Estimating COVID-19 Pneumonia Extent and Severity From Chest Computed Tomography

Carvalho, Alysson Roncally Silva; Guimarães, Alan; Garcia, Thiego de Souza Oliveira; Madeira Werberich, Gabriel; Ceotto, Victor Fraga; Bozza, Fernando Augusto; Rodrigues, Rosana Souza; Pinto, Joana Sofia F.; Schmitt, Willian Rebouças; Zin, Walter Araujo; França, Manuela

BACKGROUND: COVID-19 pneumonia extension is assessed by computed tomography (CT) with the ratio between the volume of abnormal pulmonary opacities (PO) and CT-estimated lung volume (CT(LV)). CT-estimated lung weight (CT(LW)) also correlates with pneumonia severity. However, both CT(LV) and CT(LW) depend on demographic and anthropometric variables. PURPOSES: To estimate the extent and severity of COVID-19 pneumonia adjusting the volume and weight of abnormal PO to the predicted CT(LV) (pCT(LV)) and CT(LW) (pCT(LW)), respectively, and to evaluate their possible association with clinical and radiological outcomes. METHODS: Chest CT from 103 COVID-19 and 86 healthy subjects were examined retrospectively. In controls, predictive equations for estimating pCT(LV) and pCT(LW) were assessed. COVID-19 pneumonia extent and severity were then defined as the ratio between the volume and the weight of abnormal PO expressed as a percentage of the pCT(LV) and pCT(LW), respectively. A ROC analysis was used to test differential diagnosis ability of the proposed method in COVID-19 and controls. The degree of pneumonia extent and severity was assessed with Z-scores relative to the average volume and weight of PO in controls. Accordingly, COVID-19 patients were classified as with limited, moderate and diffuse pneumonia extent and as with mild, moderate and severe pneumonia severity. RESULTS: In controls, CT(LV) could be predicted by sex and height (adjusted R(2) = 0.57; P < 0.001) while CT(LW) by age, sex, and height (adjusted R(2) = 0.6; P < 0.001). The cutoff of 20% (AUC = 0.91, 95%CI 0.88–0.93) for pneumonia extent and of 50% (AUC = 0.91, 95%CI 0.89–0.92) for pneumonia severity were obtained. Pneumonia extent were better correlated when expressed as a percentage of the pCT(LV) and pCT(LW) (r = 0.85, P < 0.001), respectively. COVID-19 patients with diffuse and severe pneumonia at admission presented significantly higher CRP concentration, intra-hospital mortality, ICU stay and ventilatory support necessity, than those with moderate and limited/mild pneumonia. Moreover, pneumonia severity, but not extent, was positively and moderately correlated with age (r = 0.46) and CRP concentration (r = 0.44). CONCLUSION: The proposed estimation of COVID-19 pneumonia extent and severity might be useful for clinical and radiological patient stratification.