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.
Clin Med Res. 2023 Mar;21(1):14-25. doi: 10.3121/cmr.2023.1772.
We evaluated the triage and prognostic performance of seven proposed computed tomography (CT)-severity score (CTSS) systems in two different age groups. Retrospective study. COVID-19 pandemic. Admitted COVID-19, PCR-positive patients were included, excluding patients with heart failure and significant pre-existing pulmonary disease. Patients were divided into two age groups: ≥65 years and ≤64 years. Clinical data indicating disease severity at presentation and at peak disease severity were recorded. Initial CT images were scored by two radiologists according to seven CTSSs (CTSS1-CTSS7). Receiver operating characteristic (ROC) analysis for the performance of each CTSS in diagnosing severe/critical disease on admission (triage performance) and at peak disease severity (prognostic performance) was done for the whole cohort and each age group separately. Included were 96 patients. Intraclass correlation coefficient (ICC) between the two radiologists scoring the CT scan images were good for all the CTSSs (ICC=0.764-0.837). In the whole cohort, all CTSSs showed an unsatisfactory area under the curve (AUC) in the ROC curve for triage, excluding CTSS2 (AUC=0.700), and all CTSSs showed acceptable AUCs for prognostic usage (0.759-0.781). In the older group (≥65 years; n=55), all CTSSs excluding CTSS6 showed excellent AUCs for triage (0.804-0.830), and CTSS6 was acceptable (AUC=0.796); all CTSSs showed excellent or outstanding AUCs for prognostication (0.859-0.919). In the younger group (≤64 years; n=41), all CTSSs showed unsatisfactory AUCs for triage (AUC=0.487-0.565) and prognostic usage (AUC=0.668-0.694), excluding CTSS6, showing marginally acceptable AUC for prognostic performance (0.700). Those CTSSs requiring more numerous segmentations, namely CTSS2, CTSS7, and CTSS5 showed the best ICCs; therefore, they are the best when comparison between two separate scores is needed. Irrespective of patients' age, CTSSs show minimal value in triage and acceptable prognostic value in COVID-19 patients. CTSS performance is highly variable in different age groups. It is excellent in those aged ≥65 years, but has little if any value in younger patients. Multicenter studies with larger sample size to evaluate results of this study should be conducted.
我们评估了七种建议的计算机断层扫描（CT）严重程度评分（CTSS）系统在两个不同年龄组中的分诊和预后表现。回顾性研究。COVID-19 大流行。纳入 PCR 阳性的 COVID-19 住院患者，排除心力衰竭和有明显既往肺部疾病的患者。患者分为两个年龄组：≥65 岁和≤64 岁。记录入院时和疾病高峰期表明疾病严重程度的临床数据。最初的 CT 图像由两名放射科医生根据七种 CTSS（CTSS1-CTSS7）进行评分。对每个 CTSS 在整个队列和每个年龄组中的入院时（分诊表现）和疾病高峰期（预后表现）诊断严重/危重症的性能进行接收者操作特征（ROC）分析。共纳入 96 例患者。两名放射科医生对 CT 扫描图像进行评分的组内相关系数（ICC）对于所有 CTSS 均良好（ICC=0.764-0.837）。在整个队列中，所有 CTSS 在 ROC 曲线中的曲线下面积（AUC）都显示出不理想的分诊（AUC=0.700），除 CTSS2 外，所有 CTSS 在预后应用中均显示出可接受的 AUC（0.759-0.781）。在年龄较大的组（≥65 岁；n=55）中，所有 CTSS 除 CTSS6 外，在分诊方面均具有出色的 AUC（0.804-0.830），而 CTSS6 则可接受（AUC=0.796）；所有 CTSS 在预后方面均具有出色或杰出的 AUC（0.859-0.919）。在年龄较小的组（≤64 岁；n=41）中，所有 CTSS 在分诊（AUC=0.487-0.565）和预后使用（AUC=0.668-0.694）方面的 AUC 均不理想，除 CTSS6 外，在预后表现方面显示出边缘可接受的 AUC（0.700）。需要更多分段的那些 CTSS，即 CTSS2、CTSS7 和 CTSS5，显示出最好的 ICC；因此，在需要比较两个单独的分数时，它们是最好的。无论患者年龄大小，CTSS 在 COVID-19 患者中的分诊中价值很小，在预后中具有可接受的价值。CTSS 性能在不同年龄组中差异很大。在≥65 岁的患者中表现出色，但在年轻患者中几乎没有价值。应该进行多中心研究，以更大的样本量评估本研究的结果。
