Tekcan Sanli Deniz Esin, Yildirim Duzgun, Sanli Ahmet Necati, Erozan Neval, Husmen Guray, Altundag Aytug, Tuzuner Filiz, Dikensoy Oner, Erel Kirisoglu Ceyda
Department of Radiology, Acibadem Kozyatagi Hospital, Istanbul, Turkey.
Department of Radiology, Acibadem Taksim Hospital, Istanbul, Turkey.
Diagn Interv Radiol. 2021 Sep;27(5):599-606. doi: 10.5152/dir.2020.20421.
In this study, we aimed to reveal the relationship between initial lung parenchymal involvement patterns and the subsequent need for hospitalization and/or intensive care unit admission in coronavirus disease 2019 (COVID-19) positive cases.
Overall, 231 patients diagnosed with COVID-19 as proven by PCR were included in this study. Based on the duration of hospitalization, patients were divided into three groups as follows: Group 1, patients receiving outpatient treatment or requiring hospitalization <7 days; Group 2, requiring hospitalization ≥7 days; Group 3, patients requiring at least 1 day of intensive care at any time. Chest CT findings at first admission were evaluated for the following features: typical/atypical involvement of the disease, infiltration patterns (ground-glass opacities, crazy-paving pattern, consolidation), distribution and the largest diameters of the lesions, total lesion numbers, number of affected lung lobes, and affected total lung parenchyma percentages. The variability of all these findings according to the groups was analyzed statistically.
In this study, 172 patients were in Group 1, 39 patients in Group 2, and 20 patients in Group 3. The findings obtained in this study indicated that there was no statistically significant difference in ground-glass opacity rates among the groups (p = 0.344). The rates of crazy-paving and consolidation patterns were significantly higher in Groups 2 and 3 than in Group 1 (p = 0.001, p = 0.002, respectively). The rate of right upper, left upper lobe, and right middle lobe involvements as consolidation pattern was significantly higher in Group 3 than in Group 1 (p = 0.148, p = 0.935, p = 0.143, respectively). A statistically significant difference was also found between the affected lobe numbers, total lesion numbers, the diameter of the largest lesion, and the affected lung parenchyma percentages between the groups (p = 0.001). The average number of impacted lobes in Group 1 was 2; 4 in Group 2 and Group 3. The mean percentage of affected lung parenchyma percentage was 25% in Group 1 and Group 2, and 50% in Group 3.
In case of infiltration dominated by right middle or upper lobe involvement with a consolidation pattern, there is a higher risk of future intensive care need. Also, the need for intensive care increases as the number of affected lobes and percentage of affected parenchymal involvement increase.
在本研究中，我们旨在揭示2019冠状病毒病（COVID-19）阳性病例的初始肺实质受累模式与随后住院和/或入住重症监护病房需求之间的关系。
本研究共纳入231例经PCR确诊为COVID-19的患者。根据住院时间，患者分为以下三组：第1组，接受门诊治疗或住院时间<7天的患者；第2组，住院时间≥7天的患者；第3组，随时需要至少1天重症监护的患者。首次入院时的胸部CT表现评估以下特征：疾病的典型/非典型受累、浸润模式（磨玻璃影、铺路石样、实变）、病变的分布和最大直径、病变总数、受累肺叶数以及受累肺实质百分比。对所有这些发现根据分组进行统计学分析。
本研究中，第1组有172例患者，第2组有39例患者，第3组有20例患者。本研究获得的结果表明，各组间磨玻璃影发生率无统计学显著差异（p = 0.344）。第2组和第3组的铺路石样和实变模式发生率显著高于第1组（分别为p = 0.001，p = 0.002）。第3组右上叶、左上叶和右中叶以实变模式受累的发生率显著高于第1组（分别为p = 0.148，p = 0.935，p = 0.143）。各组间受累肺叶数、病变总数、最大病变直径和受累肺实质百分比也存在统计学显著差异（p = 0.001）。第1组受累肺叶的平均数量为2个；第2组和第3组为4个。第1组和第2组受累肺实质百分比的平均值为25%，第3组为50%。
如果以右中叶或上叶受累并伴有实变模式为主的浸润，未来需要重症监护的风险更高。此外，随着受累肺叶数量和受累实质百分比的增加，重症监护的需求也会增加。
