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Prediction of prognosis in patients with severe COVID-19 pneumonia using CT score by emergency physicians: a single-center retrospective study.

ABSTRACT: We aimed to develop a method to determine the CT score that can be easily obtained from CT images and examine its prognostic value for severe COVID pneumonia. Patients with COVID pneumonia who required ventilatory management by intubation were included. CT score was based on anatomical information in axial CT images and were divided into three sections of height from the apex to the bottom. The extent of pneumonia in each section was rated from 0 to 5 and summed. The primary outcome was the prediction of patients who died or were managed on extracorporeal membrane oxygenation (ECMO) based on the CT score at admission. Of the 71 patients included, 12 (16.9%) died or required ECMO management, and the CT score predicted death or ECMO management with ROC of 0.718 (0.561-0.875). The death or ECMO versus survival group (median [quartiles]) had a CT score of 17.75 (14.75-20) versus 13 (11-16.5), p = 0.017. In conclusion, a higher score on our generated CT score could predict the likelihood of death or ECMO management. A CT score at the time of admission allows for early preparation and transfer to a hospital that can manage patients who may need ECMO.

SUBMITTER: Oi Y

PROVIDER: S-EPMC10004443 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

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Prediction of prognosis in patients with severe COVID-19 pneumonia using CT score by emergency physicians: a single-center retrospective study.

Oi Yasufumi Y Ogawa Fumihiro F Yamashiro Tsuneo T Matsushita Shoichiro S Oguri Ayako A Utada Shusuke S Misawa Naho N Honzawa Hiroshi H Abe Takeru T Takeuchi Ichiro I

Scientific reports 20230310 1

We aimed to develop a method to determine the CT score that can be easily obtained from CT images and examine its prognostic value for severe COVID pneumonia. Patients with COVID pneumonia who required ventilatory management by intubation were included. CT score was based on anatomical information in axial CT images and were divided into three sections of height from the apex to the bottom. The extent of pneumonia in each section was rated from 0 to 5 and summed. The primary outcome was the pred ...[more]

PMID: 36899171

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Project description:BackgroundEmergency laparotomy (EL) has a high mortality rate. Clinically, frail patients have a poor tolerance for EL. In recent years, sarcopenia has been used as an important indicator of frailty and has received much attention. There have been five different calculation methods of psoas for computed tomography (CT) to measure sarcopenia, but lack of assessment of these calculation methods in Eastern Asian EL patients.MethodsWe conducted a 2-year retrospective cohort study of patients over 18 years of age who underwent EL in our institution. Five CT measurement values (PMI: psoas muscle index, PML3: psoas muscle to L3 vertebral body ratio, PMD: psoas muscle density, TPG: total psoas gauge, PBSA: psoas muscle to body face area ratio) were calculated to define sarcopenia. Patients with sarcopenia defined by the sex-specific lowest quartile of each measurement were compared with the rest of the cohort. The primary outcome was "ideal outcome", defined as: (1) No postoperative complications of Clavien-Dindo Grade ≥ 4; (2) No mortality within 30 days; (3) When discharged, no need for fluid resuscitation and assisted ventilation, semi-liquid diet tolerated, and able to mobilize independently. The second outcome was mortality at 30-days. Multivariate logistic regression and receiver operating characteristic (ROC) analysis were used.ResultsTwo hundred and twenty-eight patients underwent EL met the inclusion criteria, 192 (84.2%) patients had an ideal outcome after surgery; 32 (14%) patients died within 30 days. Multivariate analysis showed that, except PMD, each calculation method of psoas was independently related to clinical outcome (ideal outcome: PML3, P < 0.001; PMI, P = 0.001; PMD, P = 0.157; TPG, P = 0.006; PBSA, P < 0.001; mortality at 30-days: PML3, P < 0.001; PMI, P = 0.002; PMD, P = 0.088; TPG, P = 0.002; PBSA, P = 0.001). In ROC analysis, the prediction model containing PML3 had the largest area under the curve (AUC) value (AUC value = 0.922 and 0.920, respectively).ConclusionThe sarcopenia determined by CT psoas measurements is significantly related to the clinical outcome of EL. The calculation of CT psoas measurement is suitable for application in outcome prediction of EL. In the future, it is necessary to develop a scoring tool that includes sarcopenia to evaluate the risk of EL better.

Project description:BackgroundSevere community-acquired pneumonia (sCAP) is a condition where infection-induced lung tissue inflammation intensifies to a certain stage, resulting in organ dysfunction and even life-threatening disease. When sCAP occurs, neutrophils and monocytes will be activated and released into the peripheral blood to kill bacteria. There are significant morphological changes in these activated neutrophils and monocytes. Haematological parameters can reflect these morphological changes, and indicate the occurrence of sCAP and the severity of infection. This study is designed to establish a new haematological model and explore its clinical value in the diagnosis and prognosis of sCAP.MethodsPatients who fulfilled the diagnostic criteria of common pneumonia (CP) and sCAP were enrolled in this study. Healthy body check-up patients were also enrolled as a control group. Characteristic information and 28-day survival of patients were recorded. Haematological results, C-reactive protein (CRP) and procalcitonin (PCT) were calculated by BC-6800 Plus automated haematology analyser and cobas E601 automated biochemical immunoassay analyser.ResultsA total of 100 check-ups patients, 100 CP patients, and 111 sCAP patients were enrolled in this study. The new haematological model WBC & Mon-XW, combining WBC (white blood cell count) and Mon-XW (monocytes complexity distribution width), was significantly elevated in the sCAP group and significantly higher than in the control group and the CP group. The new model had good diagnostic efficacy for sCAP, with an area under the receiver operating characteristic curve (ROC-AUC) of 0.842, which was higher than that of CRP (0.633) and PCT (0.750). Moreover, WBC & Mon-XW was effective for survival prognostic evaluations of sCAP, with an ROC-AUC of 0.748. The new model was the independent predictors for the death of pneumonia with an OR (odds ratio) value of 1.82. The 28-day mortality rate was approximately 40% in the WBC & Mon-XW ≥8.9 group, which was approximately 15% higher than that in the WBC & Mon-XW <8.9 group.ConclusionsThe new haematological model can be used as an indicator for sCAP diagnosis and prognosis.

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Project description:BackgroundBloodstream infections (BSI) are one of the most severe healthcare-associated infections in intensive care units (ICU). However, there are few studies on pneumonia-related BSI (PRBSI) in the ICU. This study aimed to investigate the clinical and prognostic characteristics of patients with PRBSI in the ICU and to provide a clinical basis for early clinical identification.MethodsWe retrospectively collected data from patients with bacterial BSI in a single-center ICU between January 1, 2017, and August 31, 2020. Clinical diagnosis combined with whole-genome sequencing (WGS) was used to clarify the diagnosis of PRBSI, and patients with PRBSI and non-PRBSI were analyzed for clinical features, prognosis, imaging presentation, and distribution of pathogenic microorganisms.ResultsOf the 2,240 patients admitted to the MICU, 120 with bacterial BSI were included in this study. Thirty-two (26.7%) patients were identified as having PRBSI based on the clinical diagnosis combined with WGS. Compared to patients without PRBSI, those with PRBSI had higher 28-day mortality (81.3 vs.51.1%, p = 0.003), a higher total mortality rate (93.8 vs. 64.8%, p = 0.002), longer duration of invasive mechanical ventilation (median 16 vs. 6 days, p = 0.037), and prolonged duration of ICU stay (median 21 vs. 10 days, p = 0.004). There were no differences in other baseline data between the two groups, but patients with PRBSI had extensive consolidation on chest radiographs and significantly higher Radiographic Assessment of Lung Edema scores (mean 35 vs. 24, p < 0.001). The most common causative organisms isolated in the PRBSI group were gram-negative bacteria (n = 31, 96.9%), with carbapenem-resistant gram-negative bacteria accounting for 68.8% (n = 22) and multidrug-resistant bacteria accounting for 81.3% (n = 26).ConclusionPneumonia-related BSI is an important component of ICU-BSI and has a poor prognosis. Compared to non-PRBSI, patients with PRBSI do not have typical clinical features but have more severe lung consolidation lesions, and should be alerted to the possibility of their occurrence when combined with pulmonary gram-negative bacterial infections, especially carbapenem-resistant bacteria. Further multicenter, large-sample studies are needed to identify the risk factors for the development of PRBSI and prevention and treatment strategies.

Dataset Information

Prediction of prognosis in patients with severe COVID-19 pneumonia using CT score by emergency physicians: a single-center retrospective study.

Publications

Prediction of prognosis in patients with severe COVID-19 pneumonia using CT score by emergency physicians: a single-center retrospective study.

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