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3.
Eur J Phys Rehabil Med ; 56(3): 335-338, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: covidwho-689752

RESUMEN

Corona virus disease 2019 (COVID-19) is a new disease characterized by lung damage and involvement in multiple tissues and organs in the whole body. Some of the patients may have long-term impairment and dysfunctions, including pulmonary fibrosis, heart, liver, kidney, nerve and immune system. Rehabilitation has certain beneficial effect in the acute stage, and especially in the recovery stage, including improving respiratory function, exercise endurance, self-care in daily living activities, as well as psychological support, etc. Rehabilitation is not offside or absent. A reasonable rehabilitation program needs scientific research to avoid arbitrary conclusions.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/rehabilitación , Neumonía Viral/complicaciones , Neumonía Viral/rehabilitación , Actividades Cotidianas , China/epidemiología , Infecciones por Coronavirus/epidemiología , Terapia por Ejercicio , Humanos , Pandemias , Neumonía Viral/epidemiología
4.
Med Sci Monit ; 26: e925047, 2020 Jul 28.
Artículo en Inglés | MEDLINE | ID: covidwho-689085

RESUMEN

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.


Asunto(s)
Factores de Edad , Infecciones por Coronavirus/epidemiología , Cardiopatías/epidemiología , Pandemias , Neumonía Viral/epidemiología , Síndrome de Dificultad Respiratoria del Adulto/epidemiología , Lesión Renal Aguda/epidemiología , Lesión Renal Aguda/etiología , Adulto , Anciano , Anciano de 80 o más Años , Betacoronavirus , China/epidemiología , Terapia Combinada , Infecciones por Coronavirus/sangre , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/tratamiento farmacológico , Infecciones por Coronavirus/terapia , Cardiopatías/etiología , Humanos , Pacientes Internos , Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Insuficiencia Multiorgánica/epidemiología , Insuficiencia Multiorgánica/etiología , Cuidados Paliativos/estadística & datos numéricos , Neumonía Viral/sangre , Neumonía Viral/complicaciones , Neumonía Viral/terapia , Síndrome de Dificultad Respiratoria del Adulto/etiología , Estudios Retrospectivos , Centros de Atención Terciaria , Resultado del Tratamiento , Adulto Joven
5.
J Infect Dis ; 221(11): 1762-1769, 2020 05 11.
Artículo en Inglés | MEDLINE | ID: covidwho-688308

RESUMEN

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.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/fisiopatología , Subgrupos Linfocitarios , Neumonía Viral/complicaciones , Neumonía Viral/fisiopatología , Neumonía/etiología , Neumonía/fisiopatología , Adulto , Anciano , Betacoronavirus/aislamiento & purificación , China , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/terapia , Femenino , Citometría de Flujo , Humanos , Recuento de Linfocitos , Subgrupos Linfocitarios/inmunología , Masculino , Persona de Mediana Edad , Pandemias , Neumonía/diagnóstico , Neumonía/terapia , Neumonía Viral/diagnóstico , Neumonía Viral/terapia , Pronóstico , Resultado del Tratamiento
6.
Monaldi Arch Chest Dis ; 90(2)2020 Jun 23.
Artículo en Inglés | MEDLINE | ID: covidwho-688266

RESUMEN

There is a need of consensus about the pulmonary rehabilitation (PR) in patients with COVID-19 after discharge from acute care. To facilitate the knowledge of the evidence and its translation into practice, we developed suggestions based on experts' opinion. A steering committee identified areas and questions sent to experts. Other international experts participated to a RAND Delphi method in reaching consensus and proposing further suggestions. Strong agreement in suggestions was defined when the mean agreement was >7 (1 = no agreement and 9 = maximal agreement). Panelists response rate was >95%. Twenty-three questions from 4 areas: Personnel protection equipment, phenotypes, assessments, interventions, were identified and experts answered with 121 suggestions, 119 of which received high level of concordance. The evidence-based suggestions provide the clinicians with current evidence and clinical experts opinion. This framework can be used to facilitate clinical decision making within the context of the individual patient. Further studies will evaluate the clinical usefulness of these suggestions.


Asunto(s)
Infecciones por Coronavirus/rehabilitación , Modalidades de Fisioterapia , Neumonía Viral/rehabilitación , Insuficiencia Respiratoria/rehabilitación , Terapia Respiratoria/métodos , Atención Ambulatoria , Betacoronavirus , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/fisiopatología , Técnica Delfos , Prueba de Esfuerzo , Humanos , Unidades de Cuidados Intensivos , Italia , Estado Nutricional , Pandemias , Equipo de Protección Personal , Neumonía Viral/complicaciones , Neumonía Viral/fisiopatología , Calidad de Vida , Pruebas de Función Respiratoria , Insuficiencia Respiratoria/etiología , Insuficiencia Respiratoria/fisiopatología , Trastornos por Estrés Postraumático
7.
Neurologia ; 35(5): 318-322, 2020 Jun.
Artículo en Inglés, Español | MEDLINE | ID: covidwho-688165

RESUMEN

INTRODUCTION: Contradictory data have been reported on the incidence of stroke in patients with COVID-19 and the risk of SARS-CoV-2 infection among patients with history of stroke. METHODS: This study systematically reviews case series reporting stroke as a complication of COVID-19, and analyses the prognosis of patients with COVID-19 and history of stroke. The pathophysiological mechanisms of stroke in patients with COVID-19 are also reviewed. CONCLUSIONS: History of stroke increases the risk of death due to COVID-19 by 3 times. Stroke currently seems not to be one of the main complications of COVID-19.


Asunto(s)
Enfermedades Virales del Sistema Nervioso Central/patología , Enfermedades Virales del Sistema Nervioso Central/virología , Sistema Nervioso Central/virología , Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Accidente Cerebrovascular/virología , Betacoronavirus/aislamiento & purificación , Infecciones por Coronavirus/virología , Humanos , Pandemias , Neumonía Viral/virología , Pronóstico
8.
Int J Infect Dis ; 95: 376-383, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: covidwho-687543

RESUMEN

OBJECTIVES: This study aimed to compare clinical courses and outcomes between pregnant and reproductive-aged non-pregnant women with COVID-19, and to assess the vertical transmission potential of COVID-19 in pregnancy. METHODS: Medical records of pregnant and reproductive-aged non-pregnant women hospitalized with COVID-19 from January 15 to March 15, 2020 were retrospectively reviewed. The severity of disease, virus clearance time, and length of hospital stay were measured as the primary objective, while the vertical transmission potential of COVID-19 was also assessed. RESULTS: Eighty-two patients (28 pregnant women, 54 reproductive-aged non-pregnant women) with laboratory-confirmed COVID-19 were enrolled in this study. Univariate regression indicated no association between pregnancy and severity of disease (OR 0.73, 95% CI 0.08-5.15; p=0.76), virus clearance time (HR 1.16, 95% CI 0.65-2.01; p=0.62), and length of hospital stay (HR 1.10, 95% CI 0.66-1.84; p=0.71). Of the pregnant women, 22 delivered 23 live births, either by cesarean section (17, 60.7%) or vaginal delivery (5, 17.9%), and no neonate was infected with SARS-CoV-2. CONCLUSIONS: Pregnant women have comparable clinical courses and outcomes with reproductive-aged non-pregnant women when infected with SARS-CoV-2. No evidence supported vertical transmission of COVID-19 in the late stage of pregnancy, including vaginal delivery.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/transmisión , Transmisión Vertical de Enfermedad Infecciosa , Neumonía Viral/transmisión , Complicaciones Infecciosas del Embarazo , Adulto , Cesárea , Infecciones por Coronavirus/complicaciones , Femenino , Humanos , Pandemias , Neumonía Viral/complicaciones , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Estudios Retrospectivos
10.
Circulation ; 142(2): 114-128, 2020 07 14.
Artículo en Inglés | MEDLINE | ID: covidwho-684109

RESUMEN

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.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Neumonía Viral/diagnóstico , Trombosis de la Vena/diagnóstico , Adulto , Anciano , Anticoagulantes/uso terapéutico , Betacoronavirus/aislamiento & purificación , Presión Sanguínea , China/epidemiología , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/fisiopatología , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/análisis , Humanos , Estimación de Kaplan-Meier , Extremidad Inferior/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/mortalidad , Neumonía Viral/fisiopatología , Prevalencia , Pronóstico , Frecuencia Respiratoria , Estudios Retrospectivos , Factores de Riesgo , Resultado del Tratamiento , Trombosis de la Vena/complicaciones , Trombosis de la Vena/tratamiento farmacológico , Trombosis de la Vena/epidemiología
11.
J Am Heart Assoc ; 9(13): e016997, 2020 07 07.
Artículo en Inglés | MEDLINE | ID: covidwho-683343

RESUMEN

Medicine and public health have traditionally separated the prevention and treatment of communicable and noncommunicable diseases. The coronavirus disease 2019 (COVID-19) pandemic has challenged this paradigm, particularly in the setting of cardiovascular disease (CVD). Overall, individuals with underlying CVD who acquire severe acute respiratory syndrome coronavirus 2 experience up to a 10-fold higher case-fatality rate compared with the general population. Although the impact of the pandemic on cardiovascular health continues to evolve, few have defined this association from a frontline, public health perspective of populations disproportionately affected by CVD and COVID-19. Louisiana is ranked within the bottom 5 states for cardiovascular health, and it is home to several parishes that have experienced among the highest COVID-19 case-fatality rates nationally. Herein, we review CVD prevention and implications of COVID-19 in New Orleans, LA, a city holding a sobering yet resilient history with previous public health disasters. In particular, we discuss potential pandemic-driven changes in access to health care, preventive pharmacotherapy, and lifestyle behaviors, all of which may adversely affect CVD prevention and management, while amplifying racial disparities. Through this process, we highlight proposed recommendations for how CVD prevention efforts can be improved in the midst of the current COVID-19 pandemic and future public health crises.


Asunto(s)
Betacoronavirus , Enfermedades Cardiovasculares/prevención & control , Infecciones por Coronavirus/complicaciones , Prestación de Atención de Salud/métodos , Estilo de Vida , Pandemias , Neumonía Viral/complicaciones , Salud Pública , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Infecciones por Coronavirus/epidemiología , Humanos , Incidencia , Nueva Orleans/epidemiología , Neumonía Viral/epidemiología
14.
Am J Phys Med Rehabil ; 99(8): 669-673, 2020 08.
Artículo en Inglés | MEDLINE | ID: covidwho-682738

RESUMEN

Severe acute respiratory syndrome coronavirus 2-also known as COVID-19-is primarily known for respiratory illness. Although it is clear that patients with moderate to severe cases of COVID-19 will require pulmonary rehabilitation, physiatrists will need to consider effective management plans for COVID-19 survivors with extrapulmonary involvement. This report will summarize key nonpulmonary considerations to guide rehabilitation clinicians who may be involved in the care of COVID-19 survivors with the best available early evidence.


Asunto(s)
Enfermedad Crónica/rehabilitación , Infecciones por Coronavirus/complicaciones , Pandemias/estadística & datos numéricos , Fisiatras/normas , Medicina Física y Rehabilitación/normas , Neumonía Viral/complicaciones , Guías de Práctica Clínica como Asunto/normas , Infecciones por Coronavirus/rehabilitación , Femenino , Estudios de Seguimiento , Salud Global , Humanos , Masculino , Neumonía Viral/rehabilitación , Medición de Riesgo , Síndrome Respiratorio Agudo Grave/fisiopatología , Síndrome Respiratorio Agudo Grave/rehabilitación , Índice de Severidad de la Enfermedad , Sobrevivientes/estadística & datos numéricos , Factores de Tiempo , Resultado del Tratamiento
15.
Acad Emerg Med ; 27(7): 566-569, 2020 07.
Artículo en Inglés | MEDLINE | ID: covidwho-682398

RESUMEN

The novel coronavirus, or COVID-19, has rapidly become a global pandemic. A major cause of morbidity and mortality due to COVID-19 has been the worsening hypoxia that, if untreated, can progress to acute respiratory distress syndrome (ARDS) and respiratory failure. Past work has found that intubated patients with ARDS experience physiological benefits to the prone position, because it promotes better matching of pulmonary perfusion to ventilation, improved secretion clearance, and recruitment of dependent areas of the lungs. We created a systemwide multi-institutional (New York-Presbyterian Hospital enterprise) protocol for placing awake, nonintubated, emergency department patients with suspected or confirmed COVID-19 in the prone position. In this piece, we describe the background literature and the approach we have taken at our institution as we care for a high burden of COVID-19 cases with respiratory symptoms.


Asunto(s)
Betacoronavirus , Estado de Conciencia , Infecciones por Coronavirus , Pandemias , Neumonía Viral , Vigilia , Infecciones por Coronavirus/complicaciones , Servicio de Urgencia en Hospital , Humanos , Hipoxia/etiología , Neumonía Viral/complicaciones , Guías de Práctica Clínica como Asunto , Posición Prona
16.
J Pediatric Infect Dis Soc ; 9(3): 393-398, 2020 Jul 13.
Artículo en Inglés | MEDLINE | ID: covidwho-681598

RESUMEN

We present a series of 6 critically ill children with multisystem inflammatory syndrome in children. Key findings of this syndrome include fever, diarrhea, shock, and variable presence of rash, conjunctivitis, extremity edema, and mucous membrane changes.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Neumonía Viral/complicaciones , Síndrome de Respuesta Inflamatoria Sistémica/etiología , Adolescente , Niño , Preescolar , Infecciones por Coronavirus/patología , Femenino , Humanos , Masculino , Pandemias , Neumonía Viral/patología , Síndrome de Respuesta Inflamatoria Sistémica/patología , Síndrome de Respuesta Inflamatoria Sistémica/virología
17.
Buenos Aires; GCBA. Gerencia Operativa de Epidemiología; 19 jun. 2020. a) f: 41 l:49 p. graf.(Boletín Epidemiológico Semanal: Ciudad Autónoma de Buenos Aires, 200).
Monografía en Español | LILACS (Américas) | ID: covidwho-677127

RESUMEN

Se presenta un reporte realizado por los equipos de trabajo que pertenecen a Salud Ambiental, Agencia de Protección Ambiental y Gerencia Operativa de Epidemiología. El mismo tiene como objetivo realizar un análisis descriptivo de la contaminación registrada en la Ciudad de Buenos Aires durante el período abarcado entre el 1 de marzo y el 14 de mayo de 2020, a fin de evaluar las modificaciones en las concentraciones de contaminantes durante el período de aislamiento. A tal fin se utilizaron las mediciones de los contaminantes criterio que a continuación se detallan: Monóxido de Carbono (CO), Óxidos de Nitrógeno Totales (NOx), Dióxido de Nitrógeno (NO2) y Material Particulado menor a 10 micrones (PM10), obtenidos por las estaciones que conforman la "Red de Monitoreo de la Calidad del Aire de la Ciudad de Buenos Aires". (AU)


Asunto(s)
Aislamiento Social , Análisis del Aire , Monitoreo del Aire , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/epidemiología , Contaminación del Aire/análisis , Contaminación del Aire/estadística & datos numéricos
18.
Rev Gastroenterol Mex ; 85(3): 282-287, 2020.
Artículo en Inglés, Español | MEDLINE | ID: covidwho-680708

RESUMEN

BACKGROUND: There is an increasing number of reports on the presentation of gastrointestinal symptoms in cases of COVID-19. AIM: To review the studies reporting gastrointestinal symptoms in COVID-19. RESULTS: Fifteen articles (2,800 patients) were identified. Gastrointestinal symptom frequency varied from 3.0% to 39.6% and included diarrhea (7.5%), náusea (4.5%), anorexia (4.4%), vomiting (1.3%), abdominal pain (0.5%), and belching/reflux (0.3%). Those symptoms can be the first manifestation of COVID-19, but whether they reflect a better or worse prognosis, is controversial. The potential relation of the angiotensin converting enzyme 2 receptor in the digestive tract as an entry route for the virus is discussed. CONCLUSION: Gastrointestinal symptoms may be common in COVID-19, in some cases appearing as the first manifestation, even before fever and respiratory symptoms. Therefore, clinicians and gastroenterologists must be aware of those atypical cases during the current pandemic, as well as of the fecal-oral route and corresponding preventive measures.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Enfermedades Gastrointestinales/etiología , Neumonía Viral/complicaciones , Infecciones por Coronavirus/terapia , Gastroenterólogos , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/terapia , Humanos , Pandemias , Neumonía Viral/terapia
19.
Pneumologie ; 74(7): 423-428, 2020 Jul.
Artículo en Alemán | MEDLINE | ID: covidwho-680639

RESUMEN

We report the case of a 60-year old female patient with advanced severe lung injury as a consequence of COVID-19-pneumonia. The patient was initially treated with highflow oxygen via nasal cannula (HFNC) and CPAP for two days but had to be intubated and mechanically ventilated. After failure of mechanical ventilation because of persistant severe hypoxemia treatment was switched to ECMO which was applicated for 24 days. Prognostic parameters indicated a favourable trend after day 14. After discontinuation of ECMO and 11 days of intermittent assisted ventilation via tracheostoma and low dose oxygen (1 l/min), the patient could be transferred to rehabilitation. The last chest radiograph prior to transferral revealed a nearly complete resolution of bilateral pulmonary infiltrates. Our case demonstrates that severe COVID-19-associated lung injury can be reversible even after prolonged ECMO.


Asunto(s)
Infecciones por Coronavirus/complicaciones , Coronavirus , Oxigenación por Membrana Extracorpórea/métodos , Neumonía Viral/complicaciones , Síndrome de Dificultad Respiratoria del Adulto/terapia , Insuficiencia Respiratoria/terapia , Betacoronavirus , Infecciones por Coronavirus/virología , Femenino , Humanos , Pulmón/fisiopatología , Persona de Mediana Edad , Pandemias , Neumonía Viral/virología , Síndrome de Dificultad Respiratoria del Adulto/etiología , Resultado del Tratamiento
20.
Int J Med Sci ; 17(12): 1773-1782, 2020.
Artículo en Inglés | MEDLINE | ID: covidwho-680183

RESUMEN

Rationale: Acute respiratory distress syndrome (ARDS) is one of the major reasons for ventilation and intubation management of COVID-19 patients but there is no noninvasive imaging monitoring protocol for ARDS. In this study, we aimed to develop a noninvasive ARDS monitoring protocol based on traditional quantitative and radiomics approaches from chest CT. Methods: Patients diagnosed with COVID-19 from Jan 20, 2020 to Mar 31, 2020 were enrolled in this study. Quantitative and radiomics data were extracted from automatically segmented regions of interest (ROIs) of infection regions in the lungs. ARDS existence was measured by Pa02/Fi02 <300 in artery blood samples. Three different models were constructed by using the traditional quantitative imaging metrics, radiomics features and their combinations, respectively. Receiver operating characteristic (ROC) curve analysis was used to assess the effectiveness of the models. Decision curve analysis (DCA) was used to test the clinical value of the proposed model. Results: The proposed models were constructed using 352 CT images from 86 patients. The median age was 49, and the male proportion was 61.9%. The training dataset and the validation dataset were generated by randomly sampling the patients with a 2:1 ratio. Chi-squared test showed that there was no significant difference in baseline of the enrolled patients between the training and validation datasets. The areas under the ROC curve (AUCs) of the traditional quantitative model, radiomics model and combined model in the validation dataset was 0.91, 0.91 and 0.94, respectively. Accordingly, the sensitivities were 0.55, 0.82 and 0.58, while the specificities were 0.97, 0.86 and 0.98. The DCA curve showed that when threshold probability for a doctor or patients is within a range of 0 to 0.83, the combined model adds more net benefit than "treat all" or "treat none" strategies, while the traditional quantitative model and radiomics model could add benefit in all threshold probability. Conclusions: It is feasible to monitor ARDS from CT images using radiomics or traditional quantitative analysis in COVID-19. The radiomics model seems to be the most practical one for possible clinical use. Multi-center validation with a larger number of samples is recommended in the future.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus/complicaciones , Pulmón/diagnóstico por imagen , Modelos Teóricos , Pandemias , Neumonía Viral/complicaciones , Síndrome de Dificultad Respiratoria del Adulto/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Algoritmos , Área Bajo la Curva , China/epidemiología , Infecciones por Coronavirus/epidemiología , Conjuntos de Datos como Asunto , Femenino , Humanos , Procesamiento de Imagen Asistido por Computador/métodos , Masculino , Persona de Mediana Edad , Neumonía Viral/epidemiología , Curva ROC , Síndrome de Dificultad Respiratoria del Adulto/etiología , Estudios Retrospectivos , Muestreo , Sensibilidad y Especificidad , Investigación en Medicina Traslacional/métodos , Flujo de Trabajo
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