Lung Lesion Burden found on Chest CT as a Prognostic Marker in Hospitalized Patients with High Clinical Suspicion of COVID-19 Pneumonia: a Brazilian experience

OBJECTIVE: To investigate the relationship between lung lesion burden (LLB) found on chest computed tomography (CT) and 30-day mortality in hospitalized patients with high clinical suspicion of coronavirus disease 2019 (COVID-19), accounting for tomographic dynamic changes. METHODS: Patients hospitalized with high clinical suspicion of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in a dedicated and reference hospital for COVID-19, having undergone at least one RT-PCR test, regardless of the result, and with one CT compatible with COVID-19, were retrospectively studied. Clinical and laboratory data upon admission were assessed, and LLB found on CT was semi-quantitatively evaluated through visual analysis. The primary outcome was 30-day mortality after admission. Secondary outcomes, including the intensive care unit (ICU) admission, mechanical ventilation used, and length of stay (LOS), were assessed. RESULTS: A total of 457 patients with a mean age of 57±15 years were included. Among these, 58% presented with positive RT-PCR result for COVID-19. The median time from symptom onset to RT-PCR was 8 days [interquartile range 6-11 days]. An initial LLB of ≥50% using CT was found in 201 patients (44%), which was associated with an increased crude at 30-day mortality (31% vs. 15% in patients with LLB of <50%, p<0.001). An LLB of ≥50% was also associated with an increase in the ICU admission, the need for mechanical ventilation, and a prolonged LOS after adjusting for baseline covariates and accounting for the CT findings as a time-varying covariate; hence, patients with an LLB of ≥50% remained at a higher risk at 30-day mortality (adjusted hazard ratio 2.17, 95% confidence interval 1.47-3.18, p<0.001). CONCLUSION: Even after accounting for dynamic CT changes in patients with both clinical and imaging findings consistent with COVID-19, an LLB of ≥50% might be associated with a higher risk of mortality

Tomographic evaluation of coronary calcium burden in critically ill patients with acute respiratory failure due to SARS-COV-2 in the intensive care unit

Introdução: Dos mecanismos fisiopatológicos à estratificação de risco, persistem muitos debates e discussões sobre a doença arterial coronariana (DAC) como fator de risco para desfechos adversos em pacientes com COVID-19. Objetivo: Investigar o papel da carga de calcificação arterial coronariana (CAC) por meio da tomografia computadorizada (TC) de tórax não sincronizada ao eletrocardiograma (ECG) para a predição de mortalidade em 28 dias em pacientes críticos com COVID-19 internados em unidade de terapia intensiva (UTI). Métodos: Foram identificados pacientes adultos críticos consecutivos com insuficiência respiratória aguda pela COVID-19 internados na UTI entre março e junho de 2020 (n = 1.503), sendo incluídos na coorte final aqueles submetidos a TC de tórax sem contraste não sincronizada ao ECG (n = 768). Os pacientes foram estratificados em quatro grupos: (a) CAC = 0, (b) CAC 1-100, (c) CAC 101-300 e (d) CAC > 300. Resultados: CAC foi detectada em 376 pacientes (49%), dos quais 218 (58%) apresentaram CAC > 300. CAC > 300 foi independentemente associado à mortalidade na UTI em 28 dias após a admissão (risco relativo ajustado [RR] 1,79, intervalo de confiança de 95% [IC] 1,36-2,36, p 300. Results: CAC was detected in 376 patients (49%), of whom 218 (58%) showed CAC > 300. CAC > 300 was independently associated with ICU mortality at 28 days after admission (adjusted hazard ratio [aHR] 1.79, 95% confidence interval [CI] 1.36-2.36, p < 0.001), and incrementally improved prediction of death over a model with clinical features and biomarkers assessed within the first 24h in ICU (likelihood ratio test = 140 vs. 123, respectively, p < 0.001). In the final cohort, 286 (37%) patients died within 28 days of ICU admission. Conclusions: In critically ill patients with COVID-19, a high CAC burden quantified with a non-gated chest CT performed for COVID-19 pneumonia assessment is an independent predictor of 28-day mortality, with an incremental prognostic value over a comprehensive clinical assessment during the first 24h in IC