Górecki Andrzej, Piech Piotr, Bronikowska Anna, Szostak Zuzanna, Jankowska Ada, Kołodziejczyk Karolina, Borowski Bartosz, Staśkiewicz Grzegorz
Medical Diagnostic Center Voxel, Regional Hospital in Łańcut, 37-100 Łańcut, Poland.
Department of Correct, Clinical and Imaging Anatomy, Medical University of Lublin, 20-090 Lublin, Poland.
J Clin Med. 2025 Jun 21;14(13):4423. doi: 10.3390/jcm14134423.
Effective early risk stratification in COVID-19 remains a critical challenge in emergency care, particularly due to the limitations of RT-PCR testing, including delayed processing and false negatives. There is an unmet need for imaging tools that are fast, reliable, and safe for repeated use in acute clinical settings. In this prospective, multicenter study, over 1000 patients hospitalized with suspected or confirmed COVID-19 were initially screened. A total of 555 patients with PCR-confirmed infection were ultimately included for analysis. All participants underwent low-dose chest CT (LDCT) at admission. Pulmonary involvement was assessed using the chest CT severity score (CTSS) based on a unified protocol. CTSS values were analyzed in relation to ICU admission, in-hospital mortality, demographic data, oxygen saturation, dyspnea scores, and laboratory markers (CRP, LDH, lymphocyte, and neutrophil counts). Imaging was interpreted by board-certified radiologists under harmonized reporting standards. CTSS values ≥13 and ≥15 were significantly associated with ICU admission and in-hospital mortality, respectively ( < 0.01). Strong correlations were observed between the CTSS and CRP, LDH, and dyspnea scores, with negative correlations to oxygen saturation and lymphocyte count. The standardized LDCT protocol ensured consistent image quality and minimized radiation exposure. LDCT combined with the CTSS provides a robust, reproducible, and radiation-sparing method for emergency risk stratification in COVID-19. Its high clinical utility supports deployment in frontline triage systems and future AI-enhanced diagnostic workflows.
在急诊护理中，对新型冠状病毒肺炎（COVID-19）进行有效的早期风险分层仍然是一项严峻挑战，尤其是由于逆转录聚合酶链反应（RT-PCR）检测存在局限性，包括处理延迟和假阴性。在急性临床环境中，对于快速、可靠且可安全重复使用的成像工具存在未被满足的需求。在这项前瞻性多中心研究中，对1000多名疑似或确诊COVID-19的住院患者进行了初步筛查。最终纳入555例PCR确诊感染患者进行分析。所有参与者在入院时均接受了低剂量胸部CT（LDCT）检查。根据统一方案，使用胸部CT严重程度评分（CTSS）评估肺部受累情况。分析CTSS值与入住重症监护病房（ICU）、院内死亡率、人口统计学数据、血氧饱和度、呼吸困难评分以及实验室指标（C反应蛋白、乳酸脱氢酶、淋巴细胞和中性粒细胞计数）之间的关系。成像由具有委员会认证的放射科医生按照统一的报告标准进行解读。CTSS值≥13和≥15分别与入住ICU和院内死亡率显著相关（<0.01）。观察到CTSS与C反应蛋白、乳酸脱氢酶和呼吸困难评分之间存在强相关性，与血氧饱和度和淋巴细胞计数呈负相关。标准化的LDCT方案确保了一致的图像质量，并将辐射暴露降至最低。LDCT结合CTSS为COVID-19的急诊风险分层提供了一种强大、可重复且节省辐射的方法。其高临床实用性支持在一线分诊系统和未来人工智能增强的诊断工作流程中应用。
