Charing Cross Hospital, London, UK; Addenbrooke's Hospital, Cambridge, UK.
Royal London Hospital, London, UK.
Neuroimage Clin. 2024;42:103590. doi: 10.1016/j.nicl.2024.103590. Epub 2024 Mar 15.
Apical ground-glass opacification (GGO) identified on CT angiography (CTA) performed for suspected acute stroke was developed in 2020 as a coronavirus-disease-2019 (COVID-19) diagnostic and prognostic biomarker in a retrospective study during the first wave of COVID-19.
To prospectively validate whether GGO on CTA performed for suspected acute stroke is a reliable COVID-19 diagnostic and prognostic biomarker and whether it is reliable for COVID-19 vaccinated patients.
In this prospective, pragmatic, national, multi-center validation study performed at 13 sites, we captured study data consecutively in patients undergoing CTA for suspected acute stroke from January-March 2021. Demographic and clinical features associated with stroke and COVID-19 were incorporated. The primary outcome was the likelihood of reverse-transcriptase-polymerase-chain-reaction swab-test-confirmed COVID-19 using the GGO biomarker. Secondary outcomes investigated were functional status at discharge and survival analyses at 30 and 90 days. Univariate and multivariable statistical analyses were employed.
CTAs from 1,111 patients were analyzed, with apical GGO identified in 8.5 % during a period of high COVID-19 prevalence. GGO showed good inter-rater reliability (Fleiss κ = 0.77); and high COVID-19 specificity (93.7 %, 91.8-95.2) and negative predictive value (NPV; 97.8 %, 96.5-98.6). In subgroup analysis of vaccinated patients, GGO remained a good diagnostic biomarker (specificity 93.1 %, 89.8-95.5; NPV 99.7 %, 98.3-100.0). Patients with COVID-19 were more likely to have higher stroke score (NIHSS (mean +/- SD) 6.9 +/- 6.9, COVID-19 negative, 9.7 +/- 9.0, COVID-19 positive; p = 0.01), carotid occlusions (6.2 % negative, 14.9 % positive; p = 0.02), and larger infarcts on presentation CT (ASPECTS 9.4 +/- 1.5, COVID-19 negative, 8.6 +/- 2.4, COVID-19 positive; p = 0.00). After multivariable logistic regression, GGO (odds ratio 15.7, 6.2-40.1), myalgia (8.9, 2.1-38.2) and higher core body temperature (1.9, 1.1-3.2) were independent COVID-19 predictors. GGO was associated with worse functional outcome on discharge and worse survival after univariate analysis. However, after adjustment for factors including stroke severity, GGO was not independently predictive of functional outcome or mortality.
Apical GGO on CTA performed for patients with suspected acute stroke is a reliable diagnostic biomarker for COVID-19, which in combination with clinical features may be useful in COVID-19 triage.
在 2020 年第一波 COVID-19 期间的一项回顾性研究中，CT 血管造影（CTA）中检测到的疑似急性中风的尖部磨玻璃样混浊（GGO）被开发为 COVID-19 的诊断和预后生物标志物。
前瞻性验证 CTA 中检测到的疑似急性中风的 GGO 是否是可靠的 COVID-19 诊断和预后生物标志物，以及对于 COVID-19 接种患者是否可靠。
在这项在 13 个地点进行的前瞻性、实用、全国性、多中心验证研究中，我们连续收集了 2021 年 1 月至 3 月疑似急性中风患者进行 CTA 的研究数据。纳入了与中风和 COVID-19 相关的人口统计学和临床特征。主要结局是使用 GGO 生物标志物检测逆转录酶聚合酶链反应拭子检测确证 COVID-19 的可能性。次要结局是出院时的功能状态和 30 天和 90 天的生存分析。采用单变量和多变量统计分析。
对 1111 例 CTA 进行了分析，在 COVID-19 高发期间发现 8.5% 的患者存在尖部 GGO。GGO 具有良好的组内一致性（Fleiss κ=0.77）；具有高 COVID-19 特异性（93.7%，91.8-95.2）和高阴性预测值（97.8%，96.5-98.6）。在接种疫苗患者的亚组分析中，GGO 仍然是一种良好的诊断生物标志物（特异性 93.1%，89.8-95.5；阴性预测值 99.7%，98.3-100.0）。COVID-19 患者更有可能出现更高的中风评分（NIHSS（平均值 +/- 标准差）6.9 +/- 6.9，COVID-19 阴性，9.7 +/- 9.0，COVID-19 阳性；p=0.01）、颈动脉闭塞（6.2%阴性，14.9%阳性；p=0.02）和更大的梗死灶在 CT 上（ASPECTS 9.4 +/- 1.5，COVID-19 阴性，8.6 +/- 2.4，COVID-19 阳性；p=0.00）。在多变量逻辑回归后，GGO（优势比 15.7，6.2-40.1）、肌痛（8.9，2.1-38.2）和更高的核心体温（1.9，1.1-3.2）是 COVID-19 的独立预测因子。GGO 与出院时的功能结局较差和单因素分析后的生存较差相关。然而，在调整了包括中风严重程度在内的因素后，GGO 不能独立预测功能结局或死亡率。
在疑似急性中风患者的 CTA 中检测到的尖部 GGO 是 COVID-19 的可靠诊断生物标志物，结合临床特征可能有助于 COVID-19 的分诊。
