How automated measurement of lung lesions can predict the course of patients hospitalized with SARS-Cov-2 pneumonia

Abstract IntroductionThe aim of this study was to evaluate if an automated measurement of lung lesions, epicardial fat and pericardial volume during the days surrounding hospital admission for COVID-19 pneumonia may predict intubation or mortality. The second purpose of this study was to assess whether the association of these Computed Tomography (CT) measures with the SOFA (Sequential Organ Failure Assessment) score, could predict intubation and mortality better than the SOFA score alone.MethodsThis observational retrospective study was conducted in Timone university hospital in Marseille in France, between March 10th and May 10th 2020. All adult patients with COVID-19, admitted with respiratory symptoms and having performed a chest CT three days before to two days after admission were eligible for inclusion. All chest CTs were analyzed using a local automated CT measurement software. The primary outcome was invasive mechanical ventilation (IMV) or death during the 60-day follow-up. Wilcoxon-Mann-Whitney test was used for univariate analysis and logistic regression were calculated for multivariate analysis. Results176 patients were included in the study. 57 (32.4%) received IMV or died during the 60-day follow-up. After univariate analysis, all lung automated volumetric measures of ground-glass (p=0.015), consolidation (p<0.001) and all lesions to parenchymal volume ratio (p<0.001) were significantly higher for the patients who required IMV or who died. All pulmonary-lesion rate was tested in multivariate analysis and remained significantly higher in the IMV or death group (p=0.003), with an Odd Ratio of 3.52 (1.55-8.01, 95% CI) for patients who had more than 19.5% of pulmonary lesion. Pericardial volume and epicardial fat were not significantly associated with IMV or mortality. In this study, the association of the criterion “pulmonary lesion >20%” to the SOFA score improves its predictive value on IMV or mortality with a AUC of 0.82.ConclusionAutomated chest CT measures of COVID-19 patients with respiratory symptoms admitted to hospital showed a significantly higher rate of lung lesions (ground glass, consolidation, or both) for those who later died or required IMV. Furthermore, the association of these automated CT measures to the SOFA score could help select patients requiring ICU upon entering hospital.