CT lung lesions as predictors of early death or ICU admission in COVID-19 patients

Ruch, Yvon; Kaeuffer, Charlotte; Ohana, Mickael; Labani, Aissam; Fabacher, Thibaut; Bilbault, Pascal; Kepka, Sabrina; Solis, Morgane; Greigert, Valentin; Lefebvre, Nicolas; Hansmann, Yves; Danion, François

OBJECTIVE: The main objective of this study was to investigate the prognostic value of early systematic chest computed tomography (CT) with quantification of lung lesions in coronavirus disease 2019 (COVID-19) patients. METHODS: We studied 572 patients diagnosed with COVID-19, confirmed using polymerase chain reaction for whom a chest CT was performed at hospital admission. Visual quantification was used to classify patients as per the percentage of lung parenchyma affected by COVID-19 lesions: normal CT, 0%–10%, 11%–25%, 26%–50%, 51%–75%, and >75%. The primary endpoint was severe disease, defined by death or intensive care unit admission in the 7 days following admission. RESULTS: The mean patient age was 66.0 ± 16.0 years, and 343/572 (60.0%) were men. The primary endpoint occurred in 206/572 (36.0%) patients. The extent of lesions on initial CT was independently associated with prognosis (odds ratio = 2.35, 95% confidence interval 1.24–4.46; p <0.01). Most patients with lung involvement >50% developed severe disease (66/95, 69.5%), compared to patients with lung involvement of 26%–50% (70/171, 40.9%) and ≤25% (70/306, 22.9%) (p <0.01 and p <0.01, respectively). None (0/14) of the patients with normal CT had severe disease. CONCLUSION: Chest CT findings at admission are associated with bad outcome in COVID-19 patients.