Acharya Dilaram, Park Jungi, Lee Yebong, Hamm In Suk, Lee Dong Seok, Moon Seong-Su, Lee Kwan
Department of Preventive Medicine, College of Medicine, Dongguk University, Gyeongju 38066, Korea.
Department of Community Medicine, Devdaha Medical College and Research Institute, Kathmandu University, Rupandehi 32900, Nepal.
Healthcare (Basel). 2020 Nov 29;8(4):518. doi: 10.3390/healthcare8040518.
Coronavirus Disease 2019 (COVID-19) has rapidly spread to all corners of the globe. Different diagnostic tools, such as Chest X-ray (CXR), lung ultrasound (LUS), and computerized tomography (CT), have been used to detect active pneumonic lesions associated with COVID-19 with their varying degrees of sensitivity and specificity. This study was undertaken to investigate the clinical characteristics of COVID-19 patients with a pneumonic lung lesion detected by CT that is not detected by CXR. A total of 156 COVID-19 patients hospitalized at three nationally designated South Korean hospitals with no active lesion detected by CXR but on clinical suspicion of pneumonia underwent the CT examination and were enrolled. Medical records, which included demographic and clinical features, including comorbidity, symptoms, radiological, and laboratory findings on admission, were reviewed and analyzed. The risk factors of pneumonia detected by CT for patients without an active lesion detected by CXR were investigated. Of the 156 patients without an active lesion detected by CXR, 35 (22.44%) patients were found to have pneumonia by CT. The patients with pneumonia defined by CT were older than those without (64.1 years vs. 41.2 years). Comorbidities such as hypertension, diabetes, cardiovascular disease, preexisting stroke, and dementia were more common among patients with pneumonia defined by CT than those without. Serum albumin level, C-reactive protein (CRP), stroke, and age ≥ 70 years were significantly associated with pneumonia defined by CT after adjustment for age. In multivariable regression analysis, serum albumin level (adjusted odds ratio (AOR) = 0.123, 95% CI = (0.035-0.429)) and preexisting stroke (AOR = 11.447, 95% CI = (1.168-112.220)) significantly and independently predicted pneumonia detection by CT. Our results suggest that CT scans should be performed on COVID-19 patients negative for a pneumonic lung lesion by CXR who are suspected to be pneumonic on clinical grounds. In addition, older patients with a lower albumin level and a preexisting stroke should be checked for the presence of pneumonia despite a negative CXR finding for an active lesion.
2019冠状病毒病（COVID-19）已迅速蔓延至全球各个角落。不同的诊断工具，如胸部X光（CXR）、肺部超声（LUS）和计算机断层扫描（CT），已被用于检测与COVID-19相关的活动性肺部病变，它们具有不同程度的敏感性和特异性。本研究旨在调查经CT检测出肺部有肺炎性病变但CXR未检测出的COVID-19患者的临床特征。共有156名在韩国三家国家级指定医院住院的COVID-19患者，这些患者CXR未检测出活动性病变，但临床怀疑患有肺炎，接受了CT检查并被纳入研究。回顾并分析了包括人口统计学和临床特征（包括合并症、症状、入院时的影像学和实验室检查结果）在内的病历。研究了CXR未检测出活动性病变的患者经CT检测出肺炎的危险因素。在156名CXR未检测出活动性病变的患者中，35名（22.44%）患者经CT检查发现患有肺炎。经CT确诊的肺炎患者比未患肺炎的患者年龄更大（64.1岁对41.2岁）。高血压、糖尿病、心血管疾病、既往中风和痴呆等合并症在经CT确诊的肺炎患者中比未患肺炎的患者更为常见。调整年龄后，血清白蛋白水平、C反应蛋白（CRP）、中风和年龄≥70岁与经CT确诊的肺炎显著相关。在多变量回归分析中，血清白蛋白水平（调整后的优势比（AOR）=0.123，95%置信区间=（0.035-0.429））和既往中风（AOR = 11.447，95%置信区间=（1.168-112.220））显著且独立地预测了经CT检测出肺炎。我们的结果表明，对于临床怀疑患有肺炎但CXR显示肺部无肺炎性病变的COVID-19患者，应进行CT扫描。此外，白蛋白水平较低且既往有中风的老年患者，尽管CXR检查未发现活动性病变，也应检查是否存在肺炎。
