume (GGO-V), and consolidation volume (CONS-V) as absolute volume and as a percentage of total lung volume (TLV). The ratio between CONS-V, GGO-V, and VLV (CONS-V/VLV and GGO-V/VLV, respectively), TLV (CONS-V/TLV, GGO-V/TLV, and GGO-V + CONS-V/TLV respectively), and the ratio between VLV and TLV (VLV/TLV) were calculated. RESULTS: A total of 108 patients were enrolled. GGO-V/TLV significantly correlated with WBC (r = 0.369), neutrophils (r = 0.446), platelets (r = 0.182), CRP (r = 0.190), PaCO2 (r = 0.176), HCO3- (r = 0.284), and PaO2/FiO2 (P/F) values (r = - 0.344). CONS-V/TLV significantly correlated with WBC (r = 0.294), neutrophils (r = 0.300), lymphocytes (r = -0.225), CRP (r = 0.306), PaCO2 (r = 0.227), pH (r = 0.162), HCO3- (r = 0.394), and P/F (r = - 0.419) values. Statistically significant differences between CONS-V, GGO-V, GGO-V/TLV, CONS-V/TLV, GGO-V/VLV, CONS-V/VLV, GGO-V + CONS-V/TLV, VLV/TLV, CT score, and invasive ventilation by ET were found (all p < 0.05). CONCLUSION: The use of quantitative semi-automated algorithm for lung CT elaboration effectively correlates the severity of SARS-CoV-2-related pneumonia with laboratory parameters and the need for invasive ventilation. KEY POINTS: • Pathological lung volumes, expressed both as GGO-V and as CONS-V, can be considered a useful tool in SARS-CoV-2-related pneumonia. • All lung volumes, expressed themselves and as ratio with TLV and VLV, correlate with laboratory data, in particular C-reactive protein and white blood cell count. • All lung volumes correlate with patient's outcome, in particular concerning invasive ventilation.


Subject(s)
COVID-19 , Pneumonia , Humans , Lung/diagnostic imaging , Lung Volume Measurements , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed
9.
World J Gastroenterol ; 27(32): 5448-5459, 2021 Aug 28.
Article in English | MEDLINE | ID: covidwho-1379994

ABSTRACT

BACKGROUND: Intestinal ischemia has been described in case reports of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (coronavirus disease 19, COVID-19). AIM: To define the clinical and histological, characteristics, as well as the outcome of ischemic gastrointestinal manifestations of SARS-CoV-2 infection. METHODS: A structured retrospective collection was promoted among three tertiary referral centres during the first wave of the pandemic in northern Italy. Clinical, radiological, endoscopic and histological data of patients hospitalized for COVID-19 between March 1st and May 30th were reviewed. The diagnosis was established by consecutive analysis of all abdominal computed tomography (CT) scans performed. RESULTS: Among 2929 patients, 21 (0.7%) showed gastrointestinal ischemic manifestations either as presenting symptom or during hospitalization. Abdominal CT showed bowel distention in 6 patients while signs of colitis/enteritis in 12. Three patients presented thrombosis of main abdominal veins. Endoscopy, when feasible, confirmed the diagnosis (6 patients). Surgical resection was necessary in 4/21 patients. Histological tissue examination showed distinctive features of endothelial inflammation in the small bowel and colon. Median hospital stay was 9 d with a mortality rate of 39%. CONCLUSION: Gastrointestinal ischemia represents a rare manifestation of COVID-19. A high index of suspicion should lead to investigate this complication by CT scan, in the attempt to reduce its high mortality rate. Histology shows atypical feature of ischemia with important endotheliitis, probably linked to thrombotic microangiopathies.


Subject(s)
COVID-19 , Gastrointestinal Diseases , Humans , Pandemics , Retrospective Studies , SARS-CoV-2
10.
Hepatol Res ; 51(9): 1000-1006, 2021 Sep.
Article in English | MEDLINE | ID: covidwho-1309764

ABSTRACT

AIM: Coronavirus disease (COVID-19) is characterized by pneumonia with secondary damage to multiple organs including the liver. Liver injury (elevated alanine aminotransferase [ALT] and aspartate aminotransferase [AST]) often correlates with disease severity in COVID-19 patients. The aim of this study is to identify pathological microthrombi in COVID-19 patient livers by correlating their morphology with liver injury, and examine hyperfibrinogenemia and von Willebrand factor (vWF) as mechanisms of their formation. METHODS: Forty-three post-mortem liver biopsy samples from COVID-19 patients were obtained from Papa Giovanni XXIII Hospital in Bergamo, Italy. Three morphological features of microthrombosis (sinusoidal erythrocyte aggregation [SEA], platelet microthrombi [PMT], and fibrous thrombi) were evaluated. RESULTS: We found liver sinusoidal microthrombosis in 23 COVID-19 patients (53%) was associated with a higher serum ALT and AST level compared to those without (ALT: 10-fold, p = 0.04; AST: 11-fold, p = 0.08). Of 43 livers, PMT and SEA were observed in 14 (33%) and 19 (44%) cases, respectively. Fibrous thrombi were not observed. Platelet microthrombi were associated with increased ALT (p < 0.01), whereas SEA was not (p = 0.73). In COVID-19 livers, strong vWF staining in liver sinusoidal endothelial cells was associated with significantly increased platelet adhesion (1.7-fold, p = 0.0016), compared to those with weak sinusoidal vWF (2-fold, p < 0.0001). Sinusoidal erythrocyte aggregation in 19 (83%) liver samples was mainly seen in zone 2. Livers with SEA had significantly higher fibrinogen (1.6-fold, p = 0.031) compared to those without SEA in COVID-19 patients. CONCLUSIONS: Liver PMT is a pathologically important thrombosis associated with liver injury in COVID-19, while SEA is a unique morphological feature of COVID-19 patient livers. Sinusoidal vWF and hyperfibrinogenemia could contribute to PMT and SEA formation.

11.
J Hepatol ; 75(3): 647-658, 2021 09.
Article in English | MEDLINE | ID: covidwho-1228069

ABSTRACT

BACKGROUND AND AIMS: COVID-19 is associated with liver injury and elevated interleukin-6 (IL-6). We hypothesized that IL-6 trans-signaling in liver sinusoidal endothelial cells (LSECs) leads to endotheliopathy (a proinflammatory and procoagulant state) and liver injury in COVID-19. METHODS: Coagulopathy, endotheliopathy, and alanine aminotransferase (ALT) were retrospectively analyzed in a subset (n = 68), followed by a larger cohort (n = 3,780) of patients with COVID-19. Liver histology from 43 patients with COVID-19 was analyzed for endotheliopathy and its relationship to liver injury. Primary human LSECs were used to establish the IL-6 trans-signaling mechanism. RESULTS: Factor VIII, fibrinogen, D-dimer, von Willebrand factor (vWF) activity/antigen (biomarkers of coagulopathy/endotheliopathy) were significantly elevated in patients with COVID-19 and liver injury (elevated ALT). IL-6 positively correlated with vWF antigen (p = 0.02), factor VIII activity (p = 0.02), and D-dimer (p <0.0001). On liver histology, patients with COVID-19 and elevated ALT had significantly increased vWF and platelet staining, supporting a link between liver injury, coagulopathy, and endotheliopathy. Intralobular neutrophils positively correlated with platelet (p <0.0001) and vWF (p <0.01) staining, and IL-6 levels positively correlated with vWF staining (p <0.01). IL-6 trans-signaling leads to increased expression of procoagulant (factor VIII, vWF) and proinflammatory factors, increased cell surface vWF (p <0.01), and increased platelet attachment in LSECs. These effects were blocked by soluble glycoprotein 130 (IL-6 trans-signaling inhibitor), the JAK inhibitor ruxolitinib, and STAT1/3 small-interfering RNA knockdown. Hepatocyte fibrinogen expression was increased by the supernatant of LSECs subjected to IL-6 trans-signaling. CONCLUSION: IL-6 trans-signaling drives the coagulopathy and hepatic endotheliopathy associated with COVID-19 and could be a possible mechanism behind liver injury in these patients. LAY SUMMARY: Patients with SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection often have liver injury, but why this occurs remains unknown. High levels of interleukin-6 (IL-6) and its circulating receptor, which form a complex to induce inflammatory signals, have been observed in patients with COVID-19. This paper demonstrates that the IL-6 signaling complex causes harmful changes to liver sinusoidal endothelial cells and may promote blood clotting and contribute to liver injury.


Subject(s)
COVID-19/complications , Endothelial Cells/pathology , Interleukin-6/physiology , Liver Diseases/etiology , SARS-CoV-2 , Adult , Blood Coagulation Disorders/etiology , Fibrinogen/analysis , Humans , Interleukin-6/blood , Janus Kinase 1/metabolism , Nitriles , Pyrazoles/pharmacology , Pyrimidines , Retrospective Studies , STAT3 Transcription Factor/metabolism , Signal Transduction/physiology , von Willebrand Factor/analysis
12.
BMC Pulm Med ; 21(1): 96, 2021 Mar 20.
Article in English | MEDLINE | ID: covidwho-1143203

ABSTRACT

BACKGROUND: Gender-related factors might affect vulnerability to Covid-19. The aim of this study was to describe the role of gender on clinical features and 28-day mortality in Covid-19 patients. METHODS: Observational study of Covid-19 patients hospitalized in Bergamo, Italy, during the first three weeks of the outbreak. Medical records, clinical, radiological and laboratory findings upon admission and treatment have been collected. Primary outcome was 28-day mortality since hospitalization. RESULTS: 431 consecutive adult patients were admitted. Female patients were 119 (27.6%) with a mean age of 67.0 ± 14.5 years (vs 67.8 ± 12.5 for males, p = 0.54). Previous history of myocardial infarction, vasculopathy and former smoking habits were more common for males. At the time of admission PaO2/FiO2 was similar between men and women (228 [IQR, 134-273] vs 238 mmHg [150-281], p = 0.28). Continuous Positive Airway Pressure (CPAP) assistance was needed in the first 24 h more frequently in male patients (25.7% vs 13.0%; p = 0.006). Overall 28-day mortality was 26.1% in women and 38.1% in men (p = 0.018). Gender did not result an independent predictor of death once the parameters related to disease severity at presentation were included in the multivariable analysis (p = 0.898). Accordingly, the Kaplan-Meier survival analysis in female and male patients requiring CPAP or non-invasive ventilation in the first 24 h did not find a significant difference (p = 0.687). CONCLUSION: Hospitalized women are less likely to die from Covid-19; however, once severe disease occurs, the risk of dying is similar to men. Further studies are needed to better investigate the role of gender in clinical course and outcome of Covid-19.


Subject(s)
COVID-19/epidemiology , Aged , Aged, 80 and over , COVID-19/mortality , COVID-19/physiopathology , COVID-19/therapy , Comorbidity , Continuous Positive Airway Pressure/statistics & numerical data , Diabetes Mellitus/epidemiology , Female , Humans , Hypertension/epidemiology , Hypoxia/epidemiology , Hypoxia/physiopathology , Hypoxia/therapy , Italy/epidemiology , Kaplan-Meier Estimate , Male , Middle Aged , Myocardial Infarction/epidemiology , Noninvasive Ventilation/statistics & numerical data , SARS-CoV-2 , Severity of Illness Index , Sex Factors , Smoking/epidemiology
13.
Eur J Radiol ; 138: 109676, 2021 May.
Article in English | MEDLINE | ID: covidwho-1141738

ABSTRACT

PURPOSE: To evaluate chest computed tomography (CT) and pulmonary function test (PFT) findings in severe COVID-19 patients after discharge and correlate CT pulmonary involvement with PFT results. METHODS: COVID-19 patients admitted to our hospital between February 25 and May 2, 2020, were retrospectively included according to the following criteria: (a) COVID-19 defined as severe based on the WHO interim guidance (i.e., clinical signs of pneumonia plus respiratory rate > 30 breaths/min, severe respiratory distress, and/or SpO2 < 90 % on room air); (b) chest radiograph in the acute setting; (c) post-discharge unenhanced chest CT; and (d) post-discharge comprehensive PFT. Imaging findings were retrospectively evaluated in consensus by two readers, and volume of abnormal lung was measured on CT using 3D Slicer software. Differences between demographics, comorbidities, acute radiographic findings, PFT, and post-discharge clinical and laboratory data of patients with normal and abnormal CT findings were assessed by Mann-Whitney or Fisher tests, and the compromised lung volume-PFT association by Pearson correlation after removing possible outliers. RESULTS: At a median of 105 days from symptom onset, 74/91 (81 %) patients had CT abnormalities. The most common CT pattern was combined ground-glass opacity and reticular pattern (46/74, 62 %) along with architectural distortion (68/74, 92 %) and bronchial dilatation (66/74, 89 %). Compromised lung volume had a median value of 15 % [11-23], was higher in dyspneic patients, and negatively correlated with the percentage of predicted DLCO, VA, and FVC values (r = -0.39, -0.5, and -0.42, respectively). These PFT parameters were significantly lower in patients with CT abnormalities. Impairment of DLCO and KCO was found in 12 (13 %) cases, possibly implying an underlying pulmonary vasculopathy in this subgroup of patients. CONCLUSIONS: Most severe COVID-19 survivors still had physiologically relevant CT abnormalities about three months after the disease onset, with an impairment of diffusion capacity on PFT. A pulmonary vasculopathy was suggested in a minor proportion of patients.


Subject(s)
COVID-19 , Aftercare , Humans , Lung/diagnostic imaging , Patient Discharge , Respiratory Function Tests , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed
14.
Panminerva Med ; 63(1): 51-61, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-1068211

ABSTRACT

BACKGROUND: Findings from February 2020, indicate that the clinical spectrum of COVID-19 can be heterogeneous, probably due to the infectious dose and viral load of SARS-CoV-2 within the first weeks of the outbreak. The aim of this study was to investigate predictors of overall 28-day mortality at the peak of the Italian outbreak. METHODS: Retrospective observational study of all COVID-19 patients admitted to the main hospital of Bergamo, from February 23 to March 14, 2020. RESULTS: Five hundred and eight patients were hospitalized, predominantly male (72.4%), mean age of 66±15 years; 49.2% were older than 70 years. Most of patients presented with severe respiratory failure (median value [IQR] of PaO2/FiO2: 233 [149-281]). Mortality rate at 28 days resulted of 33.7% (N.=171). Thirty-nine percent of patients were treated with continuous positive airway pressure (CPAP), 9.5% with noninvasive ventilation (NIV) and 13.6% with endotracheal intubation. 9.5% were admitted to Semi-Intensive Respiratory Care Unit, and 18.9% to Intensive Care Unit. Risk factors independently associated with 28-day mortality were advanced age (≥78 years: odds ratio [OR], 95% confidence interval [CI]: 38.91 [10.67-141.93], P<0.001; 70-77 years: 17.30 [5.40-55.38], P<0.001; 60-69 years: 3.20 [1.00-10.20], P=0.049), PaO2/FiO2<200 at presentation (3.50 [1.70-7.20], P=0.001), need for CPAP/NIV in the first 24 hours (8.38 [3.63-19.35], P<0.001), and blood urea value at admission (1.01 [1.00-1.02], P=0.015). CONCLUSIONS: At the peak of the outbreak, with a probable high infectious dose and viral load, older age, the severity of respiratory failure and renal impairment at presentation, but not comorbidities, are predictors of 28-day mortality in COVID-19.


Subject(s)
Age Factors , COVID-19/epidemiology , COVID-19/pathology , Adult , Aged , Aged, 80 and over , COVID-19/complications , COVID-19/mortality , Female , Humans , Italy/epidemiology , Male , Middle Aged , Retrospective Studies , SARS-CoV-2/isolation & purification , Severity of Illness Index
15.
Br J Radiol ; 94(1118): 20200716, 2021 Feb 01.
Article in English | MEDLINE | ID: covidwho-1038510

ABSTRACT

OBJECTIVES: Ground-glass opacity and consolidation are recognized typical features of Coronavirus disease-19 (COVID-19) pneumonia on Chest CT, yet ancillary findings have not been fully described. We aimed to describe ancillary findings of COVID-19 pneumonia on CT, to define their prevalence, and investigate their association with clinical data. METHODS: We retrospectively reviewed our CT chest cases with coupled reverse transcriptase polymerase chain reaction (rt-PCR). Patients with negative rt-PCR or without admission chest CT were excluded. Ancillary findings included: vessel enlargement, subpleural curvilinear lines, dependent subpleural atelectasis, centrilobular solid nodules, pleural and/or pericardial effusions, enlarged mediastinal lymph nodes. Continuous data were expressed as median and 95% confidence interval (95% CI) and tested by Mann-Whitney U test. RESULTS: Ancillary findings were represented by 106/252 (42.1%, 36.1 to 48.2) vessel enlargement, 50/252 (19.8%, 15.4 to 25.2) subpleural curvilinear lines, 26/252 (10.1%, 7.1 to 14.7) dependent subpleural atelectasis, 15/252 (5.9%, 3.6 to 9.6) pleural effusion, 15/252 (5.9%, 3.6 to 9.6) mediastinal lymph nodes enlargement, 13/252 (5.2%, 3 to 8.6) centrilobular solid nodules, and 6/252 (2.4%, 1.1 to 5.1) pericardial effusion. Air space disease was more extensive in patients with vessel enlargement or centrilobular solid nodules (p < 0.001). Vessel enlargement was associated with longer history of fever (p = 0.035) and lower admission oxygen saturation (p = 0.014); dependent subpleural atelectasis with lower oxygen saturation (p < 0.001) and higher respiratory rate (p < 0.001); mediastinal lymph nodes with shorter history of cough (p = 0.046); centrilobular solid nodules with lower prevalence of cough (p = 0.023), lower oxygen saturation (p < 0.001), and higher respiratory rate (p = 0.032), and pericardial effusion with shorter history of cough (p = 0.015). Ancillary findings associated with longer hospital stay were subpleural curvilinear lines (p = 0.02), whereas centrilobular solid nodules were associated with higher rate of intensive care unit admission (p = 0.01). CONCLUSION: Typical high-resolution CT findings of COVID-19 pneumonia are frequently associated with ancillary findings that variably associate with disease extent, clinical parameters, and disease severity. ADVANCES IN KNOWLEDGE: Ancillary findings might reflect the broad range of heterogeneous mechanisms in severe acute respiratory syndrome from viral pneumonia, and potentially help disease phenotyping.


Subject(s)
COVID-19/diagnostic imaging , Incidental Findings , Lung/diagnostic imaging , SARS-CoV-2 , Adult , Aged , Aged, 80 and over , Dilatation, Pathologic/diagnostic imaging , Female , Humans , Lung/blood supply , Lymph Nodes/diagnostic imaging , Lymphadenopathy/diagnostic imaging , Male , Middle Aged , Multidetector Computed Tomography/methods , Observer Variation , Pleural Effusion/diagnostic imaging , Pulmonary Artery/diagnostic imaging , Pulmonary Veins/diagnostic imaging , Retrospective Studies
16.
Radiol Med ; 126(5): 669-678, 2021 May.
Article in English | MEDLINE | ID: covidwho-1014200

ABSTRACT

PURPOSE: To analyze pulmonary embolism (PE) on chest computed tomography pulmonary angiography (CTPA) in hospitalized patients affected by SARS-CoV-2, according to the severity of lung disease based both on temporal CT features changes and on CT-severity lung involvement (CT-severity score), along with the support of clinical and laboratory findings. METHODS: We retrospectively enrolled a total of 170 patients with confirmed SARS-CoV-2 infection who underwent CTPA examination for PE suspicion. Pulmonary arteries diameters, right ventricle/left ventricle (RV/LV) ratio, presence, absence, and distribution of PE, pulmonary artery obstructive index (PAO index), and lobe involvement were recorded. All CT scans were reviewed to assess temporal CT changes and the COVID CT-severity score. RESULTS: A total of 76 out of 170 patients (44.7%) developed PE without having any major risk factors for venous thromboembolism. The most severe pulmonary arteries involvement, expressed in terms of PAO Index, occurred in those patients with markedly elevated D-dimer and C-reactive protein (CRP) values and those patients with an advanced temporal stage of lung disease. The majority PE-positive patients were hospitalized in non-intensive wards. PE-positive patients showed a slightly higher hospitalization time in comparison with PE-negative ones. In the three months of study, overall 85.9% of patients were discharged while 14.1% died, of whom 13 PE-positive (54.2%). CONCLUSIONS: Patients hospitalized for SARS-CoV-2 infection present a higher cumulative incidence of PE compared to the general population of hospitalized patients, regardless of the severity of lung inflammation or the temporal stage of the disease.


Subject(s)
COVID-19/complications , Pulmonary Embolism/diagnostic imaging , Pulmonary Embolism/etiology , Acute Disease , Aged , Endemic Diseases , Female , Hospitalization , Humans , Italy/epidemiology , Male , Middle Aged , Retrospective Studies , Severity of Illness Index , Tomography, X-Ray Computed
17.
Eur Radiol ; 31(6): 4031-4041, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-996387

ABSTRACT

OBJECTIVES: Enlarged main pulmonary artery diameter (MPAD) resulted to be associated with pulmonary hypertension and mortality in a non-COVID-19 setting. The aim was to investigate and validate the association between MPAD enlargement and overall survival in COVID-19 patients. METHODS: This is a cohort study on 1469 consecutive COVID-19 patients submitted to chest CT within 72 h from admission in seven tertiary level hospitals in Northern Italy, between March 1 and April 20, 2020. Derivation cohort (n = 761) included patients from the first three participating hospitals; validation cohort (n = 633) included patients from the remaining hospitals. CT images were centrally analyzed in a core-lab blinded to clinical data. The prognostic value of MPAD on overall survival was evaluated at adjusted and multivariable Cox's regression analysis on the derivation cohort. The final multivariable model was tested on the validation cohort. RESULTS: In the derivation cohort, the median age was 69 (IQR, 58-77) years and 537 (70.6%) were males. In the validation cohort, the median age was 69 (IQR, 59-77) years with 421 (66.5%) males. Enlarged MPAD (≥ 31 mm) was a predictor of mortality at adjusted (hazard ratio, HR [95%CI]: 1.741 [1.253-2.418], p < 0.001) and multivariable regression analysis (HR [95%CI]: 1.592 [1.154-2.196], p = 0.005), together with male gender, old age, high creatinine, low well-aerated lung volume, and high pneumonia extension (c-index [95%CI] = 0.826 [0.796-0.851]). Model discrimination was confirmed on the validation cohort (c-index [95%CI] = 0.789 [0.758-0.823]), also using CT measurements from a second reader (c-index [95%CI] = 0.790 [0.753;0.825]). CONCLUSION: Enlarged MPAD (≥ 31 mm) at admitting chest CT is an independent predictor of mortality in COVID-19. KEY POINTS: • Enlargement of main pulmonary artery diameter at chest CT performed within 72 h from the admission was associated with a higher rate of in-hospital mortality in COVID-19 patients. • Enlargement of main pulmonary artery diameter (≥ 31 mm) was an independent predictor of death in COVID-19 patients at adjusted and multivariable regression analysis. • The combined evaluation of clinical findings, lung CT features, and main pulmonary artery diameter may be useful for risk stratification in COVID-19 patients.


Subject(s)
COVID-19 , Pulmonary Artery , Aged , Cohort Studies , Female , Humans , Italy/epidemiology , Male , Pulmonary Artery/diagnostic imaging , Retrospective Studies , SARS-CoV-2 , Tomography, X-Ray Computed
18.
Radiol Med ; 126(3): 498-502, 2021 Mar.
Article in English | MEDLINE | ID: covidwho-915235

ABSTRACT

PURPOSE: In overwhelmed emergency departments (EDs) facing COVID-19 outbreak, a swift diagnosis is imperative. CT role was widely debated for its limited specificity. Here we report the diagnostic role of CT in two EDs in Lombardy, epicenter of Italian outbreak. MATERIAL AND METHODS: Admitting chest CT from 142 consecutive patients with suspected COVID-19 were retrospectively analyzed. CT scans were classified in "highly likely," "likely," and "unlikely" COVID-19 pneumonia according to the presence of typical, indeterminate, and atypical findings, or "negative" in the absence of findings, or "alternative diagnosis" when a different diagnosis was found. Nasopharyngeal swab results, turnaround time, and time to positive results were collected. CT diagnostic performances were assessed considering RT-PCR as reference standard. RESULTS: Most of cases (96/142, 68%) were classified as "highly likely" COVID-19 pneumonia. Ten (7%) and seven (5%) patients were classified as "likely" and "unlikely" COVID-19 pneumonia, respectively. In 21 (15%) patients a differential diagnosis was provided, including typical pneumonia, pulmonary edema, neoplasia, and pulmonary embolism. CT was negative in 8/142 (6%) patients. Mean turnaround time for the first COVID-19 RT-PCR was 30 ± 13 h. CT diagnostic accuracy in respect of the first test swab was 79% and increased to 91.5% after repeated swabs and/or BAL, for 18 false-negative first swab. CT performance was good with 76% specificity, 99% sensitivity, 90% positive predictive value and 97% negative predictive value. CONCLUSION: Chest CT was useful to streamline patients' triage while waiting for RT-PCR in the ED, supporting the clinical suspicion of COVID-19 or providing alternative diagnosis.


Subject(s)
COVID-19/diagnostic imaging , Emergency Service, Hospital , Lung/diagnostic imaging , Tomography, X-Ray Computed , Aged , Female , Humans , Italy , Male , Middle Aged , Retrospective Studies , Sensitivity and Specificity , Triage
19.
Eur Radiol ; 31(4): 1999-2012, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-841709

ABSTRACT

OBJECTIVES: To evaluate the inter-rater agreement of chest X-ray (CXR) findings in coronavirus disease 2019 (COVID-19) and to determine the value of initial CXR along with demographic, clinical, and laboratory data at emergency department (ED) presentation for predicting mortality and the need for ventilatory support. METHODS: A total of 340 COVID-19 patients who underwent CXR in the ED setting (March 1-13, 2020) were retrospectively included. Two reviewers independently assessed CXR abnormalities, including ground-glass opacities (GGOs) and consolidation. Two scoring systems (Brixia score and percentage of lung involvement) were applied. Inter-rater agreement was assessed by weighted Cohen's kappa (κ) or intraclass correlation coefficient (ICC). Predictors of death and respiratory support were identified by logistic or Poisson regression. RESULTS: GGO admixed with consolidation (n = 235, 69%) was the most common CXR finding. The inter-rater agreement was almost perfect for type of parenchymal opacity (κ = 0.90), Brixia score (ICC = 0.91), and percentage of lung involvement (ICC = 0.95). The Brixia score (OR: 1.19; 95% CI: 1.06, 1.34; p = 0.003), age (OR: 1.16; 95% CI: 1.11, 1.22; p < 0.001), PaO2/FiO2 ratio (OR: 0.99; 95% CI: 0.98, 1; p = 0.002), and cardiovascular diseases (OR: 3.21; 95% CI: 1.28, 8.39; p = 0.014) predicted death. Percentage of lung involvement (OR: 1.02; 95% CI: 1.01, 1.03; p = 0.001) and PaO2/FiO2 ratio (OR: 0.99; 95% CI: 0.99, 1.00; p < 0.001) were significant predictors of the need for ventilatory support. CONCLUSIONS: CXR is a reproducible tool for assessing COVID-19 and integrates with patient history, PaO2/FiO2 ratio, and SpO2 values to early predict mortality and the need for ventilatory support. KEY POINTS: • Chest X-ray is a reproducible tool for assessing COVID-19 pneumonia. • The Brixia score and percentage of lung involvement on chest X-ray integrate with patient history, PaO2/FIO2 ratio, and SpO2 values to early predict mortality and the need for ventilatory support in COVID-19 patients presenting to the emergency department.


Subject(s)
COVID-19 , Emergency Service, Hospital , Humans , Lung , Radiography, Thoracic , Retrospective Studies , SARS-CoV-2 , X-Rays
SELECTION OF CITATIONS
SEARCH DETAIL