Radiographic Findings and Association With Clinical Severity and Outcomes in Critically Ill Patients With COVID-19

To describe evolution and severity of radiographic findings and assess association with disease severity and outcomes in critically ill COVID-19 patients. This retrospective study included 62 COVID-19 patients admitted to the intensive care unit (ICU). Clinical data was obtained from electronic medi...

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Veröffentlicht in:Current problems in diagnostic radiology 2022-11, Vol.51 (6), p.884-891
Hauptverfasser: Wu, Wei, Bhatraju, Pavan K., Cobb, Natalie, Sathe, Neha A., Duan, Kevin I., Seitz, Kevin P., Thau, Matthew R., Sung, Clifford C., Hippe, Daniel S., Reddy, Gautham, Pipavath, Sudhakar
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container_end_page 891
container_issue 6
container_start_page 884
container_title Current problems in diagnostic radiology
container_volume 51
creator Wu, Wei
Bhatraju, Pavan K.
Cobb, Natalie
Sathe, Neha A.
Duan, Kevin I.
Seitz, Kevin P.
Thau, Matthew R.
Sung, Clifford C.
Hippe, Daniel S.
Reddy, Gautham
Pipavath, Sudhakar
description To describe evolution and severity of radiographic findings and assess association with disease severity and outcomes in critically ill COVID-19 patients. This retrospective study included 62 COVID-19 patients admitted to the intensive care unit (ICU). Clinical data was obtained from electronic medical records. A total of 270 chest radiographs were reviewed and qualitatively scored (CXR score) using a severity scale of 0-30. Radiographic findings were correlated with clinical severity and outcome. The CXR score increases from a median initial score of 10 at hospital presentation to the median peak CXR score of 18 within a median time of 4 days after hospitalization, and then slowly decreases to a median last CXR score of 15 in a median time of 12 days after hospitalization. The initial and peak CXR score was independently associated with invasive MV after adjusting for age, gender, body mass index, smoking, and comorbidities (Initial, odds ratio [OR]: 2.11 per 5-point increase, confidence interval [CI] 1.35-3.32, P= 0.001; Peak, OR: 2.50 per 5-point increase, CI 1.48-4.22, P= 0.001). Peak CXR scores were also independently associated with vasopressor usage (OR: 2.28 per 5-point increase, CI 1.30-3.98, P= 0.004). Peak CXR scores strongly correlated with the duration of invasive MV (Rho = 0.62, P< 0.001), while the initial CXR score (Rho = 0.26) and the peak CXR score (Rho = 0.27) correlated weakly with the sequential organ failure assessment score. No statistically significant associations were found between radiographic findings and mortality. Evolution of radiographic features indicates rapid disease progression and correlate with requirement for invasive MV or vasopressors but not mortality, which suggests potential nonpulmonary pathways to death in COVID-19.
doi_str_mv 10.1067/j.cpradiol.2022.04.002
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This retrospective study included 62 COVID-19 patients admitted to the intensive care unit (ICU). Clinical data was obtained from electronic medical records. A total of 270 chest radiographs were reviewed and qualitatively scored (CXR score) using a severity scale of 0-30. Radiographic findings were correlated with clinical severity and outcome. The CXR score increases from a median initial score of 10 at hospital presentation to the median peak CXR score of 18 within a median time of 4 days after hospitalization, and then slowly decreases to a median last CXR score of 15 in a median time of 12 days after hospitalization. The initial and peak CXR score was independently associated with invasive MV after adjusting for age, gender, body mass index, smoking, and comorbidities (Initial, odds ratio [OR]: 2.11 per 5-point increase, confidence interval [CI] 1.35-3.32, P= 0.001; Peak, OR: 2.50 per 5-point increase, CI 1.48-4.22, P= 0.001). Peak CXR scores were also independently associated with vasopressor usage (OR: 2.28 per 5-point increase, CI 1.30-3.98, P= 0.004). Peak CXR scores strongly correlated with the duration of invasive MV (Rho = 0.62, P&lt; 0.001), while the initial CXR score (Rho = 0.26) and the peak CXR score (Rho = 0.27) correlated weakly with the sequential organ failure assessment score. No statistically significant associations were found between radiographic findings and mortality. Evolution of radiographic features indicates rapid disease progression and correlate with requirement for invasive MV or vasopressors but not mortality, which suggests potential nonpulmonary pathways to death in COVID-19.</description><identifier>ISSN: 0363-0188</identifier><identifier>ISSN: 1535-6302</identifier><identifier>EISSN: 1535-6302</identifier><identifier>DOI: 10.1067/j.cpradiol.2022.04.002</identifier><identifier>PMID: 35610068</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>COVID-19 ; Critical Illness ; Humans ; Intensive Care Units ; Retrospective Studies ; Severity of Illness Index</subject><ispartof>Current problems in diagnostic radiology, 2022-11, Vol.51 (6), p.884-891</ispartof><rights>2022 Elsevier Inc.</rights><rights>Copyright © 2022 Elsevier Inc. All rights reserved.</rights><rights>2022 Elsevier Inc. 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This retrospective study included 62 COVID-19 patients admitted to the intensive care unit (ICU). Clinical data was obtained from electronic medical records. A total of 270 chest radiographs were reviewed and qualitatively scored (CXR score) using a severity scale of 0-30. Radiographic findings were correlated with clinical severity and outcome. The CXR score increases from a median initial score of 10 at hospital presentation to the median peak CXR score of 18 within a median time of 4 days after hospitalization, and then slowly decreases to a median last CXR score of 15 in a median time of 12 days after hospitalization. The initial and peak CXR score was independently associated with invasive MV after adjusting for age, gender, body mass index, smoking, and comorbidities (Initial, odds ratio [OR]: 2.11 per 5-point increase, confidence interval [CI] 1.35-3.32, P= 0.001; Peak, OR: 2.50 per 5-point increase, CI 1.48-4.22, P= 0.001). Peak CXR scores were also independently associated with vasopressor usage (OR: 2.28 per 5-point increase, CI 1.30-3.98, P= 0.004). Peak CXR scores strongly correlated with the duration of invasive MV (Rho = 0.62, P&lt; 0.001), while the initial CXR score (Rho = 0.26) and the peak CXR score (Rho = 0.27) correlated weakly with the sequential organ failure assessment score. No statistically significant associations were found between radiographic findings and mortality. Evolution of radiographic features indicates rapid disease progression and correlate with requirement for invasive MV or vasopressors but not mortality, which suggests potential nonpulmonary pathways to death in COVID-19.</description><subject>COVID-19</subject><subject>Critical Illness</subject><subject>Humans</subject><subject>Intensive Care Units</subject><subject>Retrospective Studies</subject><subject>Severity of Illness Index</subject><issn>0363-0188</issn><issn>1535-6302</issn><issn>1535-6302</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkcuO0zAUhi0EYjqFVxh5ySadYzt2kg1iVBioNFIR16XlOCetKzcudlqpb49LOyNYsbJk_5fj8xFyw2DGQFW3m5ndRdO54GccOJ9BOQPgz8iESSELJYA_JxMQShTA6vqKXKe0AWC8YdVLciWkYgCqnpD45RSyima3dpbeu6FzwypRM3T0LqVgnRldGOhPN67p3LvBWePpVzxgdOPxj2y5H23YYqJuoPN8e1L4I114Tz9nMw5jutiXPxbvC9a8Ii964xO-vpxT8v3-w7f5p-Jh-XExv3sobMnqsWirkpeyb20plRK1RbBV2-SP8Z4LI1osW4Wi6UqFveqFEI2RtaxLBClVpVoxJW_Pubt9u8XO5kmi8XoX3dbEow7G6X9fBrfWq3DQDXAhqjoHvLkExPBrj2nUW5csem8GDPukuVKNBAG5e0rUWWpjSCli_1TDQJ-A6Y1-BKZPwDSUOgPLxpu_h3yyPRLKgndnAeZVHRxGnWxeqsXORbSj7oL7X8dvTNurgg</recordid><startdate>20221101</startdate><enddate>20221101</enddate><creator>Wu, Wei</creator><creator>Bhatraju, Pavan K.</creator><creator>Cobb, Natalie</creator><creator>Sathe, Neha A.</creator><creator>Duan, Kevin I.</creator><creator>Seitz, Kevin P.</creator><creator>Thau, Matthew R.</creator><creator>Sung, Clifford C.</creator><creator>Hippe, Daniel S.</creator><creator>Reddy, Gautham</creator><creator>Pipavath, Sudhakar</creator><general>Elsevier Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-6948-2376</orcidid></search><sort><creationdate>20221101</creationdate><title>Radiographic Findings and Association With Clinical Severity and Outcomes in Critically Ill Patients With COVID-19</title><author>Wu, Wei ; Bhatraju, Pavan K. ; Cobb, Natalie ; Sathe, Neha A. ; Duan, Kevin I. ; Seitz, Kevin P. ; Thau, Matthew R. ; Sung, Clifford C. ; Hippe, Daniel S. ; Reddy, Gautham ; Pipavath, Sudhakar</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c418t-b74245fbc456638ce0c7b93022f23a3be4b6e39d46ef6f3339a58584e055676b3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>COVID-19</topic><topic>Critical Illness</topic><topic>Humans</topic><topic>Intensive Care Units</topic><topic>Retrospective Studies</topic><topic>Severity of Illness Index</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wu, Wei</creatorcontrib><creatorcontrib>Bhatraju, Pavan K.</creatorcontrib><creatorcontrib>Cobb, Natalie</creatorcontrib><creatorcontrib>Sathe, Neha A.</creatorcontrib><creatorcontrib>Duan, Kevin I.</creatorcontrib><creatorcontrib>Seitz, Kevin P.</creatorcontrib><creatorcontrib>Thau, Matthew R.</creatorcontrib><creatorcontrib>Sung, Clifford C.</creatorcontrib><creatorcontrib>Hippe, Daniel S.</creatorcontrib><creatorcontrib>Reddy, Gautham</creatorcontrib><creatorcontrib>Pipavath, Sudhakar</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Current problems in diagnostic radiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wu, Wei</au><au>Bhatraju, Pavan K.</au><au>Cobb, Natalie</au><au>Sathe, Neha A.</au><au>Duan, Kevin I.</au><au>Seitz, Kevin P.</au><au>Thau, Matthew R.</au><au>Sung, Clifford C.</au><au>Hippe, Daniel S.</au><au>Reddy, Gautham</au><au>Pipavath, Sudhakar</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Radiographic Findings and Association With Clinical Severity and Outcomes in Critically Ill Patients With COVID-19</atitle><jtitle>Current problems in diagnostic radiology</jtitle><addtitle>Curr Probl Diagn Radiol</addtitle><date>2022-11-01</date><risdate>2022</risdate><volume>51</volume><issue>6</issue><spage>884</spage><epage>891</epage><pages>884-891</pages><issn>0363-0188</issn><issn>1535-6302</issn><eissn>1535-6302</eissn><abstract>To describe evolution and severity of radiographic findings and assess association with disease severity and outcomes in critically ill COVID-19 patients. 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Peak CXR scores were also independently associated with vasopressor usage (OR: 2.28 per 5-point increase, CI 1.30-3.98, P= 0.004). Peak CXR scores strongly correlated with the duration of invasive MV (Rho = 0.62, P&lt; 0.001), while the initial CXR score (Rho = 0.26) and the peak CXR score (Rho = 0.27) correlated weakly with the sequential organ failure assessment score. No statistically significant associations were found between radiographic findings and mortality. Evolution of radiographic features indicates rapid disease progression and correlate with requirement for invasive MV or vasopressors but not mortality, which suggests potential nonpulmonary pathways to death in COVID-19.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>35610068</pmid><doi>10.1067/j.cpradiol.2022.04.002</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0001-6948-2376</orcidid><oa>free_for_read</oa></addata></record>
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source MEDLINE; Elsevier ScienceDirect Journals Complete
subjects COVID-19
Critical Illness
Humans
Intensive Care Units
Retrospective Studies
Severity of Illness Index
title Radiographic Findings and Association With Clinical Severity and Outcomes in Critically Ill Patients With COVID-19
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