CO-RADS score and its correlation with clinical and laboratory parameters in patients with COVID-19

Background Polymerase chain reaction (PCR) based SARS-CoV-2 RNA detection and serological antibody tests give a proof of Coronavirus Disease 2019 (COVID-19) infection. Several variables can influence the consequences of these tests. Inflammatory markers among mild and severe patients of COVID-19 showed dissimilarity in inflammatory markers while computed tomography (CT) in patients infected with COVID-19 used to evaluate infection severity. The aim of this study is to investigate the application of the COVID-19 Reporting and Data System (CO-RADS) classification in COVID-19 patients and its relation to clinical and laboratory finding. Results One hundred patients suspected to have COVID-19 infection were involved. Their age was 49.6 & PLUSMN;14.7. Fever and cough were the frequent presenting symptoms. Patients with positive PCR were significantly associated with dyspnea and higher inflammatory markers. Lymphopenia had sensitivity of 63.6% and specificity of 91.7%. Combination of PCR and lymphopenia increased both sensitivity and specificity. CT findings in relation to PCR showed sensitivity of 90.5% and specificity of 25%. CO-RADS score showed positive correlation with age and inflammatory biomarkers and negative correlation with absolute lymphocyte count (ALC). Conclusions CT finding was more prominent in older patients with COVID-19 and associated with higher inflammatory biomarkers and lower ALC which were correlated with CO-RADS score. Patients with positive PCR had more symptoms and inflammatory marker. Combination of PCR with either lymphopenia or CT finding had more sensitivity, specificity and accuracy in diagnosis

Patient Characteristics and Predictors of Pulmonary Embolism in Patients Infected with COVID - 19 in Upper Egypt.

Background: A little is known about the risk factors and predictors of pulmonary embolism (PE) in Coronavirus disease 2019 (Covid-19) infected patients. Therefore, we directed this study to investigate the predictors of PE in patients infected with Covid - 19 in Upper Egypt. Methods: We conducted a retrospective cohort study on 297 patients infected with COVID-19, aged ≥ 18 years old. Suspicion of COVID-19 infection was based on the World Health Organization (WHO) criteria and confirmed by nasal and pharyngeal swab for real-time reverse transcriptase-polymerase chain reaction (RT-PCR) analysis. The patient was also determined to have COVID-19 when CT results that were thought to be typical for COVID-19 and clinical data that were compatible were present. Results: PE was diagnosed in 18.2% of patients. We found that the incidence of PE was significantly higher in older patients, females, those with higher BMI, hypertensive patients, diabetics, and patients with co-morbidities. Also, PE was significantly higher in patients presented with dyspnea, chest pain, longer duration of symptoms at hospital admission, and lower oxygen concentration. The mean serum Hb level, platelet count, TLC and absolute lymphocytic count were markedly reduced in those who had PE. All the patients who developed PE had a CO-RADS scale five on their CT chest scan. Age > 65, BMI > 25, DM, and associated co-morbidities were the independent patients' characteristics associated with the development of PE after the multivariate regression analysis. Conclusion: PE is a common complication of Covid 19 infection. PE is associated with a variety of clinical and laboratory parameters in univariate analysis, but age > 65, BMI > 25, DM, and associated co-morbidities were the independent patients' characteristics associated with the development of PE in those infected with Covid-19.

Comparison of first admission hemogram parameters and chest computed tomography findings of pediatric COVID-19 patients Blood parameters of pediatric COVID-19 patients

Aim: We use computed tomography, which is one of the frequently used imaging tests, both as a disease diagnosis method and to follow the clinical course in COVID-19 patients. This also means radiation exposure. Radiation exposure, especially in pediatric patients, can cause life-threatening diseases. Is there a blood parameter that will reduce this undesirable event and allow estimation of computed tomography findings? Are hemogram analysis, one of the most commonly used blood tests, and tomography findings of the disease related? We designed this study based on the questions. Material(s) and Method(s): Among the patients under the age of 18 who applied to the emergency department, those with a positive reverse transcription-polymerase chain reaction (RT-PCR) and chest CT and hemogram were included in the study. Chest CT findings were classified according to the CO-RADS classification. We compared the CO-RADS classification with hemogram parameters and the ratios of these parameters. Result(s): Platelet-to-lymphocyte ratio (PLR) rates were found to be significantly lower as imaging findings became more severe (<0.05). The ratio of MedianPlatelet Volume and Platelet (MPV/Plt) was found to be significantly higher as the imaging findings worsened (p<0.05). When the relationship between laboratory parameters according to imaging groups in our study was evaluated, there was a moderate negative correlation between lymphocyte and platelet levels and imaging findings (p<0.05). A moderate positive correlation with the monocyte level was found (p<0.05). Discussion(s): For the CO-RADS classification, it can be said that the patient was established to classify possible COVID-19 patients only according to chest CT. There is no study in the literature on the classification of pediatric patients with RT-PCR positive definite COVID-19 according to chest CT scans and the comparison of laboratory findings of patients with this classification. The combination of laboratory parameters and CO-RADS classification will guide clinicians in pediatric COVID-19 patient management.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Chest CT diagnostic potential as a tool for early detection of suspected COVID-19 cases in pandemic peaks.

INTRODUCTION: The emergence of severe acute respiratory syndrome coronavirus disease (COVID-19) in China at the end of 2019 caused a massive global outbreak that has become a major public health issue. AIM: Our aim was to investigate the diagnostic potential of chest CT in screening patients suspected of having COVID-19 in high-prevalence settings. MATERIALS AND METHODS: This is a real-life, prospective, observational study involving 260 patients. All patients received chest CT scan at the emergency department (ED) of Kaspela University Hospital, Plovdiv, Bulgaria and RT-PCR testing for suspected COVID-19 from March 27 to December 31, 2020. COVID-19 likelihood was assessed by assigning each CT scan to a particular category of the COVID-19 Reporting and Data System (CO-RADS). IBM SPSS v. 26 was used to process the data. RESULTS: The male-to-female distribution ratio was 1.4:1 - 150 (57.7%) males vs. 110 (42.3%) females (p=0.014). The median age was 55 yrs (range 46-65 yrs). Discharged patients were 247 (95.0%), the rest died in the COVID-19 intensive care unit. Males were 4.13 times more likely to be diagnosed with CO-RADS≥3 score than females. Increasing age was associated with an increased likelihood of being classified with higher CO-RADS scores. The ROC curves analysis demonstrated that CO-RADS ≥3 was the optimal cutoff for discrimi-nating between a positive and negative PCR (Youden's index J=0.67), with an AUC of 0.825 (95% CI 0.72-0.93), sensitivity of 91.9% (95% CI 87.7%-95.1%), specificity of 75.0% (95% CI 53.3%-90.2%) and accuracy of 76.4% (95% CI 70.7%-81.4%). CONCLUSIONS: The results of this study reveal that a CT examination can provide a quick and accurate diagnosis of patients with sus-pected COVID-19 infection, whereas the PCR test is time-consuming, and the delay in receiving results can be substantial when the incidence curve begins to grow rapidly.

Clinical Dilemma of Diabetic Ketoacidosis and COVID-19 Infection

The COVID-19 Pneumonia with diabetic ketoacidosis is a dreadful health condition. Diabetic ketoacidosis is one of the severe metabolic complications and it can be precipitated by infection. We presented a case of 48 years female with no known comorbidities who presented with COVID-19 symptoms and with Diabetic Ketoacidosis. The case presented with elevated inflammatory markers, high anion gap metabolic acidosis with type I respiratory failure. During admission, the oxygen saturation had marked drop, later her improvement was steady followed by gradual tapering of the oxygenation. Marked improvement was noticed in the subsequent follow-up. COVID-19 infection can be precipitated by preexisting diabetes or newly diagnosed diabetes and the severity of COVID-19 infection is more pronounced in patients with diabetes mellitus, thus should be managed timely and accordingly. The scarce studies among the COVID-19 cases with diabetic ketoacidosis reflect the need for further studies for the availability of a wider range of information. Copyright © 2021, Kathmandu University. All rights reserved.

Chest Computed Tomography Is an Efficient Method for Initial Diagnosis of COVID-19: An Observational Study.

Coronavirus disease (COVID-19) is an infectious disease that can lead to pneumonia, pulmonary oedema, acute respiratory distress syndrome, multiple organ and system dysfunction, and death. This study aimed to verify the efficacy of chest computed tomography (CT) for the initial diagnosis of COVID-19. This observational, retrospective, cross-sectional study included 259 individuals who underwent clinical evaluation, blood collection, chest CT, and a reverse transcription polymerase chain reaction (RT-PCR) diagnostic test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during their course of treatment at a reference hospital in Belém, Pará, Brazil between April and June 2020. Inclusion criteria were flu-like symptoms in adults of both sexes. Individuals with an inconclusive COVID-19 molecular test or who had artifacts in the chest CT images were excluded. Parametric data were analyzed using Student-t-test and non-parametric data were analyzed using average test and Fisher exact test. Participants were divided into two groups: Group 1 (COVID-19 positive), n = 211 (124 males, 87 females), 51.8 ± 17.9 years old and Group 2 (COVID-19 negative), n = 48 (22 males, 26 females), 47.6 ± 18.6 years old. Most frequent symptoms were cough [Group 1 n = 199 (94%)/Group 2 n = 46 (95%)], fever [Group 1 n = 154 (72%)/Group 2 n = 28 (58%)], myalgia [Group 1 n = 172 (81%)/Group 2 n = 38 (79%)], dyspnoea [Group 1 n = 169 (80%) / Group 2 n = 37 (77%)], headache [Group 1 n = 163 (77%)/Group 2 n = 32 (66%)], and anosmia [Group 1 n = 154 (73%)/Group 2 n = 29 (60%)]. Group 1 had a higher proportion of ground-glass opacity [Group 1 n = 175 (83%)/Group 2 n = 24 (50%), 0.00], vascular enhancement sign [Group 1 n = 128 (60%)/Group 2 n = 15 (31%), 0.00], septal thickening [Group 1 n = 99 (47%)/Group 2 n = 13 (27%), 0.01], crazy-paving pattern [Group 1 n = 98 (46%) / Group 2 n = 13 (27%), 0.01], consolidations [Group 1 n = 92 (43%)/Group 2 n = 8 (16%), 0.00], and CO-RADS 4 and 5 [Group 1 n = 163 (77.25%)/Group 2 n = 24 (50%), 0.00] categories in chest CT. Chest CT, when available, was found to be an efficient method for the initial diagnosis and better management of individuals with COVID-19.

Immune checkpoint inhibitor-related pneumonitis and COVID-19: a case-matched comparison of CT findings.

OBJECTIVES: To compare the radiological findings of immune checkpoint inhibitor-related pneumonitis (IRP) and COVID-19 pneumonia, evaluating the potential of the CO-RADS score to differentiate between them. METHODS: Two readers blindly reviewed chest CTs from age- and sex-matched groups of 33 patients with IRP and 33 patients with COVID-19 pneumonia. Each examiner evaluated the presence of 13 CT features, semiquantitatively scored lung involvement, and assigned a CO-RADS score. Inter-reader reliability in the assessment of CT features and CO-RADS categories was evaluated with Cohen's κ. Distribution differences between groups were evaluated with the χ2, Fisher's, and Mann-Whitney U tests. RESULTS: Substantial or higher inter-reader reliability was found in CO-RADS assignments (κ = 0.664) and in the evaluation of CT features (κ ≥ 0.638), among which the sole feature found to significantly differentiate IRP from COVID-19 pneumonia was unilateral presentation (p < 0.001). Lung involvement semiquantitative scores and CO-RADS scores were significantly higher (p < 0.001) in COVID patients (median involvement score 4, IQR 4-6; median CO-RADS score 5, IQR 4-5) than in IRP patients (median involvement score 2.5, IQR 2-4; median CO-RADS score 3, IQR 3-4) but exploratory analysis of CO-RADS specificity revealed comparatively low values, ranging between 51.5% (Reader 1) and 54.6% (Reader 2). CONCLUSIONS: CT features of IRP and COVID-19 pneumonia frequently overlap, save for the extent of lung involvement and bilaterality. In the current SARS-CoV-2 pandemic, the low specificity of the CO-RADS score for the differential diagnosis of COVID-19 pneumonia and IRP may prompt to reconsider the role of imaging in IRP work-up.

Peripheral blood cell anomalies in COVID-19 patients in the United Arab Emirates: A single-centered study.

Introduction: In this study, we aimed at exploring the morphologic and quantitative abnormalities in the peripheral blood counts of coronavirus disease 2019 (COVID-19) patients. Methods: A cohort of 131 COVID-19 patients was recruited at University Hospital Sharjah (UHS), UAE. Their peripheral blood smears were examined for morphological evaluation. Also, their clinical laboratory investigations and radiological findings were retrieved from the medical records. Our cohort consisted of 63 males and 68 females with an age of 63.6 ± 18.6 years. Results: The presence of atypical lymphocytes was observed in around 80% of the recruited COVID-19 patients. Further, monocytes with toxic cytoplasmic vacuoles were identified in 55% of the cases. Neutrophil-associated changes, including pseudo-Pelger-Huët, bands, and long nuclear endoplasm, were reported in around 25-35% of the patients. RBCs associated changes such as microcytic and hypochromic RBCs, as well as targetoid, dacrocytes, ovalocytes, echinocytes/burr cells, and schistocytes, were described. According to disease severity, RBCs chromicity was found to be significantly different between stable and critical patients. COVID-19 patients with CO-RADS 5 showed a similar change in RBCs as well as a decrease in the neutrophils with hypogranular cytoplasm. Conclusion: Peripheral blood smear assessment in COVID-19 patients could provide information about the disease state and pulmonary involvement.

Clinical, laboratory and high-resolution computed tomography (HRCT) thorax profile of reverse transcription polymerase chain reaction (RT-PCR) negative COVID-19 suspects with moderate to severe disease.

BACKGROUND: Diagnostic dilemma arises when patients with clinical suspicion of COVID-19 disease having moderate-to-severe respiratory symptoms yield negative result for COVID-19 in reverse transcription polymerase chain reaction (RT-PCR). This study evaluated the clinical, laboratory and HRCT thorax findings among RT-PCR-negative COVID-19 suspects with moderate-to-severe disease. MATERIALS AND METHODS: A hospital-based retrospective observational study was conducted between July 2021 to December 2021, among 60 moderate and severe symptomatic COVID-19 suspects admitted in the severe acute respiratory illness (SARI) ward and intensive care unit (ICU), who were negative for COVID-19 in RT-PCR. Data were abstracted from the medical records section of the hospital using a predesigned data abstraction form and presented by descriptive statistics. RESULTS: Mean age of study participants was 55.5 years (SD 14.1 years), and majority were males (n = 43, 71.7%). Common presenting symptoms were fever (n = 60, 100%), dyspnea (n = 57, 95%), and cough (n = 54, 90%). The common laboratory findings were rise of C-reactive protein (n = 60, 100%), NLR (n = 49, 81.7%), d-dimer (n = 47, 78.3%), ferritin (n = 46, 76.7%), and LDH (n = 40, 66.7%). HRCT scan of thorax revealed ground glass opacities with or without consolidations located bilaterally with diffuse or peripheral distribution, interlobar septal thickening (n = 43, 74.1%), vascular thickening (n = 35, ≥58.3%), and sub-pleural lines (n = 32, 53.3%). Median CT-SS value was 15 (IQR 11-19), and majority (n = 56, 93.3%) belonged to CO-RADS ≥4. CONCLUSION: Diagnosis of COVID-19 can be presumed in RT-PCR-negative suspected COVID-19 patients with moderate-to-severe disease, with marked rise of inflammatory markers and HRCT revealing typical findings of COVID-19 pneumonia.

[Diagnostic accuracy of the automatic quantification software in patients with suspected COVID-19 of the Instituto Nacional de Cardiology Ignacio Chávez]. / Precisión diagnóstica del software de cuantificación automática en pacientes con sospecha de COVID-19 del Instituto Nacional de Cardiología Ignacio Chávez.

Objetivos: Establecer la precisión diagnóstica por tomografía computarizada (TC) de la probabilidad de neumopatía por enfermedad por coronavirus 2019 (COVID-19), dada por el sistema de inteligencia artificial (IA) diseñado por Siemens, y el resultado de la evaluación cualitativa CO-RADS (COVID-19 Reporting and Data System) con el estándar de referencia reacción en cadena de la polimerasa transcriptasa inversa (RT-PCR), entregando así la experiencia de nuestra institución. Métodos: Se realizó un estudio observacional, comparativo y retrolectivo en 192 pacientes adultos con sospecha de infección por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) que contaban con prueba PCR. Se obtuvo la información de precisión diagnóstica luego de comparar el estándar de referencia (RT- PCR) con el CO-RADS realizado por los observadores y la probabilidad de COVID-19 que arrojaron las imágenes de TC mediante la IA. Resultados: La comparación de la probabilidad de COVID-19 obtenida por la IA vs. la RT-PCR para SARS-CoV- 2 generó un AUC ROC de 0.774 (IC: 0.69-0.81) con p = 0.0001. La probabilidad de COVID-19 tuvo una precisión aceptable, con un buen valor predictivo positivo del 87.80%, pero con un pobre valor predictivo negativo del 58.80%. La variable CO-RADS vs. PCR obtuvo una mayor precisión con valores de sensibilidad y especificidad del 91.80 y 88.7% respectivamente. Conclusión: La comparación entre los resultados obtenidos por la IA y por la variable CO-RADS mostró mayor efectividad en esta última, sin embargo se logró documentar el alto impacto que tiene el sistema de cuantificación automática en la evaluación de estos pacientes, ya que permite agilizar la valoración del radiólogo y funciona como complemento en casos de dudas diagnósticas.

Chest X-ray Findings and Hyponatremia in COVID-19 Pneumonia Patients.

BACKGROUND: The World Health Organization declared the coronavirus disease-2019 (COVID-19) a pandemic in December 2019. COVID-19 can affect most organs of the body but predominantly affects the lungs. Chest infection is associated with hyponatremia primarily due to inappropriate ectopic secretion of antidiuretic hormone. We conducted a six-month retrospective observational study to evaluate the relationship between chest X-ray (CXR) radiological findings and serum sodium levels. Our secondary goal was to assess the relationship between CXR findings and patient outcomes. AIM OF THE STUDY: To assess the relationship between the initial CXR findings, hyponatremia severity, and outcome in COVID-19 infected patients. MATERIALS AND METHODS: We conducted a retrospective review of CXR findings of COVID-19 patients aged > 18 years. The patients were healthy and had no history of hyponatremia before COVID-19 infection. All recruited patients were admitted to one of four hospitals in Qatar (Hazm Mebaireek General Hospital, Communicable Disease Center, and all affiliated quarantine centers managed under the Communicable Disease Centre, Mesaieed Hospital, and Ras Laffan Hospital) between March and June 2020. We excluded patients with factors that contributed to hyponatremia. Three score grades were established to describe the CXR findings. Patients were divided into three groups by the principal researcher according to their serum sodium levels. A radiologist evaluated the CXR findings with the patient and group information obscured. The principal researcher collected the X-ray scores for analysis with the serum sodium levels. We used SPSS for Windows, Version 15.0. (SPSS Inc., Chicago, IL, USA) and STATA Package Version 12.0 (StataCorp, College Station, TX, USA) to analyze the data. A p-value ≤  0.05 was considered significant. RESULTS: A total of 414 CXR patients with COVID-19 were recruited; 275 patients had hyponatremia and 139 had normal sodium levels and were used as the control group. Patients with normal serum sodium and hyponatremia were classified into three categories based on the CXR findings. Grade 0 (95), Grade 1 (43), and Grade 2 (137) hyponatremic patients were reported. The mean sodium levels were 133.6, 131.3, and 127.2 mmol/L for Grades 0, 1, and 2, respectively (p < 0.001). More than 95% of the patients who developed hyponatremia were >30 years. Moderate and severe hyponatremia was more prevalent in patients with Grade 1 or Grade 2 CXR findings and were >30 years. CONCLUSION: Serum sodium levels in COVID-19 patients correlated well with the severity of the CXR findings observed at the early disease stage. Furthermore, simple CXR scores can be used to identify COVID-19 patients at a higher risk of hyponatremia, length of hospital stay, medical care support type, and mortality.

Comparison of first admission hemogram parameters and chest computed tomography findings of pediatric COVID-19 patients

Aim : We use computed tomography, which is one of the frequently used imaging tests, both as a disease diagnosis method and to follow the clinical course in COVID-19 patients. This also means radiation exposure. Radiation exposure, especially in pediatric patients, can cause life-threatening diseases. Is there a blood parameter that will reduce this undesirable event and allow estimation of computed tomography findings? Are hemogram analysis, one of the most commonly used blood tests, and tomography findings of the disease related? We designed this study based on the questions. Material and Methods: Among the patients under the age of 18 who applied to the emergency department, those with a positive reverse transcription-polymerase chain reaction (RT-PCR) and chest CT and hemogram were included in the study. Chest CT findings were classified according to the CO-RADS classification. We compared the CO-RADS classification with hemogram parameters and the ratios of these parameters. Results: Platelet-to-lymphocyte ratio (PLR) rates were found to be significantly lower as imaging findings became more severe (<0.05). The ratio of MedianPlatelet Volume and Platelet (MPV/Plt) was found to be significantly higher as the imaging findings worsened (p<0.05). When the relationship between laboratory parameters according to imaging groups in our study was evaluated, there was a moderate negative correlation between lymphocyte and platelet levels and imaging findings (p<0.05). A moderate positive correlation with the monocyte level was found (p<0.05). Discussion: For the CO-RADS classification, it can be said that the patient was established to classify possible COVID-19 patients only according to chest CT. There is no study in the literature on the classification of pediatric patients with RT-PCR positive definite COVID-19 according to chest CT scans and the comparison of laboratory findings of patients with this classification. The combination of laboratory parameters and CO-RADS classification will guide clinicians in pediatric COVID-19 patient management.

Retrospective comparison of the sociodemographic, clinical, radiological and laboratory findings of probable and definitive COVID-19 cases

Purpose: We aimed to determine the number of possible and precise cases among the patients hospitalized in our clinic and to examine the differences between the sociodemographic, clinical, chest CT and laboratory findings of these two groups. Materials and methods: The data of all patients hospitalized at the department of pulmonology service between March 13 as the date of the first case and May 5 with probable and definitive COVID-19 were evaluated retrospectively. Patient ward files and hospital data management system were examined. Chest CT findings of the patients were interpreted by two radiologists separately according to the CO-RADS classification blinded to clinical and PCR test results of the patients and then consensus was achieved with joint evaluation. Results: A total of 99 patients, 38 RT-PCR positive, 61 RT-PCR negative, were included in the study. Neutrophil-to-lymphocyte ratio(NLR) values and lymphocyte count were lower at a statistically significant level in positive patients(respectively p=0.038, p=0.041). Similarly, CRP values were observed to be lower at a statistically significant level in positive patients(p=0.029). When the patients with RT-PCR(+) and RT-PCR(-) but with positive chest CT findings according to CO-RADS staging were compared, the values of WBC, LDH and CRP level was observed to be high were statistically significant in the group with RT-PCR(-) but positive chest CT findings. Conclusion: In the presence of clinical findings, without waiting for RT-PCR positivity, the probability of COVID-19 disease will increase if there are elevated WBC, CRP and LDH findings with CT findings(stage 4-5 according to CO-RADS).Alternate :Amaç: Kliniğimizde takip edilen kesin COVID-19 vakalar ile olası COVID-19 vakalar arasındaki sosyodemografik, klinik, BT ve laboratuvar bulgularının farklarını incelemeyi amaçladık. Gereç ve yöntem: Ílk vaka tarihi olan 13 Mart 2020 ile 5 Mayıs 2020 arasında, olası ve kesin COVID-19 tanısıyla Göğüs Hastalıkları servisinde yatan tüm hastaların verileri retrospektif olarak incelendi. Hastaların toraks BT bulguları, hastaların klinik ve PCR test sonuçlarına körleştirilen iki farklı radyolog tarafından CO-RADS sınıflamasına göre ayrı ayrı yorumlandı ve daha sonra ortak değerlendirme ile konsensüs sağlandı. Klinik, laboratuvar ve görüntüleme bulguları ile çoklu regresyon modellemesi yapıldı. Bulgular: Çalışmaya 38 RT-PCR pozitif, 62 RT-PCR negatif olmak üzere toplam 99 hasta dahil edildi. Nötrofil/lenfosit oranı (NLR) ve lenfosit sayısı, RT-PCR pozitif hastalarda istatistiksel olarak anlamlı düzeyde daha düşüktü (sırasıyla p = 0.038, p = 0.041). Benzer şekilde, pozitif hastalarda CRP değerlerinin istatistiksel olarak anlamlı düzeyde düşük olduğu gözlendi (p = 0.029). RT-PCR (+) ile RT-PCR (-) ancak toraks BT ‘si CO-RADS evrelemesine göre pozitif olan hastaların karşılaştırmalarında, RT-PCR (-) ancak toraks BT pozitif olan grupta anlamlı şekilde WBC, LDH ve CRP değerlerinin daha yüksek olduğu görüldü (sırasıyla p=0.001, p=0.033, p=0.004). Öksürük, WBC, LDH, CRP değerleri ve toraks BT skoru kullanılarak geliştirilen modelde en yüksek AUC değeri elde edilmiş, RT-PCR pozitifliğini ayırt etmede başarılı olabileceği görüldü (AUC=0.725, 95% CI: 0.619-0.830) Sonuç: Klinik bulgular varlığında RT-PCR pozitifliğini beklemeden COVID-19 uyumlu BT bulguları (CO-RADS'ye göre evre 4-5) ile yüksek WBC, CRP VE LDH varsa COVID-19 olasılığı artacaktır.

Automated COVID-19 Grading With Convolutional Neural Networks in Computed Tomography Scans: A Systematic Comparison.

Amidst the ongoing pandemic, the assessment of computed tomography (CT) images for COVID-19 presence can exceed the workload capacity of radiologists. Several studies addressed this issue by automating COVID-19 classification and grading from CT images with convolutional neural networks (CNNs). Many of these studies reported initial results of algorithms that were assembled from commonly used components. However, the choice of the components of these algorithms was often pragmatic rather than systematic and systems were not compared to each other across papers in a fair manner. We systematically investigated the effectiveness of using 3-D CNNs instead of 2-D CNNs for seven commonly used architectures, including DenseNet, Inception, and ResNet variants. For the architecture that performed best, we furthermore investigated the effect of initializing the network with pretrained weights, providing automatically computed lesion maps as additional network input, and predicting a continuous instead of a categorical output. A 3-D DenseNet-201 with these components achieved an area under the receiver operating characteristic curve of 0.930 on our test set of 105 CT scans and an AUC of 0.919 on a publicly available set of 742 CT scans, a substantial improvement in comparison with a previously published 2-D CNN. This article provides insights into the performance benefits of various components for COVID-19 classification and grading systems. We have created a challenge on grand-challenge.org to allow for a fair comparison between the results of this and future research.

Comparison of Initial CT Findings and CO-RADS Stage in COVID-19 Patients with PCR, Inflammation and Coagulation Parameters in Diagnostic and Prognostic Perspectives.

Objectives: This study aims to determine whether COVID-19 patients with different initial reverse transcriptase-polymerase chain reaction (RT-PCR), computed tomography (CT) and laboratory findings have different clinical outcomes. Materials and Methods: In this multi-center retrospective cohort study, 895 hospitalized patients with the diagnosis of COVID-19 were included. According to the RT-PCR positivity and presence of CT findings, the patients were divided into four groups. These groups were compared in terms of mortality and need for intensive care unit (ICU). According to the COVID-19 Reporting and Data System (CO-RADS), all patients' CT images were staged. Multivariate binary logistic regression analysis was used to examine the relationship between CO-RADS and predictive inflammation and coagulation parameters. Results: RT-PCR test positivity was 51.5%, the CT finding was 70.7%, and 49.7% of the patients were in the CO-RADS 5 stage. The need for ICU and mortality rates was higher in the group with only CT findings compared to the group with only RT-PCR positivity, (14.9% vs. 4.0%, p < 0.001; 9.3% vs. 3.3%, p > 0.05; respectively). Mortality was 3.27 times higher in patients with CO-RADS 4 compared to those with CO-RADS 1-2. Being in the CO-RADS 4 stage and LDH were discovered to be the most efficient parameters in determining mortality risk. Conclusion: Performing only the RT-PCR test in the initial evaluation of patients in SARS-CoV-2 infection may lead to overlooking groups that are more at risk for severe disease. The use of a chest CT to perform CO-RADS staging would be beneficial in terms of providing both diagnostic and prognostic information.

Investigation of the relationship of CO-RADS and CT patterns with laboratory parameters in COVID-19 patients and a new perspective on the total CT scoring system.

BACKGROUND: It is important to determine the correlation of the CO-RADS classification and computed tomography (CT) patterns of the lung with laboratory data. To investigate the relationship of CO-RADS categories and CT patterns with laboratory data in patients with a positive RT-PCR test. We also developed a structured total CT scoring system and investigated its correlation with the total CT scoring system. METHOD: The CT examinations of the patients were evaluated in terms of the CO-RADS classification, pattern groups and total CT score. Structured total CT score values were obtained by including the total CT score values and pattern values in a regression analysis. The CT data were compared according to the laboratory data. RESULTS: A total of 198 patients were evaluated. There were significant differences between the CO-RADS groups in terms of age, ICU transfer, oxygen saturation, creatinine, LDH, D-dimer, high-sensitivity cardiac troponin-T (hs-TnT), CRP, structured total CT score values, and total CT score values. A significant difference was also observed between the CT pattern groups and oxygen saturation, creatinine and CRP values. When the structured total CT score values and total CT score values were compared they were observed to be correlated. CONCLUSIONS: Creatinine can be considered as an important marker for the CO-RADS and pattern classifications in lung involvement. LDH can be considered as an important marker of parenchymal involvement, especially bilateral and diffuse involvement. The structured total CT scoring system is a new system that can be used as an alternative.

Diagnostic performance and inter-observer variability of CO-RADS in the triage of patients with suspected COVID-19 infection: initial experience in Zagazig University Hospital.

Purpose: In many healthcare settings in developing nations, multislice computed tomography (MSCT) imaging may be the only available diagnostic modality for patients with suspected COVID-19 infection, due to a shortage of laboratory kits. This study aimed to evaluate the diagnostic performance and interobserver variability of CO-RADS (COVID-19 Reporting and Data System) in the triage of patients with suspected COVID-19 infection in Zagazig University Hospital. Material and methods: This study included 2500 patients with suspected COVID-19 infection, mean age 60.61 years ± 13.89. 61.4% were male. Unstable patients requiring urgent invasive ventilation, acute coronary syndrome patients, pregnant females, and patients with RT-PCR results available prior to MSCT were excluded from this study. RT-PCR was performed in all patients included in the study. Results: Fever and dry cough were the most common clinical symptoms, detected in 80.16% and 52.00%, respectively. The most common comorbidities were cardiovascular diseases, followed by chronic lung disease and diabetes, found in 27.36%, 22.80%, and 18.00%, respectively. Of the 1500 RT-PCR-positive patients, 40% had CO-RADS score 5, while 3.4% had CO-RADS score 1. Of the 1000 RT-PCR-negative patients, 36% had CO-RADS score 2 and 1% were scored as CO-RADS 5. There was excellent agreement in the studied patients as the weighted κ value was 0.846, which was more pronounced at CO-RADS 5 (24.40%). The sensitivity of CO-RADS was higher in the 2nd scenario (83.27% vs. 55.27%) while the specificity was higher in the 1st scenario (95% vs. 65%). Conclusion: The CO-RADS scoring system is a sensitive and specific method that can help in the diagnosis of COVID-19 during the peak of the COVID-19 pandemic. CO-RADS is a triage test in resource-constrained environments, assisting in the optimization of RT-PCR tests, isolation beds, and intensive care units.

Hepatic steatosis as an independent risk factor for severe disease in patients with COVID-19: A computed tomography study.

Background and Aim: Hepatic steatosis (HS) is associated with diabetes, hypertension, and obesity, comorbidities recently related to COVID-19 severity. Here, we assessed if tomographic HS is also a risk factor for severe COVID-19 pneumonia. Methods: We included 213 patients with a positive real time polymerase chain reaction (RT-PCR) test and chest computed tomography (CT) from an out-hospital facility and a hospital. We obtained information on demographics; weight; height; smoking history; diabetes; hypertension; and cardiovascular, lung, and renal disease. Two radiologists scored the CO-RADs system (COVID-19 Reporting and Data System) (1 = normal, 2 = inconsistent, 3-4 = indeterminate, and 5 = typical findings) and the chest CT severity index (≥20 of 40 was considered severe disease). They evaluated the liver-to-spleen ratio (CTL/S) and defined tomographic steatosis as a CTL/S index ≤0.9. We used descriptive statistics, χ2 and t student tests, logistic regression, and reported odds ratio (OR) with 95% confidence interval (CI). Results: Of the patients, 61% were men, with a mean age of 51.2 years, 48.3% were CO-RADs 1 and 51.7% CO-RADs 2-5. Severe tomographic disease was present in 103 patients (48.4%), all CO-RADs 5. This group was older; mostly men; and with a higher prevalence of obesity, hypertension, diabetes, and HS (69.9 vs 29%). On multivariate analysis, age (OR 1.058, 95% CI 1.03-1.086, P < 0.0001), male gender (OR 1.9, 95% CI 1.03-3.8, P = 0.04), and HS (OR 4.9, 95% CI 2.4-9.7, P < 0.0001) remained associated. Conclusion: HS was independently associated with severe COVID pneumonia. The physiopathological explanation of this finding remains to be elucidated. CTL/S should be routinely measured in thoracic CT scans in patients with COVID-19 pneumonia.

Electrocardiographic QRS axis shift, rotation and COVID-19.

Background: In patients with coronavirus disease-2019 (COVID-19), severe dyspnea is the most dramatic complication. Severe respiratory difficulties may include electrocardiographic frontal QRS axis rightward shift (Rws) and clockwise rotation (Cwr). Aim: This study investigated the predictability of advanced lung tomography findings with QRS axis shift and rotation. Patients and Methods: This was a retrospective analysis of 160 patients. Patients were divided into the following two groups: normal (n = 80) and low (n = 80) oxygen saturation. These groups were further divided into four groups according to the rightward and leftward axis shift (Lws) on the electrocardiographic follow-up findings. These groups were compared in terms of electrocardiographic rotation (Cwr, counterclockwise rotation, or normal transition), tomographic stage (CO-RADS5(advanced)/CO-RADS1-4), electrocardiographic intervals, and laboratory findings. Results: In patients with low oxygen saturation, the amount of QRS axis shift, Cwr, and tomographic stage were significantly higher in the Rws group than in the Lws group. There were no differences in the above parameters between the Rws and Lws groups in patients with normal oxygen saturation. Logistic regression analysis revealed that the presence of Cwr and Rws independently increased the risk of CO-RADS5 by 18.9 and 4.6 fold, respectively, in patients with low oxygen saturation. Conclusion: In COVID-19 patients who have dyspnea with low oxygen saturation, electrocardiographically clockwise rotation with a rightward axis shift demonstrated good sensitivity (80% [0.657-0.943]) and specificity (80% [0.552->1]) for predicting advanced lung tomographic findings. ClinicalTrialsgov Identifier: NCT04698083.

FEATURES OF COVID-19 PNEUMONIA DIAGNOSIS.

OBJECTIVE: The aim: The purpose of the study is to evaluate the clinical and laboratory features of COVID-19 pneumonia course, the diagnostic significance of laboratory methods for detecting the SARS-CoV-2 virus based on a retrospective analysis. PATIENTS AND METHODS: Materials and methods: We studied the case histories of 96 patients who were treated at the Municipal Non-Profit Enterprise "Lviv Clinical Emergency Care Hospital" for the period from 01/07/2020 to 31/07/2020 with a diagnosis of pneumonia, which corresponded to 5 points on the CO -RADS scale. We analyzed the clinical and laboratory signs of COVID-19 pneumonia depending on the results of the Quantitative Reverse Transcription Polymerase Chain Reaction (RT-qPCR) tests to the SARS-CoV-2 infection (positive result of RT-qPCR was observed in the first group and negative - in the second group). RESULTS: Results: In both groups, no clinical differences in the course of the disease were found. The most common symptoms of coronavirus pneumonia were found with the same frequency in both patients with a laboratory-confirmed diagnosis and without it. A positive PCR test in nasopharyngeal and oropharyngeal swabs was more often detected during testing up to 10 days, in patients over 60 years of age and in severe COVID-19. CONCLUSION: Conclusions: The COVID-19 pneumonia diagnosis should be based on a combination of clinical, laboratory, and radiological signs of this disease. A negative PCR test result does not exclude the diagnosis of coronavirus disease. The test results are influenced by the timing of the sampling, the severity of the disease and the age of the patients.