The incremental value of computed tomography of COVID-19 pneumonia in predicting ICU admission

  1. Maurizio Bartolucci
  2. Matteo Benelli
  3. Margherita Betti
  4. Sara Bicchi
  5. Luca Fedeli
  6. Federico Giannelli
  7. Donatella Aquilini
  8. Alessio Baldini
  9. Guglielmo Consales
  10. Massimo Edoardo Di Natale
  11. Pamela Lotti
  12. Letizia Vannucchi
  13. Michele Trezzi
  14. Lorenzo Nicola Mazzoni
  15. Sandro Santini
  16. Roberto Carpi
  17. Daniela Matarrese
  18. Luca Bernardi
  19. Mario Mascalchi
  20. the COVID Working Group
  21. Edoardo Cavigli
  22. Alessandra Bindi
  23. Diletta Cozzi
  24. Vittorio Miele
  25. Simone Busoni
  26. Adriana Taddeucci
  27. Germana Allescia
  28. Chiara Zini
  29. Giovanni Luca Dedola
  30. Silvia Mazzocchi
  31. Chiara Pozzessere
  32. Adriano Viviani

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Abstract

Triage is crucial for patient’s management and estimation of the required intensive care unit (ICU) beds is fundamental for health systems during the COVID-19 pandemic. We assessed whether chest computed tomography (CT) of COVID-19 pneumonia has an incremental role in predicting patient’s admission to ICU. We performed volumetric and texture analysis of the areas of the affected lung in CT of 115 outpatients with COVID-19 infection presenting to the emergency room with dyspnea and unresponsive hypoxyemia. Admission blood laboratory including lymphocyte count, serum lactate dehydrogenase, D-dimer and C-reactive protein and the ratio between the arterial partial pressure of oxygen and inspired oxygen were collected. By calculating the areas under the receiver-operating characteristic curves (AUC), we compared the performance of blood laboratory-arterial gas analyses features alone and combined with the CT features in two hybrid models (Hybrid radiological and Hybrid radiomics)for predicting ICU admission. Following a machine learning approach, 63 patients were allocated to the training and 52 to the validation set. Twenty-nine (25%) of patients were admitted to ICU. The Hybrid radiological model comprising the lung %consolidation performed significantly ( p  = 0.04) better in predicting ICU admission in the validation (AUC = 0.82; 95% confidence interval 0.73–0.97) set than the blood laboratory-arterial gas analyses features alone (AUC = 0.71; 95% confidence interval 0.56–0.86). A risk calculator for ICU admission was derived and is available at: https://github.com/cgplab/covidapp . The volume of the consolidated lung in CT of patients with COVID-19 pneumonia has a mild but significant incremental value in predicting ICU admission.

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  1. Version published to 10.1038/s41598-021-95114-3
  2. ScreenIT

    SciScore for 10.1101/2021.01.08.20249041: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All the analyses were performed using the R statistical programming language (https://cran.r-project.org/).
    https://cran.r-project.org/
    suggested: (CRAN, RRID:SCR_003005)

    Results from OddPub: Thank you for sharing your code.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    We recognize the following limitations of our study. We performed a single centre study and assessment of the proposed models with data from other centres are required to verify their external validity. In our models we considered a large array of continuous variables in different domains, including D-dimer and P/F ratio which reflect the more characteristic physiopathological features of COVID-19 pneumonia(14,15,41) and are associated with worst prognosis (42), but discarded some potentially relevant categorical variables as gender, obesity and co-morbidities (43,44) which however are more closely linked with mortality than ICU admission. Moreover the recently described ABO blood-group system and genetic susceptibility loci (45) and some continuous variables as serum Interleukin-6 (23,46), ferritin and procalcitonin (16) were not available. Finally, we did not evaluate death as an outcome due to the small samples.However this would imply to consider treatments and other variables and was beyond the scope of the present investigation. In conclusion, the combination of the volume of lung consolidation on CT at ER presentation has a mild but significant incremental value as compared to blood laboratory and arterial gas analyses results in predicting ICU admission. Inclusion of CT in the triage of patients with symptomatic COVID-19 pneumonia may have a practical value for individual patient’s management (possibly using the free application we developed) and help planning and org...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

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  3. Version published to 10.1101/2021.01.08.20249041v1 on medRxiv