The Clinical and Chest CT Features Associated With Severe and Critical COVID-19 Pneumonia
The Clinical and Chest CT Features Associated With Severe and Critical COVID-19 Pneumonia
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DOI：
10.1097/rli.0000000000000672
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发表时间：
2020-06-01
影响因子：
6.7
通讯作者：
Li, Chuanming
中科院分区：
文献类型：
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作者：
Li, Kunhua;Wu, Jiong;Li, Chuanming
目的探讨2019冠状病毒病（COVID-19）重症和危重症肺炎的临床和CT特征。资料与方法83例COVID-19肺炎患者，其中重症/危重症25例，普通型58例。回顾性分析其胸部CT影像及临床资料，并进行比较。分析与疾病严重程度相关的危险因素。结果与普通患者相比，重症/危重症患者年龄大，合并症、咳嗽、咳痰、胸痛、呼吸困难发生率高。重症/危重症患者实变、线状阴影、铺路样改变和支气管壁增厚的发生率明显高于普通患者。此外，重症/危重症患者的淋巴结肿大、心包积液和胸腔积液的发生率高于普通患者。重症/危重症患者的CT评分明显高于普通患者（P< 0.001）。受试者工作特征曲线显示，CT评分鉴别两型的敏感性和特异性分别为80.0%和82.8%。年龄大于50岁、合并症、呼吸困难、胸痛、咳嗽、咳痰、淋巴细胞减少和炎症指标增加等临床因素是重度/危重COVID-19肺炎的风险因素。实变、线性阴影、疯狂铺路模式、支气管壁增厚、高CT评分和肺外病变的计算机断层扫描结果是重度/危重COVID-19肺炎的特征。结论普通患者与重症/危重症患者在临床症状、实验室检查及CT表现上存在显著差异。许多因素与疾病的严重程度有关，可以帮助临床医生判断患者的严重程度和评估预后。
Objective The aim of this study was to investigate the clinical and computed tomography (CT) features associated with severe and critical coronavirus disease 2019 (COVID-19) pneumonia. Materials and Methods Eighty-three patients with COVID-19 pneumonia including 25 severe/critical cases and 58 ordinary cases were enrolled. The chest CT images and clinical data of them were reviewed and compared. The risk factors associated with disease severity were analyzed. Results Compared with the ordinary patients, the severe/critical patients had older ages, higher incidence of comorbidities, cough, expectoration, chest pain, and dyspnea. The incidences of consolidation, linear opacities, crazy-paving pattern, and bronchial wall thickening in severe/critical patients were significantly higher than those of the ordinary patients. Besides, severe/critical patients showed higher incidences of lymph node enlargement, pericardial effusion, and pleural effusion than the ordinary patients. The CT scores of severe/critical patients were significantly higher than those of the ordinary patients (P< 0.001). Receiver operating characteristic curve showed that the sensitivity and specificity of CT score were 80.0% and 82.8%, respectively, for the discrimination of the 2 types. The clinical factors of age older than 50 years, comorbidities, dyspnea, chest pain, cough, expectoration, decreased lymphocytes, and increased inflammation indicators were risk factors for severe/critical COVID-19 pneumonia. Computed tomography findings of consolidation, linear opacities, crazy-paving pattern, bronchial wall thickening, high CT scores, and extrapulmonary lesions were features of severe/critical COVID-19 pneumonia. Conclusions There are significant differences in clinical symptoms, laboratory examinations, and CT manifestations between the ordinary patients and the severe/critical patients. Many factors are related to the severity of the disease, which can help clinicians to judge the severity of the patient and evaluate the prognosis.