Risk of in-hospital death associated with Covid-19 lung consolidations on chest computed tomography - A novel translational approach using a radiation oncology contour software

Lucas G Sapienza; Karim Nasra; Vinícius F Calsavara; Tania B Little; Vrinda Narayana; Eyad Abu-Isa

doi:10.1016/j.ejro.2021.100322

Risk of in-hospital death associated with Covid-19 lung consolidations on chest computed tomography - A novel translational approach using a radiation oncology contour software

Eur J Radiol Open. 2021:8:100322. doi: 10.1016/j.ejro.2021.100322. Epub 2021 Jan 6.

Authors

Lucas G Sapienza¹, Karim Nasra², Vinícius F Calsavara³, Tania B Little⁴, Vrinda Narayana⁵, Eyad Abu-Isa⁵

Affiliations

¹ Department of Internal Medicine, Ascension Providence Hospital, Michigan State University, Southfield, MI, United States.
² Department of Radiology, Ascension Providence Hospital, Michigan State University, Southfield, MI, United States.
³ Department of Epidemiology and Statistics, A.C.Camargo Cancer Center, São Paulo, São Paulo, Brazil.
⁴ Department of Infectious Diseases, Ascension Providence Hospital, Michigan State University, Southfield, MI, United States.
⁵ Department of Radiation Oncology, University of Michigan, Ann Arbor, MI, United States.

Abstract

Purpose: To determine whether the percentage of lung involvement at the initial chest computed tomography (CT) is related to the subsequent risk of in-hospital death in patients with coronavirus disease-2019 (Covid-19).

Materials and methods: Using a cohort of 154 laboratory-confirmed Covid-19 pneumonia cases that underwent chest CT between February and April 2020, we performed a volumetric analysis of the lung opacities. The impact of relative lung involvement on outcomes was evaluated using multivariate logistic regression. The primary endpoint was the in-hospital mortality rate. The secondary endpoint was major adverse hospitalization events (intensive care unit admission, use of mechanical ventilation, or death).

Results: The median age of the patients was 65 years: 50.6 % were male, and 36.4 % had a history of smoking. The median relative lung involvement was 28.8 % (interquartile range 9.5-50.3). The overall in-hospital mortality rate was 16.2 %. Thirty-six (26.3 %) patients were intubated. After adjusting for significant clinical factors, there was a 3.6 % increase in the chance of in-hospital mortality (OR 1.036; 95 % confidence interval, 1.010-1.063; P = 0.007) and a 2.5 % increase in major adverse hospital events (OR 1.025; 95 % confidence interval, 1.009-1.042; P = 0.002) per percentage unit of lung involvement. Advanced age (P = 0.013), DNR/DNI status at admission (P < 0.001) and smoking (P = 0.008) also increased in-hospital mortality. Older (P = 0.032) and male patients (P = 0.026) had an increased probability of major adverse hospitalization events.

Conclusions: Among patients hospitalized with Covid-19, more lung consolidation on chest CT increases the risk of in-hospital death, independently of confounding clinical factors.

Keywords: COVID19; Chest CT; Consolidations; Covid-19, coronavirus disease-2019; DNR/DNI, do-not-resuscitate and do-not-intubate status; ICU, intensive care unit; IQR, interquartile range; In-hospital death; OR, Odds Ratio; PACS, picture archiving and communication system; Pneumonia; Prognosis; ROC, receiver operating characteristics; RT-PCR, reverse transcription polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.