Chest computed tomography and alveolar-arterial oxygen gradient as rapid tools to diagnose and triage mildly symptomatic COVID-19 pneumonia patients

Marlise P de Roos; Iris D Kilsdonk; Pieter-Paul W Hekking; Jan Peringa; Nynke G Dijkstra; Peter W A Kunst; Paul Bresser; Herre J Reesink

doi:10.1183/23120541.00737-2020

Chest computed tomography and alveolar-arterial oxygen gradient as rapid tools to diagnose and triage mildly symptomatic COVID-19 pneumonia patients

ERJ Open Res. 2021 Mar 8;7(1):00737-2020. doi: 10.1183/23120541.00737-2020. eCollection 2021 Jan.

Authors

Marlise P de Roos¹, Iris D Kilsdonk², Pieter-Paul W Hekking¹, Jan Peringa², Nynke G Dijkstra¹, Peter W A Kunst¹, Paul Bresser¹, Herre J Reesink¹

Affiliations

¹ Dept of Respiratory Medicine, OLVG, Amsterdam, The Netherlands.
² Dept of Radiology, OLVG, Amsterdam, The Netherlands.

Abstract

Background: In the coronavirus disease 2019 (COVID-19) pandemic, rapid clinical triage is crucial to determine which patients need hospitalisation. We hypothesised that chest computed tomography (CT) and alveolar-arterial oxygen tension ratio (A-a) gradient may be useful to triage these patients, since they reflect the severity of the pneumonia-associated ventilation/perfusion abnormalities.

Methods: A retrospective analysis was performed in 235 consecutive patients suspected for COVID-19. The diagnostic protocol included low-dose chest CT and arterial blood gas analysis. In patients with CT-based COVID-19 pneumonia, the association between "need for hospitalisation" and A-a gradient was investigated by a multivariable logistic regression model. The A-a gradient was tested as a predictor for need for hospitalisation using receiver operating characteristic curve analysis and a logistic regression model.

Results: 72 out of 235 patients (mean±sd age 55.5±14.6 years, 40% female) screened by chest CT showed evidence for COVID-19 pneumonia. In these patients, A-a gradient was shown to be a predictor of need for hospitalisation, with an optimal decision level (cut-off) of 36.4 mmHg (95% CI 0.70-0.91, p<0.001). The A-a gradient was shown to be independently associated with need for hospitalisation (OR 1.97 (95% CI 1.23-3.15), p=0.005; A-a gradient per 10 points) from CT severity score (OR 1.13 (95% CI 0.94-1.36), p=0.191), National Early Warning Score (OR 1.19 (95% CI 0.91-1.57), p=0.321) or peripheral oxygen saturation (OR 0.88 (95% CI 0.68-1.14), p=0.345).

Conclusion: Low-dose chest CT and the A-a gradient may serve as rapid and accurate tools to diagnose COVID-19 pneumonia and to select mildly symptomatic patients in need for hospitalisation.