Almasi Nokiani Alireza, Shahnazari Razieh, Abbasi Mohammad Amin, Divsalar Farshad, Bayazidi Marzieh, Sadatnaseri Azadeh
Department of Radiology, Firoozabadi Hospital, Iran University of Medical Sciences, Tehran, Iran.
Firoozabadi Clinical Research Development Unit (FCRDU), Iran University of Medical Sciences, Tehran, Iran.
Caspian J Intern Med. 2022;13(Suppl 3):228-235. doi: 10.22088/cjim.13.0.228.
lung involvement in COVID-19 can be quantified by chest CT scan. We evaluated the triage and prognostication performance of seven proposed CT-severity score (CTSS) systems in two age groups of ≥65 and <65 years old.
Confirmed COVID-19 patients by reverse transcriptase polymerase chain reaction (RT-PCR) admitted from February 20th, 2020 to July 22nd were included in a retrospective single center study. Clinical disease severity at presentation and at peak disease severity were recorded. CT images were scored according to seven different scoring systems (CTSS1-CTSS7). The cohort was divided into two age groups of ≥65 and <65 years old. Receiver operator characteristic (ROC) curves for each age group for diagnosis of severe/critical disease on admission (for triage) were plotted. Such curves were also plotted for predicting severe/critical disease at peak disease severity (for prognostication), and critical disease at peak severity (for prognostication). Areas under the curve (AUCs), best thresholds, and corresponding sensitivities (Sens.) and specificities (Spec.) were calculated.
96 patients were included with a mean age of 63.6±17.4 years. All CTSSs in 65-year-old or more group (N=55) showed excellent performance (AUC=0.80-0.83, Sens.+Spec.= 155-162%) in triage and excellent or outstanding performance (AUC=0.81-0.92, Sens.+Spec.= 153-177%) in prognostication. In the younger group (N=44), all CTSSs were unsatisfactory for triage (AUC=0.49-0.57) and predicting severe/critical disease (AUC=0.67-0.70), but were acceptable for predicting critical disease (AUC=0.70-0.73, Sens.+Spec.= 132-151%).
CTSS is an excellent tool in triage and prognostication in patients with COVID-19 ≥65 years old, but is of limited value in younger patients.
新型冠状病毒肺炎（COVID-19）患者的肺部受累情况可通过胸部CT扫描进行量化评估。我们评估了七种拟议的CT严重程度评分（CTSS）系统在两个年龄组（≥65岁和<65岁）中的分诊和预后评估性能。
对2020年2月20日至7月22日收治的经逆转录聚合酶链反应（RT-PCR）确诊的COVID-19患者进行回顾性单中心研究。记录患者就诊时及疾病严重程度峰值时的临床疾病严重程度。根据七种不同的评分系统（CTSS1-CTSS7）对CT图像进行评分。将队列分为≥65岁和<65岁两个年龄组。绘制每个年龄组入院时诊断严重/危重症疾病（用于分诊）的受试者工作特征（ROC）曲线。还绘制了预测疾病严重程度峰值时的严重/危重症疾病（用于预后评估）以及峰值严重程度时的危重症疾病（用于预后评估）的ROC曲线。计算曲线下面积（AUC）、最佳阈值以及相应的敏感性（Sens.）和特异性（Spec.）。
纳入96例患者，平均年龄为63.6±17.4岁。65岁及以上组（N = 55）的所有CTSS系统在分诊方面表现出色（AUC = 0.80 - 0.83，Sens.+Spec. = 155 - 162%），在预后评估方面表现优异或出色（AUC = 0.81 - 0.92，Sens.+Spec. = 153 - 177%）。在较年轻组（N = 44）中，所有CTSS系统在分诊（AUC = 0.49 - 0.57）和预测严重/危重症疾病（AUC = 0.67 - （此处原文有误，应为0.70）0.70）方面均不理想，但在预测危重症疾病方面尚可接受（AUC = 0.70 - 0.73，Sens.+Spec. = 132 - 151%）。
CTSS是≥65岁COVID-19患者分诊和预后评估的优秀工具，但对较年轻患者价值有限。
