Roles of Clinical Features and Chest CT in Predicting the Outcomes of Hospitalized Patients with COVID-19 Developing AKI.

This research aimed to evaluate the clinical features and computed tomography (CT) scans associated with poor outcomes in COVID-19 patients with acute kidney injury (AKI). A total of 351 COVID-19 patients (100 AKI, 251 non-AKI) hospitalized at Imam Hossein Teaching Hospital affiliated to Shahid Beheshti University of Medical Sciences were included. To investigate the factors associated with in-hospital mortality in COVID-19 patients developing AKI, COX univariate and multivariate regression models were applied after controlling other confounding variables. C-reactive protein CRP, lactate, and procalcitonin levels were significantly higher in AKI patients than in non-AKI patients (P < .05). In addition, AKI patients had higher frequencies of lymphopenia and leukocytosis (P < .05). The troponin levels and WBC were the most significant factors for predicting mortality in patients with AKI. Our findings showed that AKI per se is much more important than any other prognostic factor affecting non-AKI patients. However, AKI patients with higher CRP, PCT, and lactate levels had a poor prognosis.  DOI: 10.52547/ijkd.7241.

A randomized controlled clinical trial on efficacy and safety of anakinra in patients with severe COVID-19.

INTRODUCTION: Hyperinflammatory state has a role in the pathogenesis of COVID-19. Anakinra could reduce inflammation and help to combat the condition. In this study, we aimed to assess the safety and efficacy of anakinra (PerkinRA®) in severe COVID-19. METHOD: The study was an open-label, randomized, controlled trial conducted in Imam Hossein Medical Center from May to July 2020. Patients with a confirmed diagnosis of COVID-19 were included in this study. We administered anakinra 100 mg daily intravenously. All patients received COVID-19 pharmacotherapy based on the represented national guideline. The need for invasive mechanical ventilation is considered the primary outcome. RESULTS: Thirty patients were included in this study, and 15 of them received Anakinra. Nineteen patients were male (63.3%), and 11 were female (36.7%). The mean age of patients was 55.77 ± 15.89 years. In the intervention group, the need for invasive mechanical ventilation was significantly reduced compared to the control group (20.0% vs. 66.7%, p = .010). Also, these patients had a significantly lower length of hospital stay (p = .043). No significant higher rate of infection was recorded. CONCLUSION: Anakinra as an immunomodulatory agent has been associated with the reduced need for mechanical ventilation in patients admitted to intensive care units because of severe COVID-19. The medication reduced the hospital length of stay. Furthermore, no increased risk of infection was observed. Further randomized placebo-controlled trials with a larger sample size are needed to confirm these findings.

Organizing pneumonia-like pattern in COVID-19.

INTRODUCTION: Organizing pneumonia (OP) is a radio-histologic pattern that forms in response to lung damage in patients with focal or diffuse lung injury. OP is frequently observed subsequent to viral-induced lung damage and is associated with a diverse range of clinical outcomes. MATERIAL AND METHODS: We included 210 patients (mean age: 55.8 ± 16.5 years old; 61% male) with mild Coronavirus disease 2019 (COVID-19) who underwent chest computed tomography (CT) from 25 February to 22 April, 2020. The patients were divided into two groups based on the presence (n = 103) or absence of typical OP-like pattern (n =107) on initial chest CT. The extent of lung involvement and final outcome was compared across the two groups. Serial changes in imaging were also evaluated in 36 patients in the OP-group with a second CT scan. RESULTS: Duration from symptom onset to presentation was significantly higher in the OP group (7.07 ± 3.71 versus 6.13 ± 4.96 days, p = 0.008). A higher COVID-19-related mortality rate was observed among patients with OP-like pattern (17.5% vs 3.7%, p = 0.001).There was no significant difference in the overall involvement of the lungs (p = 0.358), but lower lobes were significantly more affected in the OP group (p < 0.001). Of the 36 patients with follow-up imaging (mean duration of follow-up = 8.3 ± 2.1 days), progression of infiltration was seen in more than 61% of patients while lesions had resolved in only 22.2% of cases. CONCLUSIONS: Our observation indicates that physicians should carefully monitor for the presence of OP-like pattern on initial CT as it is associated with a poor outcome. Furthermore, we recommend interval CT to evaluate the progression of infiltrations in these patients.

Comparison of Mortality Rate and Severity of Pulmonary Involvement in Coronavirus Disease-2019 Adult Patients With and Without Type 2 Diabetes: A Cohort Study.

OBJECTIVES: Patients with diabetes are potentially at higher risk of mortality due to coronavirus disease-2019 (COVID-19). In this study, we aimed to compare the outcomes and severity of pulmonary involvement in COVID-19 patients with and without diabetes. METHODS: In this cohort study, we recruited patients with diabetes who were hospitalized due to COVID-19 during the period from February 2020 to May 2020. Hospitalized individuals without diabetes were enrolled as control subjects. All patients were followed for 90 days and clinical findings and patients' outcomes were reported. RESULTS: Over a period of 4 months, 127 patients with diabetes and 127 individuals without diabetes with a diagnosis of COVID-19 were recruited. Their mean age was 65.70±12.51 years. Mortality was higher in the group with diabetes (22.8% vs 15.0%; p=0.109), although not significantly. More severe pulmonary involvement (p=0.015), extended hospital stay (p<0.001) and greater need for invasive ventilation (p=0.029) were reported in this population. Stepwise logistic regression revealed that diabetes was not independently associated with mortality (p=0.092). Older age (odds ratio [OR], 1.054; p=0.003), aggravated pulmonary involvement on admission (OR, 1.149; p=0.001), presence of comorbidities (OR, 1.290; p=0.020) and hypothyroidism (OR, 6.576; p=0.021) were associated with mortality. Diabetic foot infection had a strong positive correlation with mortality (OR, 49.819; p=0.016), whereas insulin therapy had a negative correlation (OR, 0.242; p=0.045). CONCLUSIONS: The mortality rate due to COVID-19 did not differ significantly between patients with or without diabetes. Older age, macrovascular complications and presence of comorbidities could increase mortality in people with diabetes. Insulin therapy during hospitalization could attenuate the detrimental effects of hyperglycemia and improve prognosis of patients with COVID-19 and diabetes.

A Multicenter Survey on the Trend of Chest CT Scan Utilization: Tracing the First Footsteps of COVID-19 in Iran.

BACKGROUND: Chest computed tomography (CT) scan has been used widely to diagnose COVID-19 in Iran. OBJECTIVES: To trace the footsteps of COVID-19 in Iran by exploring the trend in using chest CT scans and its economic impact on radiology departments. Methods: In this cross-sectional study, the number of imaging examinations from 33 tertiary radiology departments in 9 large cities of Iran was collected from September 23, 2019 to March 20, 2020 (Months 1 to 6) and the corresponding months in 2018-2019. RESULTS: A 50.2% increase was noted in the chest CT scan utilization in 2019-2020 compared to 2018-2019. This increase was +15%, +15%, +27%, +2%, +1% in Months 1-5 of 2019-2020, respectively. In Month 6 of 2019-2020, a 251% increase in the acquisition of chest CT scans was observed compared to the Month 6 of 2018-2019. Following negative balance of revenue from Month 1 to 5 with respect to the inflation rate, the total income in Month 6 was further 1.5% less than the same Month in 2018-19. CONCLUSION: The observed peak in chest CT utilization in Month 3 prior to the surge in Month 6 could be explained by the seasonal influenza. However, unawareness about an emerging viral disease, i.e. COVID-19, might have underutilized chest CT in Months 4 and 5 before the official announcement in Month 6. The unbalanced increase in the workload of radiology departments in the shortage of cardiothoracic radiologists with the simultaneous decrease in income initiated a vicious cycle that worsened the economic repercussions of the pandemic.

Well-controlled vs poorly-controlled diabetes in patients with COVID-19: Are there any differences in outcomes and imaging findings?

AIMS: We aimed to compare the clinical outcomes and imaging findings between COVID-19 patients with well-controlled diabetes and those with poorly-controlled diabetes. METHODS: In this retrospective single-center study, 117 patients with coexistent COVID-19 and type 2 diabetes mellitus were included. Patients were divided into two groups based on HbA1c values. Clinical data and laboratory parameters were collected from patients' medical records. Also, the chest computed tomography (CT) score was defined by the summation of individual scores from 5 lung lobes: scores of 0, 1, 2, 3, 4 and 5 were respectively assigned for each lobe if pulmonary involvement was 0%, less than 5%, 5%-25%, 26%-49%, 50%-75%, or more than 75% of each region. RESULTS: Among all patients with diabetes, 93 (79.5%) patients had poorly-controlled diabetes and 24 (20.5%) had well-controlled diabetes; 66 (56.4%) patients were male and the median age was 66 years (IQR, 55-75 years). The chest CT severity scores were not significantly different between patients with well-controlled diabetes and those with poorly-controlled diabetes (p = 0.33). Also, the mortality and recovery rates were similar between the two groups (p = 0.54 and p = 0.85, respectively). CONCLUSION: Based on the results, clinical outcomes and chest CT severity scores are similar between patients with well-controlled and poorly-controlled diabetes among the Iranian population with COVID-19.

Correlation Between Low-Dose Chest Computed Tomography and RT-PCR Results for the Diagnosis of COVID-19: A Report of 27,824 Cases in Tehran, Iran.

RATIONALE AND OBJECTIVES: Real-time polymerase chain reaction (RT-PCR) remains the gold standard for confirmation of Coronavirus Disease 2019 (COVID-19) despite having many disadvantages. Here, we investigated the diagnostic performance of chest computed tomography (CT) as an alternative to RT-PCR in patients with clinical suspicion of COVID-19 infection. METHODS: In this descriptive cross-sectional study, 27,824 patients with clinical suspicion of COVID-19 infection who underwent unenhanced low-dose chest CT from 20 February, 2020 to 21 May, 2020 were evaluated. Patients were recruited from seven specifically designated hospitals for patients with COVID-19 infection affiliated to Shahid Beheshti University of Medical Sciences. In each hospital, images were interpreted by two independent radiologists. CT findings were considered as positive/negative for COVID-19 infection based on RSNA diagnostic criteria. Then, the correlation between the number of daily positive chest CT scans and number of daily PCR-confirmed cases and COVID-19-related deaths in Tehran province during this three-month period was assessed. The trends of admission rate and patients with positive CT scans were also evaluated. RESULTS: A strong positive correlation between the numbers of daily positive CT scans and daily PCR-confirmed COVID-19 cases (r = 0.913, p < 0.001) was observed. Furthermore, in hospitals located in regions with a lower socioeconomic status, the admission rate and number of positive cases within this three-month period was higher as compared to other hospitals. CONCLUSION: Low-dose chest CT is a safe, rapid and reliable alternative to RT-PCR for the diagnosis of COVID-19 in high-prevalence regions. In addition, our study provides further evidence for considering patients' socioeconomic status as an important risk factor for COVID-19.

Correlation between Chest Computed Tomography Scan Findings and Mortality of COVID-19 Cases; a Cross sectional Study.

INTRODUCTION: Predicting the outcomes of COVID-19 cases using different clinical, laboratory, and imaging parameters is one of the most interesting fields of research in this regard. This study aimed to evaluate the correlation between chest computed tomography (CT) scan findings and outcomes of COVID-19 cases. METHODS: This cross sectional study was carried out on confirmed COVID-19 cases with clinical manifestations and chest CT scan findings based on Iran's National Guidelines for defining COVID-19. Baseline and chest CT scan characteristics of patients were investigated and their correlation with mortality was analyzed and reported using SPSS 21.0. RESULTS: 380 patients with the mean age of 53.62 ± 16.66 years were evaluated (66.1% male). The most frequent chest CT scan abnormalities were in peripheral (86.6%) and peribronchovascular interstitium (34.6%), with ground glass pattern (54.1%), and round (53.6%) or linear (46.7%) shape. There was a significant correlation between shape of abnormalities (p = 0.003), CT scan Severity Score (CTSS) (p <0.0001), and pulmonary artery CT diameter (p = 0. 01) with mortality. The mean CTSS of non-survived cases was significantly higher (13.68 ± 4.59 versus 8.72 ± 4.42; <0.0001). The area under the receiver operating characteristic (ROC) curve of CTSS in predicting the patients' mortality was 0.800 (95% CI: 0.716-0.884). The best cut off point of chest CTSS in this regard was 12 with 75.82% (95% CI: 56.07%-88.98%) sensitivity and 75.78% (95% CI: 70.88%-80.10%) specificity. The mean main pulmonary artery diameter in patients with CTSS ≥ 12 was higher than cases with CTSS < 12 (27.89 ± 3.73 vs 26.24 ± 3.14 mm; p < 0.0001). CONCLUSION: Based on the results of the present study it seems that there is a significant correlation between chest CT scan characteristics and mortality of COVID-19 cases. Patients with lower CTSS, lower pulmonary artery CT diameter, and round shape opacity had lower mortality.