The Prognostic Value of Pneumonia Severity Score and Pectoralis Muscle Area on Chest CT in Adult COVID-19 Patients

Ufuk, Furkan; Demirci, Mahmut; Sagtas, Ergin; Akbudak, Ismail Hakkı; Ugurlu, Erhan; Sari, Tugba

PURPOSE: To assess the prognostic value of pneumonia severity score (PSS), pectoralis muscle area (PMA), and index (PMI) on chest computed tomography (CT) in adult coronavirus disease 2019 (COVID-19) patients. METHOD: The chest CT images of COVID-19 patients were evaluated for the PSS as the ratio of the volume of involved lung parenchyma to the total lung volume. The cross-sectional areas of the pectoralis muscles (PMA, cm(2)) were also measured automatically on axial CT images, and PMI was calculated as the following formula: PMI = PMA / patient’s height square (m(2)). The relationship between clinical variables, PSS, PMA, sex-specific PMI values, and patient outcomes (intubation, prolonged hospital stay, and death) were investigated using multivariable logistic regression analysis. All patients were followed for more than a month. RESULTS: One-hundred thirty patients (76 males, 58.46%) were included in the study. Fifteen patients (11.54%) were intubated, 24 patients (18.46%) had prolonged hospital stay, and eight patients (6.15%) died during follow-up. Patients with comorbidity had a higher mean of PSS (6.3 + 4.5 vs 3.9 + 3.8; p = 0.001). After adjusting the confounders, PSS was an independent predictor of intubation (adjusted Odds Ratio [OR]: 1.73, 95% CI 1.31-2.28, p < 0.001), prolonged hospital stay (OR: 1.20, 95% CI 1.09-1.33, p < 0.001), and death (OR: 2.13, 95% CI 1.1-4.13, p = 0.026. PMI value was a predictor of prolonged hospital stay (OR: 0.83, 95% CI 0.72-0.96, p = 0.038) and death (OR: 0.53, 95% CI 0.29-0.96, p = 0.036). Incrementally increasing PMA value was a predictor of prolonged hospital stay (OR: 0.93, 95% CI 0.89-0.98, p = 0.01) and intubation (OR: 0.98, 95% CI 0.96-1, p = 0.036). CONCLUSION: PSS, PMA, and PMI values have prognostic value in adult COVID-19 patients and can be easily assessed on chest CT images.