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The value of computed tomography in assessing the risk of death in COVID-19 patients presenting to the emergency room

2021; Springer Science+Business Media; Volume: 31; Issue: 12 Linguagem: Inglês

10.1007/s00330-021-07993-9

1432-1084

Giulia Besutti, Marta Ottone, Tommaso Fasano, Pierpaolo Pattacini, Valentina Iotti, Lucia Spaggiari, Riccardo Bonacini, Andrea Nitrosi, Efrem Bonelli, Simone Canovi, Rossana Colla, Alessandro Zerbini, Marco Massari, Ivana Lattuada, Anna Ferrari, Paolo Giorgi Rossi, Massimo Costantini, Roberto Grilli, Massimiliano Marino, Giulio Formoso, Debora Formisano, Emanuela Bedeschi, Cinzia Perilli, Elisabetta La Rosa, Eufemia Bisaccia, I. Venturi, Massimo Vicentini, Cinzia Campari, Francesco Gioia, Serena Broccoli, Pamela Mancuso, Marco Foracchia, Mirco Pinotti, Nicola Facciolongo, Laura Trabucco, Stefano Pietri, G. Danelli, Laura Albertazzi, Enrica Bellesia, Mattia Corradini, Elena Magnani, Annalisa Pilia, Alessandra Polese, Silvia Storchi Incerti, Piera Zaldini, Orsola Bonanno, Matteo Revelli, Carlo Salvarani, Carmine Pinto, Francesco Venturelli,

COVID-19 and healthcare impacts

The aims of this study were to develop a multiparametric prognostic model for death in COVID-19 patients and to assess the incremental value of CT disease extension over clinical parameters. Consecutive patients who presented to all five of the emergency rooms of the Reggio Emilia province between February 27 and March 23, 2020, for suspected COVID-19, underwent chest CT, and had a positive swab within 10 days were included in this retrospective study. Age, sex, comorbidities, days from symptom onset, and laboratory data were retrieved from institutional information systems. CT disease extension was visually graded as < 20%, 20–39%, 40–59%, or ≥ 60%. The association between clinical and CT variables with death was estimated with univariable and multivariable Cox proportional hazards models; model performance was assessed using k-fold cross-validation for the area under the ROC curve (cvAUC). Of the 866 included patients (median age 59.8, women 39.2%), 93 (10.74%) died. Clinical variables significantly associated with death in multivariable model were age, male sex, HDL cholesterol, dementia, heart failure, vascular diseases, time from symptom onset, neutrophils, LDH, and oxygen saturation level. CT disease extension was also independently associated with death (HR = 7.56, 95% CI = 3.49; 16.38 for ≥ 60% extension). cvAUCs were 0.927 (bootstrap bias-corrected 95% CI = 0.899–0.947) for the clinical model and 0.936 (bootstrap bias-corrected 95% CI = 0.912–0.953) when adding CT extension. A prognostic model based on clinical variables is highly accurate in predicting death in COVID-19 patients. Adding CT disease extension to the model scarcely improves its accuracy. • Early identification of COVID-19 patients at higher risk of disease progression and death is crucial; the role of CT scan in defining prognosis is unclear. • A clinical model based on age, sex, comorbidities, days from symptom onset, and laboratory results was highly accurate in predicting death in COVID-19 patients presenting to the emergency room. • Disease extension assessed with CT was independently associated with death when added to the model but did not produce a valuable increase in accuracy.