Association of "initial CT" findings with mortality in older patients with coronavirus disease 2019 (COVID-19)
Association of "initial CT" findings with mortality in older patients with coronavirus disease 2019 (COVID-19)
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DOI：
10.1007/s00330-020-06969-5
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发表时间：
2020-06-10
影响因子：
5.9
通讯作者：
Xia, Liming
中科院分区：
文献类型：
--
作者：
Li, Yan;Yang, Zhenlu;Xia, Liming
目的探讨老年患者胸部CT表现与死亡率的关系。方法2020年1月21日至2月14日，98例老年患者（≥ 60岁）在入院时接受胸部CT扫描（“初始CT”）。比较死亡组与存活组的CT表现及评分。在每组中，根据症状发作和“初始CT”扫描之间的时间间隔对患者进行亚组：亚组1（间隔10天）。应用校正年龄和性别后的校正ROC曲线。结果死亡组（46例）CT实变率（53.2%）高于存活组（52例）（32.0%，p < 0.001）。对于亚组1和亚组2，发现死亡组的平均CT评分较高（33.0 ± 17.1vs12.9 ± 8.7，p < 0.001; 38.8 ± 12.3 vs 24.3 ± 11.9，p = 0.002，亚组3的CT评分无显著差异（p = 0.144）。在亚组1中，CT评分为14.5，预测死亡率的敏感性为83.3%，特异性为77.3%，是最佳截止值，校正后的AUC为0.881。在亚组2中，CT评分为27.5，预测死亡率的敏感性为87.5%，特异性为70.6%，是最佳截止值，校正后的AUC为0.895。结论“初始CT”评分可作为判断预后和分层的依据。早期CT表现严重可能表明老年COVID-19患者预后不良。
Objectives To investigate the association of chest CT findings with mortality in clinical management of older patients. Methods From January 21 to February 14, 2020, 98 older patients (>= 60 years) who had undergone chest CT scans ("initial CT") on admission were enrolled. Manifestation and CT score were compared between the death group and the survival group. In each group, patients were sub-grouped based on the time interval between symptom onset and the "initial CT" scan: subgroup1 (interval 10 days). Adjusted ROC curve after adjustment for age and gender was applied. Results Consolidations on CT images were more common in the death group (n = 46) than in the survival group (n = 52) (53.2% vs 32.0%,p < 0.001). For subgroup1 and subgroup2, a higher mean CT score was found for the death group (33.0 +/- 17.1 vs 12.9 +/- 8.7,p < 0.001; 38.8 +/- 12.3 vs 24.3 +/- 11.9,p = 0.002, respectively) and no significant difference of CT score was identified with respect to subgroup3 (p = 0.144). In subgroup1, CT score of 14.5 with a sensitivity of 83.3% and a specificity of 77.3% for the prediction of mortality was an optimal cutoff value, with an adjusted AUC of 0.881. In subgroup2, CT score of 27.5 with a sensitivity of 87.5% and a specificity of 70.6% for the prediction of mortality was an optimal cutoff value, with an adjusted AUC of 0.895. Conclusions "Initial CT" scores may be useful to speculate prognosis and stratify patients. Severe manifestation on CT at an early stage may indicate poor prognosis for older patients with COVID-19.