Yıldırım Ayaz Elif, Coşkun Zafer Ünsal, Kaplan Mustafa, Bulut Ahmet Sait, Yeşildal Melike, Ankaralı Handan, Uygun Gökhan, Telci Çaklılı Özge, Uzunlulu Mehmet, Vahaboğlu Haluk, Odabaş Ali Rıza
University of Health Sciences Sultan 2. Abdülhamid Training and Research Hospital, Internal Medicine Clinic, TR.
University of Health Sciences Sultan 2. Abdülhamid Training and Research Hospital, Department of Radiology, TR.
J Belg Soc Radiol. 2022 Jul 8;106(1):67. doi: 10.5334/jbsr.2714. eCollection 2022.
This study aims to determine whether COVID-19 patients with different initial reverse transcriptase-polymerase chain reaction (RT-PCR), computed tomography (CT) and laboratory findings have different clinical outcomes.
In this multi-center retrospective cohort study, 895 hospitalized patients with the diagnosis of COVID-19 were included. According to the RT-PCR positivity and presence of CT findings, the patients were divided into four groups. These groups were compared in terms of mortality and need for intensive care unit (ICU). According to the COVID-19 Reporting and Data System (CO-RADS), all patients' CT images were staged. Multivariate binary logistic regression analysis was used to examine the relationship between CO-RADS and predictive inflammation and coagulation parameters.
RT-PCR test positivity was 51.5%, the CT finding was 70.7%, and 49.7% of the patients were in the CO-RADS 5 stage. The need for ICU and mortality rates was higher in the group with only CT findings compared to the group with only RT-PCR positivity, (14.9% vs. 4.0%, p < 0.001; 9.3% vs. 3.3%, p > 0.05; respectively). Mortality was 3.27 times higher in patients with CO-RADS 4 compared to those with CO-RADS 1-2. Being in the CO-RADS 4 stage and LDH were discovered to be the most efficient parameters in determining mortality risk.
Performing only the RT-PCR test in the initial evaluation of patients in SARS-CoV-2 infection may lead to overlooking groups that are more at risk for severe disease. The use of a chest CT to perform CO-RADS staging would be beneficial in terms of providing both diagnostic and prognostic information.
本研究旨在确定具有不同初始逆转录聚合酶链反应（RT-PCR）、计算机断层扫描（CT）和实验室检查结果的新型冠状病毒肺炎（COVID-19）患者是否具有不同的临床结局。
在这项多中心回顾性队列研究中，纳入了895例确诊为COVID-19的住院患者。根据RT-PCR阳性情况和CT检查结果，将患者分为四组。对这些组在死亡率和重症监护病房（ICU）需求方面进行比较。根据COVID-19报告和数据系统（CO-RADS），对所有患者的CT图像进行分期。采用多变量二元逻辑回归分析来检验CO-RADS与预测炎症和凝血参数之间的关系。
RT-PCR检测阳性率为51.5%，CT检查结果阳性率为70.7%，49.7%的患者处于CO-RADS 5期。与仅RT-PCR阳性的组相比，仅CT检查结果阳性的组对ICU护理的需求和死亡率更高（分别为14.9%对4.0%，p<0.001；9.3%对3.3%，p>0.05）。与CO-RADS 1-2期的患者相比，CO-RADS 4期的患者死亡率高3.27倍。发现处于CO-RADS 4期和乳酸脱氢酶（LDH）水平是确定死亡风险最有效的参数。
在严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染患者的初始评估中仅进行RT-PCR检测可能会导致忽略重症风险更高的群体。使用胸部CT进行CO-RADS分期在提供诊断和预后信息方面将是有益的。
