Sapienza Lucas G, Nasra Karim, Calsavara Vinícius F, Little Tania B, Narayana Vrinda, Abu-Isa Eyad
Department of Internal Medicine, Ascension Providence Hospital, Michigan State University, Southfield, MI, United States.
Department of Radiology, Ascension Providence Hospital, Michigan State University, Southfield, MI, United States.
Eur J Radiol Open. 2021;8:100322. doi: 10.1016/j.ejro.2021.100322. Epub 2021 Jan 6.
To determine whether the percentage of lung involvement at the initial chest computed tomography (CT) is related to the subsequent risk of in-hospital death in patients with coronavirus disease-2019 (Covid-19).
Using a cohort of 154 laboratory-confirmed Covid-19 pneumonia cases that underwent chest CT between February and April 2020, we performed a volumetric analysis of the lung opacities. The impact of relative lung involvement on outcomes was evaluated using multivariate logistic regression. The primary endpoint was the in-hospital mortality rate. The secondary endpoint was major adverse hospitalization events (intensive care unit admission, use of mechanical ventilation, or death).
The median age of the patients was 65 years: 50.6 % were male, and 36.4 % had a history of smoking. The median relative lung involvement was 28.8 % (interquartile range 9.5-50.3). The overall in-hospital mortality rate was 16.2 %. Thirty-six (26.3 %) patients were intubated. After adjusting for significant clinical factors, there was a 3.6 % increase in the chance of in-hospital mortality (OR 1.036; 95 % confidence interval, 1.010-1.063; P = 0.007) and a 2.5 % increase in major adverse hospital events (OR 1.025; 95 % confidence interval, 1.009-1.042; P = 0.002) per percentage unit of lung involvement. Advanced age (P = 0.013), DNR/DNI status at admission (P < 0.001) and smoking (P = 0.008) also increased in-hospital mortality. Older (P = 0.032) and male patients (P = 0.026) had an increased probability of major adverse hospitalization events.
Among patients hospitalized with Covid-19, more lung consolidation on chest CT increases the risk of in-hospital death, independently of confounding clinical factors.
确定2019冠状病毒病（Covid-19）患者初次胸部计算机断层扫描（CT）时肺部受累的百分比是否与随后的院内死亡风险相关。
我们对2020年2月至4月间接受胸部CT检查的154例实验室确诊的Covid-19肺炎病例进行队列研究，对肺部混浊进行容积分析。使用多因素逻辑回归评估相对肺部受累对结局的影响。主要终点是院内死亡率。次要终点是主要不良住院事件（入住重症监护病房、使用机械通气或死亡）。
患者的中位年龄为65岁：50.6%为男性，36.4%有吸烟史。肺部受累的中位相对比例为28.8%（四分位间距9.5 - 50.3）。总体院内死亡率为16.2%。36例（26.3%）患者接受了气管插管。在对显著临床因素进行校正后，肺部受累每增加一个百分点，院内死亡几率增加3.6%（比值比1.036；95%置信区间，1.010 - 1.063；P = 0.007），主要不良住院事件增加2.5%（比值比1.025；95%置信区间，1.009 - 1.042；P = 0.002）。高龄（P = 0.013）、入院时的“不要复苏/不要插管”状态（P < 0.001）和吸烟（P = 0.008）也会增加院内死亡率。年龄较大（P = 0.032）和男性患者（P = 0.026）发生主要不良住院事件的概率增加。
在因Covid-19住院的患者中，胸部CT上更多的肺部实变会增加院内死亡风险，且独立于混杂的临床因素。
