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

To explore the predictive value of CT for progression, we compared the difference of CT characteristics in stable and progressive patients, and found that progressive patients had greater lung involvement and higher CT severity score. CT severity score is used to semi-quantitatively estimate the pulmonary involvement, which is associated with both number of involved lobes and extent of lesions. 17 Pan et al reported a 4-stage dynamic pattern of NCP based on CT severity score and indicated that lung abnormalities showed greatest severity approximately 10 days after initial onset of symptoms. 7 In support of our findings, a previous report regarding MERS showed the predictive value of CT severity score for prognosis and short-term mortality. 6 Furthermore, higher proportion of progressive patients showed crazy-paving sign which reflects interstitial thickening. 18 Guan et al also reported higher proportion of severe patients with interstitial abnormalities. 5 The binding of COVID-19 spike protein to the receptor angiotensin converting enzyme II (ACE2) contributes to the downregulation of ACE2, increased pulmonary capillary permeability, and diffuse alveolar damage during NCP. 19, 20 In patients with SARS, mixed and predominant reticular patterns were noted from the second week. 8, 21 Thus, we speculated that the involvement of the interstitial vascular endothelial cells results in interlobular and intralobular septal thickening, which is associated with the disease severity.