Department of Radiology, Capital Medical University, Beijing Anzhen Hospital, 2nd Anzhen Road, Chaoyang District, Beijing, China.
Department of Radiology, China Resources & WISCO General Hospital, Wuhan, Hubei Province, China.
Eur Radiol. 2020 Nov;30(11):6151-6160. doi: 10.1007/s00330-020-06955-x. Epub 2020 May 30.
To compare clinical, laboratory, and chest computed tomography (CT) findings in critically ill patients diagnosed with coronavirus disease 2019 (COVID-19) who survived and who died.
This retrospective study reviewed 60 critically ill patients (43 males and 17 females, mean age 64.4 ± 11.0 years) with COVID-19 pneumonia who were admitted to two different clinical centers. Their clinical and medical records were analyzed, and the chest CT images were assessed to determine the involvement of lobes and the distribution of lesions in the lungs between the patients who recovered from the illness and those who died.
Compared with recovered patients (50/60, 83%), deceased patients (10/60, 17%) were older (mean age, 70.6 vs. 62.6 years, p = 0.044). C-reactive protein (CRP) (110.8 ± 26.3 mg/L vs 63.0 ± 50.4 mg/L, p < 0.001) and neutrophil-to-lymphocyte ratio (NLR) (18.7 ± 16.6 vs 8.4 ± 7.5, p = 0.030) were significantly elevated in the deceased as opposed to the recovered. Medial or parahilar area involvement was observed in all the deceased patients (10/10, 100%), when compared to only 54% (27/50) in the recovered. Ground-glass opacities (97%), crazy-paving pattern (92%), and air bronchogram (93%) were the most common radiological findings. There was significant difference in diabetes (p = 0.025) and emphysema (p = 0.013), and the odds ratio on a deceased patient having diabetes and emphysema was 6 times and 21 times the odds ratio on a recovered patient having diabetes and emphysema, respectively.
Older patients with comorbidities such as diabetes and emphysema, and higher CRP and NLRs with diffuse lung involvement were more likely to die of COVID-19.
• Almost all patients critically ill with COVID-19 pneumonia had five lung lobes involved. • Medial or parahilar area involvement and degree of lung involvement were more serious in the deceased patients when compared with those who recovered from treatment. • Chronic lung disease, e.g., emphysema, diabetes, and higher serum CRP and NLR characterized patients who died of COVID-19.
比较临床、实验室和胸部计算机断层扫描（CT）在新冠肺炎（COVID-19）危重症患者存活和死亡患者中的发现。
本回顾性研究纳入了在两个不同临床中心住院的 60 例 COVID-19 肺炎危重症患者（43 名男性和 17 名女性，平均年龄 64.4±11.0 岁）。分析了他们的临床和病历记录，并评估了胸部 CT 图像，以确定从疾病中康复的患者和死亡患者之间肺叶受累和病变分布的情况。
与康复患者（50/60，83%）相比，死亡患者（10/60，17%）年龄更大（平均年龄 70.6 岁 vs. 62.6 岁，p=0.044）。死亡患者的 C 反应蛋白（CRP）（110.8±26.3 mg/L 比 63.0±50.4 mg/L，p<0.001）和中性粒细胞与淋巴细胞比值（NLR）（18.7±16.6 比 8.4±7.5，p=0.030）显著升高。所有死亡患者（10/10，100%）均有中隔或旁区受累，而康复患者仅有 54%（27/50）有中隔或旁区受累。磨玻璃影（97%）、铺路石征（92%）和空气支气管征（93%）是最常见的影像学表现。糖尿病（p=0.025）和肺气肿（p=0.013）存在显著差异，死亡患者合并糖尿病和肺气肿的比值比为康复患者合并糖尿病和肺气肿的比值比的 6 倍和 21 倍。
患有糖尿病和肺气肿等合并症的老年患者，以及 CRP 和 NLR 较高且肺部弥漫性受累的患者，更有可能死于 COVID-19。
几乎所有患有 COVID-19 肺炎的危重症患者都有五个肺叶受累。
与康复患者相比，死亡患者的中隔或旁区受累和肺部受累程度更严重。
慢性肺部疾病，如肺气肿、糖尿病以及更高的血清 CRP 和 NLR 特征，是 COVID-19 死亡患者的特点。
