Jayachandran Ajith K, Nelson Vincy, Shajahan Mohammad Easa
Department of Emergency Medicine, Travancore Medical College, Kollam, Kerala, India.
Department of Community Medicine, Travancore Medical College, Kollam, Kerala, India.
J Family Med Prim Care. 2022 Aug;11(8):4363-4367. doi: 10.4103/jfmpc.jfmpc_209_22. Epub 2022 Aug 30.
As India was slowly coming out of shock from the second wave wrecked by the Delta strain, the world population is now struck once again with a new strain of coronavirus disease 2019 (COVID-19), designated as B.1.1.529, named as OMICRON. Though several international studies have evaluated the role of computed tomography (CT) in diagnosis, predicting prognosis, and monitoring the progression of disease, to our best knowledge, there are no Indian studies published in this context.
(1) To determine the use of chest CT severity score as predictor of mortality in COVID-19 patients. (2) To determine the prognosis based on length of hospital stay.
A observational cohort study was done at Travancore Medical College Hospital. A retrospective analysis of patients who presented to the Emergency Medicine Department with a positive COVID antigen or reverse transcriptase-polymerase chain reaction (RT-PCR) results and those who underwent a CT chest at the time of presentation was conducted. Data was analyzed by using Statistical Package for Social Sciences (SPSS) version 16. Descriptive statistics such as mean, frequency, and percentages were calculated. Chi-square test was used to find the statistical significance. The Kaplan-Meier method was used to evaluate the relationship between CT score and mortality, which was compared with the log-rank test.
A total of 252 patients with positive COVID antigen or RT-PCR who underwent CT chest were included in our study. Our study population was composed of 139 (55.2%) males and 113 (44.8%) females. Only one patient with mild CT severity score required >14 days of ICU stay, whereas two (2%) and five (9.6%) patients with moderate and severe CT severity score, respectively, required ICU stay for >14 days. The value was 0.001, which again is statistically significant. In our study, out of 44 patients categorized under mild CT severity score, only two (4.5%) patients had expired. Out of 98 patients categorized under moderate CT severity score, 14 (14.3%) patients had expired, whereas out of 52 patients categorized under severe CT severity score at the time of admission, 25 (48.1%) patients had expired. The value was 0.001, which is statistically significant.
Our study could prove that patients with CT severity score ≥15 had high risk of mortality and required prolonged ICU stay of >5 days. CT severity score helps the primary care physicians to predict probable outcome and length of hospital stay at the time of admission itself and allocate the limited resources appropriately.
当印度正慢慢从由德尔塔毒株引发的第二波疫情冲击中恢复过来时，全球人口现在又再次受到了一种新型冠状病毒病2019（COVID-19）毒株的袭击，该毒株被命名为B.1.1.529，称作奥密克戎。尽管有几项国际研究评估了计算机断层扫描（CT）在疾病诊断、预测预后以及监测疾病进展中的作用，但据我们所知，在这方面尚无印度的相关研究发表。
（1）确定胸部CT严重程度评分作为COVID-19患者死亡率预测指标的用途。（2）根据住院时间确定预后情况。
在特拉凡哥尔医学院医院进行了一项观察性队列研究。对急诊科中COVID抗原检测呈阳性或逆转录聚合酶链反应（RT-PCR）结果呈阳性且就诊时接受了胸部CT检查的患者进行回顾性分析。使用社会科学统计软件包（SPSS）16版进行数据分析。计算了均值、频率和百分比等描述性统计量。采用卡方检验来确定统计学意义。使用Kaplan-Meier方法评估CT评分与死亡率之间的关系，并与对数秩检验进行比较。
共有252例COVID抗原检测呈阳性或RT-PCR检测呈阳性且接受了胸部CT检查的患者纳入我们的研究。我们的研究人群包括139名（55.2%）男性和113名（44.8%）女性。只有1例CT严重程度评分为轻度的患者需要在重症监护病房（ICU）住院超过14天，而CT严重程度评分为中度和重度的患者分别有2例（2%）和5例（9.6%）需要在ICU住院超过14天。P值为0.001，同样具有统计学意义。在我们的研究中，44例CT严重程度评分为轻度的患者中，只有2例（4.5%）死亡。98例CT严重程度评分为中度的患者中，14例（14.3%）死亡，而入院时CT严重程度评分为重度的52例患者中，25例（48.1%）死亡。P值为0.001，具有统计学意义。
我们的研究可以证明，CT严重程度评分≥15的患者死亡风险高，需要在ICU延长住院时间超过5天。CT严重程度评分有助于初级保健医生在入院时预测可能的预后和住院时间，并合理分配有限的资源。
