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. 2024 May 2;19(5):e0299390.
doi: 10.1371/journal.pone.0299390. eCollection 2024.

Association of chest computed tomography severity score at ICU admission and respiratory outcomes in critically ill COVID-19 patients

Ricardo Esper Treml  1   2 , Tulio Caldonazo  3 , Fábio Barlem Hohmann  4 , Daniel Lima da Rocha  4 , Pedro Hilton A Filho  5 , Andréia L Mori  5 , André S Carvalho  5 , Juliana S F Serrano  5 , Pedro A T Dall-Aglio  5 , Peter Radermacher  6 , João M Silva Jr  2   4   5
Affiliations

Association of chest computed tomography severity score at ICU admission and respiratory outcomes in critically ill COVID-19 patients

Ricardo Esper Treml et al. PLoS One. .

Abstract

Objective: To evaluate the association of a validated chest computed tomography (Chest-CT) severity score in COVID-19 patients with their respiratory outcome in the Intensive Care Unit.

Methods: A single-center, prospective study evaluated patients with positive RT-PCR for COVID-19, who underwent Chest-CT and had a final COVID-19 clinical diagnosis needing invasive mechanical ventilation in the ICU. The admission chest-CT was evaluated according to a validated Chest-CT Severity Score in COVID-19 (Chest-CTSS) divided into low ≤50% (<14 points) and >50% high (≥14 points) lung parenchyma involvement. The association between the initial score and their pulmonary clinical outcomes was evaluated.

Results: 121 patients were clustered into the > 50% lung involvement group and 105 patients into the ≤ 50% lung involvement group. Patients ≤ 50% lung involvement (<14 points) group presented lower PEEP levels and FiO2 values, respectively GEE P = 0.09 and P = 0.04. The adjusted COX model found higher hazard to stay longer on invasive mechanical ventilation HR: 1.69, 95% CI, 1.02-2.80, P = 0.042 and the adjusted logistic regression model showed increased risk ventilator-associated pneumonia OR = 1.85 95% CI 1.01-3.39 for COVID-19 patients with > 50% lung involvement (≥14 points) on Chest-CT at ICU admission.

Conclusion: COVID-19 patients with >50% lung involvement on Chest-CT admission presented higher chances to stay longer on invasive mechanical ventilation and more chances to developed ventilator-associated pneumonia.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Represents the radiological classification based on lung parenchymal involvement proposed by Tsakok et al. [18].
After admission and laboratory confirmation by RT-PCR of SARS-CoV-2 infection, patients underwent Chest-CT and were classified based on theirs Chest-CT severity score in high involvement and low parenchyma involvement. Image created using BioRender.com by RET.
Fig 2
Fig 2. Flow diagram of study based on the assessment of chest-CT according with criterions proposed by Tsakok et al.
The images were evaluated by two radiologists with two-year experience in chest imaging. Those patients who filled radiologic criterion for covid-19 were separated in two groups depending on their lung involvement. In the moment of the images assessment, the radiologists did not have access to results of RT-PCR.
Fig 3
Fig 3. Ventilatory and laboratory parameters variation at different study time points.
(A) Oxygen index variation from baseline by D7. (B) SaO2 variation from baseline by D7. (C) Adjusted PEEP levels from baseline by D7. (D) Adjusted FiO2 from baseline by D7. SaO2, arterial oxygen saturation; PEEP, positive end-expiratory pressure; FiO2, fraction of inspired oxygen.
Fig 4
Fig 4. Kaplan-Meier curve plots showing the hazard ratio to remain in invasive ventilation, adjusted to minimize the effect of confounding variables.
See this image and copyright information in PMC

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Grants and funding

The authors received no specific funding for this work.
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