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3.
Med Sci Monit ; 26: e925047, 2020 Jul 28.
Article in English | MEDLINE | ID: covidwho-689085

ABSTRACT

BACKGROUND The aim of this study was to describe the clinical characteristics and outcomes of patients with coronavirus disease 2019 (COVID-19) and compare these parameters in an elderly group with those in a younger group. MATERIAL AND METHODS This retrospective, single-center observational study included 69 hospitalized patients with laboratory-confirmed COVID-19 from a tertiary hospital in Wuhan, China, between January 14, 2020, and February 26, 2020. Epidemiological, demographic, clinical, and laboratory data, as well as treatments, complications, and outcomes were extracted from electronic medical records and compared between elderly patients (aged ≥60 years) and younger patients (aged <60 years). Patients were followed until March 19, 2020. RESULTS Elderly patients had more complications than younger patients, including acute respiratory distress syndrome (ARDS; 9/25, 36% vs. 5/44, 11.4%) and cardiac injury (7/25, 28% vs. 1/44, 2.3%), and they were more likely to be admitted to the intensive care unit (6/25, 24% vs. 2/44, 4.5%). As of March 19, 2020, 60/69 (87%) of the patients had been discharged, 6/69 (8.7%) had died, and 3/69 (4.3%) remained in the hospital. Of those who were discharged or died, the median duration of hospitalization was 13.5 days (interquartile range, 10-18 days). CONCLUSIONS Elderly patients with confirmed COVID-19 were more likely to develop ARDS and cardiac injury than younger patients and were more likely to be admitted to the intensive care unit. In addition to routine monitoring and respiratory support, cardiac monitoring and supportive care should be a focus in elderly patients with COVID-19.


Subject(s)
Age Factors , Coronavirus Infections/epidemiology , Heart Diseases/epidemiology , Pandemics , Pneumonia, Viral/epidemiology , Respiratory Distress Syndrome, Adult/epidemiology , Acute Kidney Injury/epidemiology , Acute Kidney Injury/etiology , Adult , Aged , Aged, 80 and over , Betacoronavirus , China/epidemiology , Combined Modality Therapy , Coronavirus Infections/blood , Coronavirus Infections/complications , Coronavirus Infections/drug therapy , Coronavirus Infections/therapy , Heart Diseases/etiology , Humans , Inpatients , Intensive Care Units/statistics & numerical data , Length of Stay/statistics & numerical data , Male , Middle Aged , Multiple Organ Failure/epidemiology , Multiple Organ Failure/etiology , Palliative Care/statistics & numerical data , Pneumonia, Viral/blood , Pneumonia, Viral/complications , Pneumonia, Viral/therapy , Respiratory Distress Syndrome, Adult/etiology , Retrospective Studies , Tertiary Care Centers , Treatment Outcome , Young Adult
4.
Int J Environ Res Public Health ; 17(8)2020 04 21.
Article in English | MEDLINE | ID: covidwho-688452

ABSTRACT

During an epidemic, almost all healthcare facilities restrict the visiting of patients to prevent disease transmission. For hospices with terminally ill patients, the trade-off between compassion and infection control becomes a difficult decision. This study aimed to survey the changes in visiting policy for all 76 hospice wards in Taiwan during the COVID-19 pandemic in March 2020. The altered visiting policies were assessed by the number of visitors per patient allowed at one time, the daily number of visiting slots, the number of hours open daily, and requisites for hospice ward entry. The differences in visiting policies between hospice wards and ordinary wards were also investigated. Data were collected by reviewing the official website of each hospital and were supplemented by phone calls in cases where no information was posted on the website. One quarter (n = 20) of hospice wards had different visiting policies to those of ordinary wards in the same hospital. Only one hospice ward operated an open policy, and in contrast, nine (11.8%) stopped visits entirely. Among the 67 hospice wards that allowed visiting, at most, two visitors at one time per patient were allowed in 46 (68.6%), one visiting time daily was allowed in 32 (47.8%), one hour of visiting per day was allowed in 29 (43.3%), and checking of identity and travel history was carried out in 12 wards (17.9%). During the COVID-19 pandemic, nearly all hospice wards in Taiwan changed their visiting policies, but the degree of restriction varied. Further studies could measure the impacts of visiting policy changes on patients and healthcare professionals.


Subject(s)
Coronavirus Infections/prevention & control , Hospices/organization & administration , Organizational Policy , Pandemics/prevention & control , Patients' Rooms/organization & administration , Pneumonia, Viral/prevention & control , Visitors to Patients , Betacoronavirus , Coronavirus Infections/epidemiology , Female , Health Care Surveys , Hospices/statistics & numerical data , Humans , Infection Control , Male , Pneumonia, Viral/epidemiology , Surveys and Questionnaires , Taiwan
5.
J Infect ; 80(6): 639-645, 2020 06.
Article in English | MEDLINE | ID: covidwho-688316

ABSTRACT

OBJECTIVE: To investigate the characteristics and prognostic factors in the elderly patients with COVID-19. METHODS: Consecutive cases over 60 years old with COVID-19 in Renmin Hospital of Wuhan University from Jan 1 to Feb 6, 2020 were included. The primary outcomes were death and survival till March 5. Data of demographics, clinical features, comorbidities, laboratory tests and complications were collected and compared for different outcomes. Cox regression was performed for prognostic factors. RESULTS: 339 patients with COVID-19 (aged 71±8 years,173 females (51%)) were enrolled, including 80 (23.6%) critical, 159 severe (46.9%) and 100 moderate (29.5%) cases. Common comorbidities were hypertension (40.8%), diabetes (16.0%) and cardiovascular disease (15.7%). Common symptoms included fever (92.0%), cough (53.0%), dyspnea (40.8%) and fatigue (39.9%). Lymphocytopenia was a common laboratory finding (63.2%). Common complications included bacterial infection (42.8%), liver enzyme abnormalities (28.7%) and acute respiratory distress syndrome (21.0%). Till Mar 5, 2020, 91 cases were discharged (26.8%), 183 cases stayed in hospital (54.0%) and 65 cases (19.2%) were dead. Shorter length of stay was found for the dead compared with the survivors (5 (3-8) vs. 28 (26-29), P < 0.001). Symptoms of dyspnea (HR 2.35, P = 0.001), comorbidities including cardiovascular disease (HR 1.86, P = 0.031) and chronic obstructive pulmonary disease (HR 2.24, P = 0.023), and acute respiratory distress syndrome (HR 29.33, P < 0.001) were strong predictors of death. And a high level of lymphocytes was predictive of better outcome (HR 0.10, P < 0.001). CONCLUSIONS: High proportion of severe to critical cases and high fatality rate were observed in the elderly COVID-19 patients. Rapid disease progress was noted in the dead with a median survival time of 5 days after admission. Dyspnea, lymphocytopenia, comorbidities including cardiovascular disease and chronic obstructive pulmonary disease, and acute respiratory distress syndrome were predictive of poor outcome. Close monitoring and timely treatment should be performed for the elderly patients at high risk.


Subject(s)
Betacoronavirus/isolation & purification , Coronavirus Infections/diagnosis , Coronavirus Infections/epidemiology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/epidemiology , Aged , China/epidemiology , Comorbidity , Coronavirus Infections/mortality , Coronavirus Infections/pathology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Pandemics , Pneumonia, Viral/mortality , Pneumonia, Viral/pathology , Prognosis , Survival Analysis
6.
J Infect Dis ; 221(11): 1762-1769, 2020 05 11.
Article in English | MEDLINE | ID: covidwho-688308

ABSTRACT

BACKGROUND: In December 2019, novel coronavirus (SARS-CoV-2) pneumonia (COVID-19) was reported in Wuhan and has since rapidly spread throughout China. We aimed to clarify the characteristics and clinical significance of peripheral lymphocyte subset alteration in COVID-19. METHODS: The levels of peripheral lymphocyte subsets were measured by flow cytometry in 60 hospitalized COVID-19 patients before and after treatment, and their association with clinical characteristics and treatment efficacy was analyzed. RESULTS: Total lymphocytes, CD4+ T cells, CD8+ T cells, B cells, and natural killer (NK) cells decreased in COVID-19 patients, and severe cases had a lower level than mild cases. The subsets showed a significant association with inflammatory status in COVID-19, especially CD8+ T cells and CD4+/CD8+ ratio. After treatment, 37 patients (67%) showed clinical response, with an increase in CD8+ T cells and B cells. No significant change in any subset was detected in nonresponsive cases. In multivariate analysis, posttreatment decrease in CD8+ T cells and B cells and increase in CD4+/CD8+ ratio were indicated as independent predictors of poor efficacy. CONCLUSIONS: Peripheral lymphocyte subset alteration was associated with clinical characteristics and treatment efficacy of COVID-19. CD8+ T cells tended to be an independent predictor for COVID-19 severity and treatment efficacy.


Subject(s)
Coronavirus Infections/complications , Coronavirus Infections/physiopathology , Lymphocyte Subsets , Pneumonia, Viral/complications , Pneumonia, Viral/physiopathology , Pneumonia/etiology , Pneumonia/physiopathology , Adult , Aged , Betacoronavirus/isolation & purification , China , Coronavirus Infections/diagnosis , Coronavirus Infections/therapy , Female , Flow Cytometry , Humans , Lymphocyte Count , Lymphocyte Subsets/immunology , Male , Middle Aged , Pandemics , Pneumonia/diagnosis , Pneumonia/therapy , Pneumonia, Viral/diagnosis , Pneumonia, Viral/therapy , Prognosis , Treatment Outcome
8.
Arch Gerontol Geriatr ; 89: 104096, 2020.
Article in English | MEDLINE | ID: covidwho-688201

ABSTRACT

A pandemic of 2019 novel coronavirus (COVID-19) is an international problem and factors associated with increased risk of mortality have been reported. However, there exists limited statistical method to estimate a comprehensive risk for a case in which a patient has several characteristics and symptoms concurrently. We applied Boolean Monte Carlo method (BMCM) to the Novel Corona Virus 2019 Dataset to determine interrelation of patient's characteristics and symptoms. In the analyses, age, fever as an onset symptom, and sex were used as explanatory variables, and death as the objective variable. Among 265 patients included in the analysis, the interrelations for estimating death were determined as age "and" fever "and" sex (p < 0.0001 for both operators). This result indicates that satisfying the three conditions of age, fever, and sex concurrently may be associated with an increased risk of mortality.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Coronavirus Infections/epidemiology , Fever/virology , Humans , Italy/epidemiology , Male , Models, Statistical , Pandemics , Pneumonia, Viral/epidemiology
10.
JCI Insight ; 5(10)2020 05 21.
Article in English | MEDLINE | ID: covidwho-687860

ABSTRACT

BACKGROUNDThe severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a novel viral pneumonia (COVID-19), which is rapidly spreading throughout the world. The positive result of nucleic acid test is a golden criterion to confirm SARS-CoV-2 infection, but the detection features remain unclear.METHODSWe performed a retrospective analysis in 5630 high-risk individuals receiving SARS-CoV-2 nucleic acid tests in Wuhan, China, and investigated their characteristics and diagnosis rates.RESULTSThe overall diagnosis rate was 34.7% (1952/5630). Male (P = 0.025) and older populations (P = 2.525 × 10-39) were at significantly higher risk of SARS-CoV-2 infection. People were generally susceptible, and most cases concentrated in people of 30-79 years. Furthermore, we investigated the association between diagnosis rate and the amount of testing in 501 subjects. Results revealed a 1.27-fold improvement (from 27.9% to 35.5%) of diagnosis rate from testing once to twice (P = 5.847 × 10-9) and a 1.43-fold improvement (from 27.9% to 39.9%) from testing once to 3 times (P = 7.797 × 10-14). More than 3 testing administrations was not helpful for further improvement. However, this improvement was not observed in subjects with pneumonia (P = 0.097).CONCLUSIONAll populations are susceptible to SARS-CoV-2 infection, and male and older-aged populations are at significantly higher risk. Increasing the amount of testing could significantly improve diagnosis rates, except for subjects with pneumonia. It is recommended to test twice in those high-risk individuals whose results are negative the first time, and performing 3 tests is better, if possible.FUNDINGThis work was supported by National Mega Project on Major Infectious Disease Prevention (no. 2017ZX10103005-007) and National Key Research and Development Program of China (no. 2018YFE0204500).


Subject(s)
Clinical Laboratory Techniques , Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , Child , Child, Preschool , China/epidemiology , Clinical Laboratory Techniques/methods , Coronavirus Infections/epidemiology , Female , Humans , Incidence , Infant , Infant, Newborn , Male , Middle Aged , Molecular Diagnostic Techniques , Pandemics , Pneumonia, Viral/epidemiology , RNA, Viral/analysis , Real-Time Polymerase Chain Reaction , Retrospective Studies , Sex Factors , Young Adult
11.
Eur Rev Med Pharmacol Sci ; 24(9): 5186-5188, 2020 05.
Article in English | MEDLINE | ID: covidwho-687446

ABSTRACT

From two COVID-19-related deaths, samples of lung, heart and kidney were collected and processed for Transmission and Scanning Electron Microscopy (TEM and SEM) with the aim of identifying the virus. Virions of SARS-CoV-2 were found in all tissues by TEM and SEM, corroborating the hypothesis that the virus enters the cells of different organs. This is the first report identifying SARS-CoV-2 in different human tissues by TEM and SEM.


Subject(s)
Betacoronavirus/isolation & purification , Betacoronavirus/ultrastructure , Coronavirus Infections/virology , Heart/virology , Kidney/virology , Lung/virology , Pneumonia, Viral/virology , Aged , Aged, 80 and over , Coronavirus Infections/pathology , Female , Humans , Kidney/pathology , Lung/pathology , Male , Microscopy, Electron, Scanning , Microscopy, Electron, Transmission , Pandemics , Pneumonia, Viral/pathology
13.
Acad Emerg Med ; 27(6): 461-468, 2020 06.
Article in English | MEDLINE | ID: covidwho-686322

ABSTRACT

OBJECTIVES: Rapid and early severity-of-illness assessment appears to be important for critically ill patients with novel coronavirus disease (COVID-19). This study aimed to evaluate the performance of the rapid scoring system on admission of these patients. METHODS: A total of 138 medical records of critically ill patients with COVID-19 were included in the study. Demographic and clinical characteristics on admission used for calculating Modified Early Warning Score (MEWS) and Rapid Emergency Medicine Score (REMS) and outcomes (survival or death) were collected for each case and extracted for analysis. All patients were divided into two age subgroups (<65 years and ≥65 years). The receiver operating characteristic (ROC) curve analyses were performed for overall patients and both subgroups. RESULTS: The median [25th quartile, 75th quartile] of MEWS of survivors versus nonsurvivors were 1 [1, 2] and 2 [1, 3] and those of REMS were 5 [2, 6] and 7 [6, 10], respectively. In overall analysis, the area under the ROC curve for the REMS in predicting mortality was 0.833 (95% confidence interval [CI] = 0.737 to 0.928), higher than that of MEWS (0.677, 95% CI = 0.541 to 0.813). An optimal cutoff of REMS (≥6) had a sensitivity of 89.5%, a specificity of 69.8%, a positive predictive value of 39.5%, and a negative predictive value of 96.8%. In the analysis of subgroup of patients aged <65 years, the area under the ROC curve for the REMS in predicting mortality was 0.863 (95% CI = 0.743 to 0.941), higher than that of MEWS (0.603, 95% CI = 0.462 to 0.732). CONCLUSION: To our knowledge, this study was the first exploration on rapid scoring systems for critically ill patients with COVID-19. The REMS could provide emergency clinicians with an effective adjunct risk stratification tool for critically ill patients with COVID-19, especially for the patients aged <65 years. The effectiveness of REMS for screening these patients is attributed to its high negative predictive value.


Subject(s)
Coronavirus Infections/mortality , Hospital Mortality , Pneumonia, Viral/mortality , Adult , Age Factors , Aged , Aged, 80 and over , Betacoronavirus , Blood Pressure , Cerebrovascular Disorders/epidemiology , China , Comorbidity , Coronavirus , Critical Illness , Early Warning Score , Emergency Medicine , Female , Glasgow Coma Scale , Humans , Lung Diseases/epidemiology , Male , Middle Aged , Oxygen/metabolism , Pandemics , Prognosis , ROC Curve , Respiratory Rate , Retrospective Studies , Risk Assessment , Sensitivity and Specificity
14.
J Med Virol ; 92(6): 584-588, 2020 06.
Article in English | MEDLINE | ID: covidwho-685102

ABSTRACT

Last December 2019, a new virus, named novel Coronavirus (COVID-2019) causing many cases of severe pneumonia was reported in Wuhan, China. The virus knowledge is limited and especially about COVID-2019 pathogenesis. The Open Reading Frame 1ab (ORF1ab) of COVID-2019 has been analyzed to evidence the presence of mutation caused by selective pressure on the virus. For selective pressure analysis fast-unconstrained Bayesian approximation (FUBAR) was used. Homology modelling has been performed by SwissModel and HHPred servers. The presence of transmembrane helical segments in Coronavirus ORF1ab non structural protein 2 (nsp2) and nsp3 was tested by TMHMM, MEMSAT, and MEMPACK tools. Three-dimensional structures have been analyzed and displayed using PyMOL. FUBAR analysis revealed the presence of potential sites under positive selective pressure (P < .05). Position 723 in the COVID-2019 has a serine instead a glycine residue, while at aminoacidic position 1010 a proline instead an isoleucine. Significant (P < .05) pervasive negative selection in 2416 sites (55%) was found. The positive selective pressure could account for some clinical features of this virus compared with severe acute respiratory syndrome (SARS) and Bat SARS-like CoV. The stabilizing mutation falling in the endosome-associated-protein-like domain of the nsp2 protein could account for COVID-2019 high ability of contagious, while the destabilizing mutation in nsp3 proteins could suggest a potential mechanism differentiating COVID-2019 from SARS. These data could be helpful for further investigation aimed to identify potential therapeutic targets or vaccine strategy, especially in the actual moment when the epidemic is ongoing and the scientific community is trying to enrich knowledge about this new viral pathogen.


Subject(s)
Betacoronavirus/genetics , SARS Virus/genetics , Viral Nonstructural Proteins/chemistry , Viral Proteins/chemistry , Betacoronavirus/pathogenicity , Coronavirus Infections/virology , Female , Gene Expression , Humans , Male , Models, Molecular , Mutation , Pandemics , Pneumonia, Viral/virology , Protein Conformation, alpha-Helical , Protein Conformation, beta-Strand , Protein Interaction Domains and Motifs , SARS Virus/pathogenicity , Selection, Genetic , Structural Homology, Protein , Viral Nonstructural Proteins/genetics , Viral Nonstructural Proteins/metabolism , Viral Proteins/genetics , Viral Proteins/metabolism
15.
BMC Infect Dis ; 20(1): 549, 2020 Jul 29.
Article in English | MEDLINE | ID: covidwho-684717

ABSTRACT

BACKGROUND: We aimed to report the epidemiological and clinical characteristics of hospitalized patients with coronavirus disease-19 (COVID-19) in Zengdu District, Hubei Province, China. METHODS: Clinical data on COVID-19 inpatients in Zengdu Hospital from January 27 to March 11, 2020 were collected; this is a community hospital in an area surrounding Wuhan and supported by volunteer doctors. All hospitalized patients with COVID-19 were included in this study. The epidemiological findings, clinical features, laboratory findings, radiologic manifestations, and clinical outcomes of these patients were analyzed. The patients were followed up for clinical outcomes until March 22, 2020. Severe COVID-19 cases include severe and critical cases diagnosed according to the seventh edition of China's COVID-19 diagnostic guidelines. Severe and critical COVID-19 cases were diagnosed according to the seventh edition of China's COVID-19 diagnostic guidelines. RESULTS: All hospitalized COVID-19 patients, 276 (median age: 51.0 years), were enrolled, including 262 non-severe and 14 severe patients. The proportion of patients aged over 60 years was higher in the severe group (78.6%) than in the non-severe group (18.7%, p < 0.01). Approximately a quarter of the patients (24.6%) had at least one comorbidity, such as hypertension, diabetes, or cancer, and the proportion of patients with comorbidities was higher in the severe group (85.7%) than in the non-severe group (21.4%, p < 0.01). Common symptoms included fever (82.2% [227/276]) and cough (78.0% [218/276]). 38.4% (106/276) of the patients had a fever at the time of admission. Most patients (94.9% [204/276]) were cured and discharged; 3.6% (10/276) deteriorated to a critical condition and were transferred to another hospital. The median COVID-19 treatment duration and hospital stay were 14.0 and 18.0 days, respectively. CONCLUSIONS: Most of the COVID-19 patients in Zengdu had mild disease. Older patients with underlying diseases were at a higher risk of progression to severe disease. The length of hospital-stay and antiviral treatment duration for COVID-19 were slightly longer than those in Wuhan. This work will contribute toward an understanding of COVID-19 characteristics in the areas around the core COVID-19 outbreak region and serve as a reference for decision-making for epidemic prevention and control in similar areas.


Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/epidemiology , Coronavirus Infections/physiopathology , Length of Stay/statistics & numerical data , Pneumonia, Viral/epidemiology , Pneumonia, Viral/physiopathology , Adolescent , Adult , Child , Child, Preschool , China/epidemiology , Comorbidity , Coronavirus Infections/diagnosis , Coronavirus Infections/drug therapy , Cough/epidemiology , Female , Fever/epidemiology , Humans , Hypertension/epidemiology , Infant , Infant, Newborn , Male , Middle Aged , Pandemics , Pneumonia, Viral/diagnosis , Retrospective Studies , Treatment Outcome , Young Adult
16.
Circulation ; 142(2): 114-128, 2020 07 14.
Article in English | MEDLINE | ID: covidwho-684109

ABSTRACT

BACKGROUND: To investigate deep vein thrombosis (DVT) in hospitalized patients with coronavirus disease 2019 (COVID-19), we performed a single institutional study to evaluate its prevalence, risk factors, prognosis, and potential thromboprophylaxis strategies in a large referral and treatment center. METHODS: We studied a total of 143 patients with COVID-19 from January 29, 2020 to February 29, 2020. Demographic and clinical data, laboratory data, including ultrasound scans of the lower extremities, and outcome variables were obtained, and comparisons were made between groups with and without DVT. RESULTS: Of the 143 patients hospitalized with COVID-19 (age 63±14 years, 74 [51.7%] men), 66 patients developed lower extremity DVT (46.1%: 23 [34.8%] with proximal DVT and 43 [65.2%] with distal DVT). Compared with patients who did not have DVT, patients with DVT were older and had a lower oxygenation index, a higher rate of cardiac injury, and worse prognosis, including an increased proportion of deaths (23 [34.8%] versus 9 [11.7%]; P=0.001) and a decreased proportion of patients discharged (32 [48.5%] versus 60 [77.9%]; P<0.001). Multivariant analysis showed an association only between CURB-65 (confusion status, urea, respiratory rate, and blood pressure) score 3 to 5 (odds ratio, 6.122; P=0.031), Padua prediction score ≥4 (odds ratio, 4.016; P=0.04), D-dimer >1.0 µg/mL (odds ratio, 5.818; P<0.014), and DVT in this cohort, respectively. The combination of a CURB-65 score 3 to 5, a Padua prediction score ≥4, and D-dimer >1.0 µg/mL has a sensitivity of 88.52% and a specificity of 61.43% for screening for DVT. In the subgroup of patients with a Padua prediction score ≥4 and whose ultrasound scans were performed >72 hours after admission, DVT was present in 18 (34.0%) patients in the subgroup receiving venous thromboembolism prophylaxis versus 35 (66.0%) patients in the nonprophylaxis group (P=0.010). CONCLUSIONS: The prevalence of DVT is high and is associated with adverse outcomes in hospitalized patients with COVID-19. Prophylaxis for venous thromboembolism may be protective in patients with a Padua protection score ≥4 after admission. Our data seem to suggest that COVID-19 is probably an additional risk factor for DVT in hospitalized patients.


Subject(s)
Coronavirus Infections/diagnosis , Pneumonia, Viral/diagnosis , Venous Thrombosis/diagnosis , Adult , Aged , Anticoagulants/therapeutic use , Betacoronavirus/isolation & purification , Blood Pressure , China/epidemiology , Coronavirus Infections/complications , Coronavirus Infections/mortality , Coronavirus Infections/physiopathology , Female , Fibrin Fibrinogen Degradation Products/analysis , Humans , Kaplan-Meier Estimate , Lower Extremity/diagnostic imaging , Male , Middle Aged , Odds Ratio , Pandemics , Pneumonia, Viral/complications , Pneumonia, Viral/mortality , Pneumonia, Viral/physiopathology , Prevalence , Prognosis , Respiratory Rate , Retrospective Studies , Risk Factors , Treatment Outcome , Venous Thrombosis/complications , Venous Thrombosis/drug therapy , Venous Thrombosis/epidemiology
17.
Invest Radiol ; 55(5): 257-261, 2020 05.
Article in English | MEDLINE | ID: covidwho-684015

ABSTRACT

OBJECTIVES: The aim of this study was to investigate the chest computed tomography (CT) findings in patients with confirmed coronavirus disease 2019 (COVID-19) and to evaluate its relationship with clinical features. MATERIALS AND METHODS: Study sample consisted of 80 patients diagnosed as COVID-19 from January to February 2020. The chest CT images and clinical data were reviewed, and the relationship between them was analyzed. RESULTS: Totally, 80 patients diagnosed with COVID-19 were included. With regards to the clinical manifestations, 58 (73%) of the 80 patients had cough, and 61 (76%) of the 80 patients had high temperature levels. The most frequent CT abnormalities observed were ground glass opacity (73/80 cases, 91%), consolidation (50/80 cases, 63%), and interlobular septal thickening (47/80, 59%). Most of the lesions were multiple, with an average of 12 ± 6 lung segments involved. The most common involved lung segments were the dorsal segment of the right lower lobe (69/80, 86%), the posterior basal segment of the right lower lobe (68/80, 85%), the lateral basal segment of the right lower lobe (64/80, 80%), the dorsal segment of the left lower lobe (61/80, 76%), and the posterior basal segment of the left lower lobe (65/80, 81%). The average pulmonary inflammation index value was (34% ± 20%) for all the patients. Correlation analysis showed that the pulmonary inflammation index value was significantly correlated with the values of lymphocyte count, monocyte count, C-reactive protein, procalcitonin, days from illness onset, and body temperature (P < 0.05). CONCLUSIONS: The common chest CT findings of COVID-19 are multiple ground glass opacity, consolidation, and interlobular septal thickening in both lungs, which are mostly distributed under the pleura. There are significant correlations between the degree of pulmonary inflammation and the main clinical symptoms and laboratory results. Computed tomography plays an important role in the diagnosis and evaluation of this emerging global health emergency.


Subject(s)
Coronavirus Infections/diagnostic imaging , Coronavirus Infections/pathology , Lung/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Pneumonia, Viral/pathology , Adult , Aged , Betacoronavirus/isolation & purification , Coronavirus Infections/virology , Cough/virology , Female , Fever/virology , Humans , Lung/pathology , Lung/virology , Male , Middle Aged , Pandemics , Pneumonia, Viral/virology , Retrospective Studies , Thorax/diagnostic imaging , Thorax/virology , Tomography, X-Ray Computed/methods , Young Adult
18.
Radiology ; 296(2): E97-E104, 2020 08.
Article in English | MEDLINE | ID: covidwho-683271

ABSTRACT

Background A categorical CT assessment scheme for suspicion of pulmonary involvement of coronavirus disease 2019 (COVID-19 provides a basis for gathering scientific evidence and improved communication with referring physicians. Purpose To introduce the COVID-19 Reporting and Data System (CO-RADS) for use in the standardized assessment of pulmonary involvement of COVID-19 on unenhanced chest CT images and to report its initial interobserver agreement and performance. Materials and Methods The Dutch Radiological Society developed CO-RADS based on other efforts for standardization, such as the Lung Imaging Reporting and Data System or Breast Imaging Reporting and Data System. CO-RADS assesses the suspicion for pulmonary involvement of COVID-19 on a scale from 1 (very low) to 5 (very high). The system is meant to be used in patients with moderate to severe symptoms of COVID-19. The system was evaluated by using 105 chest CT scans of patients admitted to the hospital with clinical suspicion of COVID-19 and in whom reverse transcription-polymerase chain reaction (RT-PCR) was performed (mean, 62 years ± 16 [standard deviation]; 61 men, 53 with positive RT-PCR results). Eight observers used CO-RADS to assess the scans. Fleiss κ value was calculated, and scores of individual observers were compared with the median of the remaining seven observers. The resulting area under the receiver operating characteristics curve (AUC) was compared with results from RT-PCR and clinical diagnosis of COVID-19. Results There was absolute agreement among observers in 573 (68.2%) of 840 observations. Fleiss κ value was 0.47 (95% confidence interval [CI]: 0.45, 0.47), with the highest κ value for CO-RADS categories 1 (0.58, 95% CI: 0.54, 0.62) and 5 (0.68, 95% CI: 0.65, 0.72). The average AUC was 0.91 (95% CI: 0.85, 0.97) for predicting RT-PCR outcome and 0.95 (95% CI: 0.91, 0.99) for clinical diagnosis. The false-negative rate for CO-RADS 1 was nine of 161 cases (5.6%; 95% CI: 1.0%, 10%), and the false-positive rate for CO-RADS category 5 was one of 286 (0.3%; 95% CI: 0%, 1.0%). Conclusion The coronavirus disease 2019 (COVID-19) Reporting and Data System (CO-RADS) is a categorical assessment scheme for pulmonary involvement of COVID-19 at unenhanced chest CT that performs very well in predicting COVID-19 in patients with moderate to severe symptoms and has substantial interobserver agreement, especially for categories 1 and 5. © RSNA, 2020 Online supplemental material is available for this article.


Subject(s)
Betacoronavirus , Coronavirus Infections/diagnostic imaging , Pneumonia, Viral/diagnostic imaging , Tomography, X-Ray Computed/standards , Adult , Aged , Communication , Female , Humans , Lung/diagnostic imaging , Male , Middle Aged , Netherlands , Observer Variation , Pandemics , Radiology Information Systems , Reverse Transcriptase Polymerase Chain Reaction/methods , Tomography, X-Ray Computed/methods
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