COVID-19 Pnömonisi ile Başvuran Yaşlı Hastalarda Göğüs BT Prognostik Değeri

Abstract

Amaç: İleri yaşlılar, koronavirüs hastalığı 2019 (coronavirus disease 2019, COVID-19) ile enfekte olan ve hayatta kalamayanların önde gelen grubudur. Bilgisayarlı tomografi (BT) görüntüleme COVID-19 için önemli bir tanı yöntemi olarak kabul edilmiştir. Bu çalışmanın amacı 75 yaş üstü hastalarda BT görüntülemenin prognostik performansını belirlemektir. Gereç ve Yöntemler: Dahil etme ve hariç tutma kriterleri karşılandıktan sonra 28 erkek 28 kadın olmak üzere 56 yaşlı hasta çalışmaya dahil edildi. İki radyolog BT görüntülerini yorumladı ve üçüncü bir deneyimli radyolog, tartışmalı ve anlaşmazlık vakalarında verileri ve görüntüleme bulgularını gözden geçirmekten sorumluydu. Her bir hasta için akciğer skoru belirlendi ve radyolojik bulgular incelendi. Bulgular: Hastaların yaş ortalaması 81,4±5,0 yıl idi. Otuz altı hasta hayatta kaldı ve 20 hasta hayatta kalamadı. 28 (%50,0) hastada merkezi tutulum varken 25 (%44,6) hastada ise yaygın tutulum vardı. Konsolidasyon ve hava bronkogramı gibi radyolojik bulgular hayatta kalamayanlar arasında hayatta kalanlardan daha yaygındı (her iki p=0,001). Hayatta kalanlar için ortalama akciğer skoru 8,75±6,21 ve hayatta kalamayanlar için 13,45±6,41 idi ve iki grup arasındaki farklılık istatistiksel olarak anlamlıydı (p=0.010). Alıcı işlem karakteristiği eğrisi altında kalan alan 12 kesim değeri için 0,714 (%95 GA, 0,577 ile 0,827, p=0,003) idi. Sonuç: Akciğer skorlarının kullanılmasının hastanede yatan 75 yaş üstü hastaların durumunu tahmin etmede çok önemli bir rol oynayabileceği görülmektedir.

Keywords

• Yaşlı
• geriatri
• COVID-19
• BT
• Görüntüleme
• Radyoloji

Prognostic Value of Chest CT in the Elderly Patients Admitted with COVID-19 Pneumonia

Abstract

Aim: The late elderly, are the leading group of non-survivors infected with the coronavirus disease 2019 (COVID-19). Computed tomography (CT) imaging has been recognized as an important diagnostic method for COVID-19. This study aimed to determine the prognostic performance of CT imaging in patients above 75 years old. Material and Methods: After meeting the inclusion and exclusion criteria 56 elderly patients, 28 male, and 28 female were included in the study. Two radiologists interpreted CT imaging and a third experienced radiologist was in charge of reviewing the data and imaging findings in the controversial and disagreement cases. The lung score was determined for each patient, and radiologic signs were also examined. Results: The mean age of the patients was 81.4±5.0 years. Thirty-six patients survived, and 20 did not. 28 (50.0%) patients had central involvement, while 25 (44.6%) patients had diffuse involvement. Radiologic signs such as consolidation and air bronchogram were more common among non-survivors than survivors (both p=0.001). The mean lung score for the survivors was 8.75±6.21 and 13.45±6.41 for non-survivors, and the difference between the two groups was statistically significant (p=0.010). The area under the receiver operating characteristic curve for a cut-off score of 12 was 0.714 (95% CI, 0.577 to 0.827, p=0.003). Conclusion: It seems that using lung scores can play a very important role in predicting the condition of hospitalized patients over 75 years old.

Keywords

• Elderly
• geriatrics
• COVID-19
• CT
• Imaging
• Radiology

References

1. Liu K, Chen Y, Lin R, Han K. Clinical features of COVID-19 in elderly patients: A comparison with young and middle-aged patients. J Infect. 2020;80(6):e14-8.
2. Lithander FE, Neumann S, Tenison E, Lloyd K, Welsh TJ, Rodrigues JCL, et al. COVID-19 in older people: a rapid clinical review. Age Ageing. 2020;49(4):501-15.
3. Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, et al. Sensitivity of chest CT for COVID-19: Comparison to RT-PCR. Radiology. 2020;296(2):E115-7.
4. Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, et al. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Mil Med Res. 2020;7(1):4.
5. Chen A, Huang JX, Liao Y, Liu Z, Chen D, Yang C, et al. Differences in clinical and imaging presentation of pediatric patients with COVID-19 in comparison with adults. Radiol Cardiothorac Imaging. 2020;2(2):e200117.
6. Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus disease 2019 (COVID-19): A systematic review of imaging findings in 919 patients. AJR Am J Roentgenol. 2020;215(1):87-93.
7. Chua F, Armstrong-James D, Desai SR, Barnett J, Kouranos V, Kon OM, et al. The role of CT in case ascertainment and management of COVID-19 pneumonia in the UK: insights from high-incidence regions. Lancet Respir Med. 2020;8(5):438-40.
8. Ng MY, Lee EYP, Yang J, Yang F, Li X, Wang H, et al. Imaging profile of the COVID-19 infection: radiologic findings and literature review. Radiol Cardiothorac Imaging. 2020;2(1):e200034.

9. who.int [Internet]. World Health Organization. Clinical management of severe acute respiratory infection (‎SARI)‎ when COVID-19 disease is suspected: interim guidance. [Cited: 2022 March 13]. Available from: https://apps.who.int/iris/handle/10665/331446
10. Kanne JP. Chest CT findings in 2019 novel coronavirus (2019-nCoV) infections from Wuhan, China: Key points for the radiologist. Radiology. 2020;295(1):16-7.
11. Kanne JP, Little BP, Chung JH, Elicker BM, Ketai LH. Essentials for radiologists on COVID-19: An update-radiology scientific expert panel. Radiology. 2020;296(2):E113-4.
12. Francone M, Iafrate F, Masci GM, Coco S, Cilia F, Manganaro L, et al. Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis. Eur Radiol. 2020;30(12):6808-17.
13. Mirza-Aghazadeh-Attari M, Zarrintan A, Nezami N, Mohammadi A, Zarrintan A, Mohebbi I, et al. Predictors of coronavirus disease 19 (COVID-19) pneumonitis outcome based on computed tomography (CT) imaging obtained prior to hospitalization: a retrospective study. Emerg Radiol. 2020;27(6):653-61.
14. Grodecki K, Lin A, Cadet S, McElhinney PA, Razipour A, Chan C, et al. Quantitative burden of COVID-19 pneumonia on chest CT predicts adverse outcomes: A post-hoc analysis of a prospective international registry. Radiology Cardiothoracic Imaging. 2020;2(5):e200389.
15. Mohammadzadeh A, Mirza-Aghazadeh-Attari M, Hallaj S, Saei AA, Alivand MR, Valizadeh A, et al. Crosstalk between P53 and DNA damage response in ageing. DNA Repair (Amst). 2019;80:8-15.
16. Gémes K, Talbäck M, Modig K, Ahlbom A, Berglund A, Feychting M, et al. Burden and prevalence of prognostic factors for severe COVID-19 in Sweden. Eur J Epidemiol. 2020;35(5):401-9.
17. Liao Y, Feng Y, Wang B, Wang H, Huang J, Wu Y, et al. Clinical characteristics and prognostic factors of COVID-19 patients progression to severe: a retrospective, observational study. Aging (Albany NY). 2020;12(19):18853-65.
18. Sun Y, Dong Y, Wang L, Xie H, Li B, Chang C, et al. Characteristics and prognostic factors of disease severity in patients with COVID-19: The Beijing experience. J Autoimmun. 2020;112:102473.
19. Li X, Xu S, Yu M, Wang K, Tao Y, Zhou Y, et al. Risk factors for severity and mortality in adult COVID-19 inpatients in Wuhan. J Allergy Clin Immunol. 2020;146(1):110-8.
20. Kang YJ. Mortality rate of infection with COVID-19 in Korea from the perspective of underlying disease. Disaster Med Public Health Prep. 2020;14(3):384-6.
21. Caruso D, Zerunian M, Polici M, Pucciarelli F, Polidori T, Rucci C, et al. Chest CT features of COVID-19 in Rome, Italy. Radiology. 2020;296(2):E79-85.
22. Zhao W, Zhong Z, Xie X, Yu Q, Liu J. Relation between chest CT findings and clinical conditions of coronavirus disease (COVID-19) pneumonia: A multicenter study. AJR Am J Roentgenol. 2020;214(5):1072-7.
23. Xia W, Shao J, Guo Y, Peng X, Li Z, Hu D. Clinical and CT features in pediatric patients with COVID-19 infection: Different points from adults. Pediatr Pulmonol. 2020;55(5):1169-74.