Early Prediction of Disease Progression in 2019 Novel Coronavirus Pneumonia Patients Outside Wuhan with CT and Clinical Characteristics

Zhichao Feng; Qizhi Yu; Shanhu Yao; Lei Luo; Junhong Duan; Zhimin Yan; Min Yang; Hongpei Tan; Mengtian Ma; Ting Li; Dali Yi; Ze Mi; Huafei Zhao; Yi Jiang; Zhenhu He; Huiling Li; Wei Nie; Yin Liu; Jing Zhao; Muqing Luo; Xuanhui Liu; Pengfei Rong; Wei Wang

The outbreak of 2019 novel coronavirus pneumonia (NCP) originated from Wuhan has shown the ability of human-to-human transmission and rapidly spread to become a world-wide emergency along with increasing imported and secondary contacted infection risk. 1 Most patients with NCP have a mild clinical course, while a proportion of patients demonstrated rapid deterioration (particularly within 7-14 days) from onset of symptoms into severe NCP with or without acute respiratory distress syndrome (ARDS). These patients have poor survival and often require intensive medical resource utilization, and the mortality of them are about 20 times higher than that of non-severe 2019 novel coronavirus (COVID-19) patients. 2,3 Thus, early identification of patients at risk of serious complications of NCP is of clinical importance. Several studies reported that the prevalence of severe NCP ranged from 15.7% to 26.1% and these cases were often associated with abnormal chest CT findings and clinical laboratory data. [3] [4] [5] Guan et al indicated that patients with severe NCP were more likely to show ground-glass opacity (GGO), local or bilateral patchy shadowing, and interstitial abnormalities on CT. 5 This likely reflects the clinical progression of disease but also offers an opportunity to investigate the clinical utility of chest CT as a predictive tool to risk-stratify the patients. Furthermore, the predictive value of chest CT in NCP prognosis is warranted as to assist the effective treatment and control of disease spread. Previous study suggested that higher CT lung score correlated with poor prognosis in patients with Middle East respiratory syndrome coronavirus (MERS). 6 Chest CT has been demonstrated to be an important approach for screening individuals with suspected NCP and monitoring treatment response according to the dynamic radiological changes of NCP. 7 Therefore, we enrolled a cohort of patients with moderate NCP on admission and observed for at least 14 days to explore the early CT and clinical risk factors for progression to severe NCP. Meanwhile, we also compared the CT and inflammatory indexes in patients with different source of infection or period from symptom onset to admission to provide deep understanding of the relationship among CT findings, epidemiological features, and inflammation.