Prognostic value of visual quantification of lesion severity at initial chest CT in confirmed Covid-19 infection: a retrospective analysis on 216 patients
This article has been Reviewed by the following groups
Listed in
- Evaluated articles (ScreenIT)
Abstract
Rationale and Objectives
Studies suggest an association between chest CT findings assessed with semi-quantitative CT score and gravity of Covid-19. The objective of this work is to analyze potential correlation between visual quantification of lesion severity at initial chest CT and clinical outcome in confirmed Covid-19 patients.
Materials and Methods
From March 5 th to March 21 st , 2020, all consecutive patients that underwent chest CT for clinical suspicion of Covid-19 at a single tertiary center were retrospectively evaluated for inclusion. Patients with lung parenchyma lesions compatible with Covid-19 and positive RT-PCR were included.
Global extensiveness of abnormal lung parenchyma was visually estimated and classified independently by 2 readers, following the European Society of Thoracic Imaging Guidelines. Death and/or mechanical ventilation within 30 days following the initial chest CT was chosen as the primary hard endpoint.
Results
216 patients (124 men, 62 years-old ± 16.5, range 22 – 94 yo) corresponding to 216 chest CT were included. Correlation between lesion severity and percentage of patients that met the primary endpoint was high, with a coefficient ρ of 0.87 (p = 0.05).
A greater than 25% involvement was significantly associated with a higher risk of mechanical ventilation or death at 30 days, with a Risk Ratio of 5.00 (95% CI [3.59–6.99]).
Conclusion
This retrospective cohort confirms a correlation between visual evaluation of lesions severity at initial chest CT and the 30 days clinical outcome of Covid-19 patients and suggests using a threshold of greater than 25% involvement to identify patients at risk.
Article activity feed
-
SciScore for 10.1101/2020.05.28.20115584: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: This retrospective study was approved by the local ethics committee of Strasbourg University Hospital and the need of written informed consent was waived.
Consent: This retrospective study was approved by the local ethics committee of Strasbourg University Hospital and the need of written informed consent was waived.Randomization not detected. Blinding CT Image Analysis: Two radiologists (ET with a 3 years’ experience in CT and AL with 10 years’ experience) blinded to the clinical data, reviewed CT images independently and resolved discrepancies by consensus, after an initial training on a separate set of 20 Power Analysis not detected. Sex as a biological … SciScore for 10.1101/2020.05.28.20115584: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: This retrospective study was approved by the local ethics committee of Strasbourg University Hospital and the need of written informed consent was waived.
Consent: This retrospective study was approved by the local ethics committee of Strasbourg University Hospital and the need of written informed consent was waived.Randomization not detected. Blinding CT Image Analysis: Two radiologists (ET with a 3 years’ experience in CT and AL with 10 years’ experience) blinded to the clinical data, reviewed CT images independently and resolved discrepancies by consensus, after an initial training on a separate set of 20 Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:This study still presents some important limitations. First, it was a retrospective and monocentric study, with a limited number of cases. Second, other clinical data were unavailable and an independent analysis with other possible cofounding factors (12) taken into account (such as age, sex, body mass index, comorbidities, smoking status…) could not be done. Therefore, we cannot assume that CT visual scoring is an independent predictor factor of Covid-19 evolution. Third, this study was done on patients from the initial part of the epidemic wave, when pressure on ICU space was the most important and when patient’s management was not completely defined and optimized. This could partly explain the high fatality rate in our cohort. Fourth, we decided to include only patients with CT lesions, which could constitute an inclusion bias. Last, we did not perform software-based quantitative measurement to validate our visual evaluation. However, the high inter-reader agreement is in favor of the validity of this visual approach. To conclude, this retrospective cohort confirms a correlation between visual evaluation of lesion severity at initial chest CT and the 30 days clinical outcome of Covid-19 patients, thus reinforcing the role of chest CT in ED triage. Future studies will help to refine knowledge about CT prognostic factors in Covid-19.
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.
-
