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. 2020 May 8;1-7.
doi: 10.1007/s00330-020-06916-4. Online ahead of print.

Clinical and Radiological Changes of Hospitalised Patients With COVID-19 Pneumonia From Disease Onset to Acute Exacerbation: A Multicentre Paired Cohort Study

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Free PMC article

Clinical and Radiological Changes of Hospitalised Patients With COVID-19 Pneumonia From Disease Onset to Acute Exacerbation: A Multicentre Paired Cohort Study

Jiayi Liu et al. Eur Radiol. .
Free PMC article

Abstract

Objectives: To analyse clinical and radiological changes from disease onset to exacerbation in coronavirus infectious disease-19 (COVID-19) patients.

Methods: We reviewed clinical histories of 276 patients with confirmed COVID-19 pneumonia and extracted data on patients who met the diagnostic criteria for COVID-19 severe/fatal pneumonia and had an acute exacerbation starting with mild or common pneumonia.

Results: Twenty-four patients were included. Of these, 8% were smokers, 54% had been to Wuhan, and 46% had comorbidities. Before acute exacerbation, elevated lactate dehydrogenase (232.9 ± 88.7) was present, and chest CT scans showed the number of involved lobes was 4 (2-5) and total CT score was 6 (2-8). Following acute exacerbation, patients were likely to have more clinical symptoms (p < 0.01) and abnormal laboratory changes (p < 0.01). The number of involved lobes and CT score after an exacerbation significantly increased to 5 (5-5) and 12 (9-14), respectively. Receiver operating characteristic (ROC) curve showed that, when the cutoff value of CT score was 5, the sensitivity and specificity for severe pneumonia were 90% and 70%, respectively. CT findings of ground glass opacity with consolidations (91.7%), bilateral distribution (100.0%), and multifocal lesion (100.0%) were features in found in patients after exacerbation.

Conclusions: There are significant changes in clinical, laboratory, and CT findings in patients from disease onset to exacerbation. An increase in the number of involved lobes or an increased CT score from the baseline may predict poor clinical outcomes. Combining an assessment of CT changes with clinical and laboratory changes could help clinical teams evaluate the prognosis.

Key points: • The common chest CT signs of COVID-19 pneumonia after exacerbation were ground glass opacity (GGO) with consolidation, bilateral distribution, and multifocal lesions. • An increase in number of involved lobes or an increased CT score from the baseline may predict a poor clinical outcome. • Worsened symptoms and abnormal laboratory results are also associated with poor prognosis.

Keywords: COVID-19; Pneumonia; Tomography, X-ray computed.

Conflict of interest statement

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Figures

Fig. 1
Fig. 1
Flow diagram of patients included and excluded in this study
Fig. 2
Fig. 2
Patient 1. CT images of a 36-year-old man from disease onset (day 3) to exacerbation (day 10). A1, A2 The CT images at disease onset. B1, B2 The CT images after exacerbation. A1 and B1 show single mixed ground glass opacity (GGO) with consolidation in one lobe that is increased in size; A2 and B2 showed multiple new mixed and consolidation lesions in multiple lobes after exacerbation. CT scores from disease onset to exacerbation were 2 and 11, respectively
Fig. 3
Fig. 3
Patient 2. CT images of a 25-year-old man from disease onset (day 2) to exacerbation (day 15). A1, A2 The CT images at disease onset. B1, B2 The CT images after exacerbation. These images indicate that the density of some patches of consolidation decreased, but the range increased significantly after exacerbation. CT scores from disease onset to exacerbation were 4 and 16, respectively

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References

    1. China National Health Commission (2020) Daily update on COVID-19 cases in China[EB/OL]. China National Health Commission, Beijing. Available via http://www.nhc.gov.cn. Accessed 16 Feb 2020
    1. Huang C, Wang Y, Li X et al (2020) Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 10.1016/S0140-6736(20)30183-5
    1. Li Q, Guan X, Wu P et al (2020) Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 10.1056/NEJMoa2001316
    1. China National Health Commission (2020) Diagnosis and treatment of pneumonia caused by COVID-19 (trial version 5). China National Health Commission, Beijing. Available via http://www.nhc.gov.cn/xcs/zhengcwj/202002/d4b895337e19445f8d728fcaf1e3e13a.html. Accessed 15 Feb 2020
    1. Chung M, Bernheim A, Mei X et al (2020) CT imaging features of 2019 novel coronavirus (2019-nCoV). Radiology. 10.1148/radiol.2020200230
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