Barbosa Camila Silva, Chaves Guilherme Wilson Otaviano Garcia, de Oliveira Camila Vilela, Bachion Guilherme Hipolito, Chi Chang Kai, Cerri Giovanni Guido, Lima Thais Carneiro, Lee Hye Ju
Radiology Department, Sírio Libanês Hospital, Sao Paulo, Brazil.
University of São Paulo (USP), Sao Paulo, Brazil.
Emerg Radiol. 2020 Dec;27(6):691-699. doi: 10.1007/s10140-020-01863-5. Epub 2020 Oct 15.
Evaluate chest computed tomography (CT) findings of laboratory-confirmed Coronavirus Disease 2019 (COVID-19) cases and correlate it with clinical and laboratorial signs of severe disease and short-term outcome.
Chest CTs of 61 consecutive cases of COVID-19 disease that attended in our emergency department (ED) were reviewed. Three groups of patients classified according to the short-term follow-up were compared: (1) early-discharged from ED, (2) hospitalized on regular wards, and (3) admitted to intensive care unit (ICU). CT findings were also correlated with clinical and laboratorial features associated with severe disease.
Median age was 52 years (IQR 39-63) with male predominance (60.7%). Most of the patients that did not require hospitalization had parenchymal involvement of less than 25% on CT (84.6%). Among hospitalized patients, interlobular septal thickening and extensive lung disease (> 50% of parenchyma) were significantly more frequent in ICU-admitted patients (P = 0.018 and P = 0.043, respectively). Interlobular septal thickening also correlated with longer ICU stay (P = 0.018). Low oxygen saturation (SpO ≤ 93%) was associated with septal thickening (P = 0.004), diffuse distribution (P = 0.016), and pleural effusion (P = 0.037) on CT. All patients with > 50% of parenchymal involvement showed SpO ≤ 93%. Elevated C-reactive protein (CRP) levels (> 5.0 mg/dL) correlated with consolidation (P = 0.002), septal thickening (P = 0.018), diffuse distribution (P = 0.020), and more extensive parenchymal involvement (P = 0.017).
Interlobular septal thickening on CT was associated with ICU admission and longer stay on ICU. Diffuse distribution, septal thickening, and more extensive lung involvement correlated with lower SpO and higher CRP levels. Patients that needed hospitalization and ICU admission presented more extensive lung disease on CT.
评估实验室确诊的2019冠状病毒病（COVID-19）病例的胸部计算机断层扫描（CT）表现，并将其与重症疾病的临床和实验室指标以及短期预后相关联。
回顾了在我们急诊科就诊的61例连续COVID-19病例的胸部CT。比较了根据短期随访分类的三组患者：（1）从急诊科早期出院，（2）在普通病房住院，（3）入住重症监护病房（ICU）。CT表现也与重症疾病相关的临床和实验室特征相关联。
中位年龄为52岁（四分位间距39 - 63岁），男性占优势（60.7%）。大多数不需要住院的患者CT上实质受累小于25%（84.6%）。在住院患者中，入住ICU的患者小叶间隔增厚和广泛肺部疾病（>50%实质）明显更常见（分别为P = 0.018和P = 0.043）。小叶间隔增厚也与ICU住院时间延长相关（P = 0.018）。低氧饱和度（SpO≤93%）与CT上的间隔增厚（P = 0.004）、弥漫分布（P = 0.016）和胸腔积液（P = 0.037）相关。所有实质受累>50%的患者SpO均≤93%。C反应蛋白（CRP）水平升高（>5.0mg/dL）与实变（P = 0.002）、间隔增厚（P = 0.018）、弥漫分布（P = 0.020）和更广泛的实质受累（P = 0.017）相关。
CT上的小叶间隔增厚与入住ICU和在ICU停留时间延长相关。弥漫分布、间隔增厚和更广泛的肺部受累与较低的SpO和较高的CRP水平相关。需要住院和入住ICU的患者CT上肺部疾病更广泛。
