胸部 CT 严重程度评分：评估住院伊朗患者 COVID-19 的严重程度和短期预后。
Chest CT severity score: assessment of COVID‑19 severity and short-term prognosis in hospitalized Iranian patients.
机构信息
Department of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Pediatric Infectious Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.
出版信息
Wien Med Wochenschr. 2022 Mar;172(3-4):77-83. doi: 10.1007/s10354-022-00914-5. Epub 2022 Feb 8.
BACKGROUND
The aim of this study was to evaluate the value of chest computed tomography (CT) severity score in the assessment of coronavirus disease 2019 (COVID‑19) severity and short-term prognosis.
METHODS
In this cross-sectional study, we evaluated all patients who were referred to our university hospital, from 21 May 2020 to 22 June 2020 with positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) reverse transcription-polymerase chain reaction (RT-PCR) test. The patients suspected of having other respiratory diseases including influenza, according to an infectious disease specialist, and those without chest CT scan were excluded. A chest CT was obtained for all patients between days 4 and 7 days after symptom onset. Chest CT severity score was also calculated based on the degree of involvement of the lung lobes as 0%, (0 points), 1-25% (1 point), 26-50% (2 points), 51-75% (3 points), and 76-100% (4 points). The CT severity score was quantified by summing the 5 lobe indices (range 0-20). The ROC curve analysis was performed for the clinical value of CT scores in distinguishing the patients based on the severity of disease (mild/moderate group versus severe group), ICU admission, intubation requirement, and mortality.
RESULTS
Of the 148 patients included, 93 patients recovered, while 55 patients died (mortality rate 37%). The area under the curve of CT score for discriminating of recovered patients from deceased individuals was 0.726, and the optimal CT score threshold was 15.5 with 61.8% sensitivity and 76.3% specificity. The best CT score cut-off for discriminating of patients based on the severity of disease was 12.5 with 68.3% sensitivity and 72.7% specificity. In addition, with CT score cut-off of 15.5, sensitivities of 70.8% and 51.6% and specificities of 78% and 72.6% were observed for intubation and ICU admission, respectively.
CONCLUSION
CT scan and semiquantitative scoring method could be beneficial and applicable in predicting the patient's condition.
背景
本研究旨在评估胸部计算机断层扫描（CT）严重程度评分在评估 2019 年冠状病毒病（COVID-19）严重程度和短期预后中的价值。
方法
在这项横断面研究中，我们评估了 2020 年 5 月 21 日至 6 月 22 日期间因严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）逆转录-聚合酶链反应（RT-PCR）检测呈阳性而被转至我们大学医院的所有患者。根据传染病专家的建议，排除了疑似患有流感等其他呼吸道疾病且未进行胸部 CT 扫描的患者。所有患者在症状出现后第 4 至 7 天之间进行胸部 CT 检查。还根据肺叶受累程度计算了胸部 CT 严重程度评分，分为 0%（0 分）、1-25%（1 分）、26-50%（2 分）、51-75%（3 分）和 76-100%（4 分）。通过将 5 个肺叶指数相加来量化 CT 严重程度评分（范围 0-20）。对 CT 评分在基于疾病严重程度（轻症/中度组与重症组）、入住 ICU、需要插管和死亡率区分患者方面的临床价值进行了 ROC 曲线分析。
结果
在纳入的 148 例患者中，93 例患者康复，55 例患者死亡（死亡率为 37%）。CT 评分区分康复患者和死亡患者的曲线下面积为 0.726，最佳 CT 评分阈值为 15.5，灵敏度为 61.8%，特异性为 76.3%。区分疾病严重程度的最佳 CT 评分截断值为 12.5，灵敏度为 68.3%，特异性为 72.7%。此外，当 CT 评分截断值为 15.5 时，对于插管和入住 ICU，灵敏度分别为 70.8%和 51.6%，特异性分别为 78%和 72.6%。
结论
CT 扫描和半定量评分方法有助于预测患者的病情。
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