Role of Renal Parenchyma Attenuation and Perirenal Fat Stranding in Chest CT of Hospitalized Patients with COVID-19
Abstract
:1. Introduction
2. Materials and Methods
2.1. Patients
2.2. CT Scanning Protocol
Qualitative Analysis
2.3. Statistical Analysis
3. Results
3.1. Clinical Characteristics on the Basis of Kidney Attenuation at Chest CT
3.2. Clinical Characteristics on the Basis of Perirenal Fat Stranding at Chest CT
3.3. Determinants of AKI
3.4. Kidney Imaging According with Kidney Function as Predictor of Outcome
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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All | Q1 (<24) | Q2-Q3-Q4 (≥24) | p Value | |
---|---|---|---|---|
Variables | ||||
N | 86 | 23 | 63 | |
RPA, HU | 31.9 ± 23.1 | 16.4 ± 6.5 | 37.6 ± 24.3 | <0.001 |
Demographic Characteristics | ||||
Age, years | 68 ± 13 | 65 ± 12 | 68 ± 13 | 0.295 |
Male gender, % | 74.4 | 69.6 | 76.2 | 0.533 |
Hypertension, % | 42.3 | 47.8 | 40.3 | 0.534 |
Diabetes, % | 12.9 | 8.7 | 14.5 | 0.478 |
Chalson score | 1.4 ± 2.1 | 1.3 ± 2.0 | 1.4 ± 2.1 | 0.871 |
Systolic blood pressure, mmHg | 133 ± 23 | 131 ± 26 | 134 ± 22 | 0.673 |
Diastolic blood pressure, mmHg | 74 ± 14 | 74 ± 15 | 75 ± 14 | 0.846 |
Heart rate, beats per min | 88 ± 17 | 90 ± 19 | 87 ± 18 | 0.546 |
Respiratory rate, n/min | 21 ± 7 | 21 ± 7 | 21 ± 7 | 0.772 |
Glasgow coma scale | 14.1 ± 2.7 | 13.6 ± 3.7 | 14.3 ± 2.3 | 0.271 |
O2 saturation, % | 91 ± 9 | 92 ± 8 | 90 ± 10 | 0.570 |
PaO2/FiO2 ratio | 250 ± 94 | 222 ± 87 | 258 ± 98 | 0.277 |
Temperature, °C | 37.6 ± 1.1 | 37.4 ± 0.8 | 37.6 ± 1.1 | 0.456 |
Laboratory Characteristics | ||||
White blood cell count, x109/L | 8865 ± 6447 | 9153 ± 5700 | 8760 ± 6739 | 0.804 |
Hemoglobin, g/dL | 13.1 ± 2.1 | 13.2 ±2.3 | 13.1 ± 2.1 | 0.889 |
Platelets count, ×109/L | 215 ± 101 | 224 ± 121 | 212 ± 93 | 0.606 |
Creatinine, mg/dL | 1.0 (4.0) | 0.9 (0.1) | 1.0 (0.5) | 0.111 |
eGFR, ml/min/1.73 m2 | 71.2 (37.7) | 73.3 (31.8) | 68.7 (38.3) | 0.100 |
Urea, mg/dL | 58 ± 42 | 47 ± 25 | 62 ± 46 | 0.156 |
Alanine aminotransferase, U/L | 41 ± 30 | 43 ± 31 | 40 ± 29 | 0.733 |
D-dimer, mg/L | 1067 (959) | 1312 (574) | 1939 (448) | 0.159 |
Creatine kinase, U/L | 98 (119) | 130 (118) | 89 (84) | 0.723 |
Lactate dehydrogenase, U/L | 285 (201) | 317 (261) | 280 (207) | 0.545 |
C-reactive protein, mg/L | 89 (112) | 101 (179) | 83 (109) | 0.149 |
Interleukin-6, pg/mL | 54 (90) | 57 (89) | 49 (76) | 0.084 |
Procalcitonin, ng/mL | 1.08 ± 5.39 | 0.66 ± 1.02 | 1.25 ± 6.39 | 0.665 |
Potassium, mEq/L | 3.8 ± 0.6 | 3.6 ± 0.5 | 3.9 ± 0.6 | 0.080 |
Kidney Status | ||||
Chronic Kidney Disease, % | 20.9 | 4.3 | 27.0 | 0.022 |
Acute Kidney Injury, % | 38.4 | 52.2 | 33.3 | 0.014 |
Acute Kidney Injury stages 1-2-3, % | 13-9-16 | 9-9-35 | 14-9-9 | 0.046 |
Teraphy | ||||
Hydroxychloroquine, % | 94.4 | 95.2 | 94.1 | 0.850 |
Tocilizumab, % | 48.3 | 67.7 | 41.9 | 0.111 |
Corticosteroids, % | 98.0 | 100.0 | 97.5 | 0.596 |
Radiologic Findings in Chest CT | ||||
Perirenal stranding, % | 69.4 | 54.5 | 74.6 | 0.079 |
Bilateral pulmonary infiltration, % | 43.0 | 47.8 | 41.3 | 0.587 |
Ground glass opacities, % | 76.4 | 91.3 | 71.4 | 0.053 |
Honeycombing opacities, % | 9.4 | 9.1 | 9.5 | 0.952 |
Outcomes | ||||
Hospitalization, days | 22 ±15 | 26 ±12 | 21 ±16 | 0.219 |
Intra-hospital mortality | 37.2 | 43.5 | 34.9 | 0.467 |
Follow up, days | 242 ±174 | 213 ±179 | 255 ±172 | 0.350 |
9 months-mortality, % | 41.9 | 52.2 | 38.1 | 0.241 |
All | NO PFS | PFS | p Value | |
---|---|---|---|---|
Variables | ||||
N | 86 | 27 | 59 | |
Demographic Characteristic | ||||
Age, years | 68 ± 13 | 61 ± 15 | 70 ± 11 | 0.003 |
Male gender, % | 74.4 | 57.7 | 83.0 | 0.012 |
Hypertension, % | 42.9 | 23.1 | 51.7 | 0.014 |
Diabetes, % | 12.8 | 3.8 | 17.2 | 0.092 |
Charlson score | 1.4 ± 2.1 | 1.1 ± 2.2 | 1.5 ± 2.1 | 0.469 |
Systolic blood pressure, mmHg | 133 ± 23 | 129 ± 19 | 134 ±24 | 0.426 |
O2 saturation, % | 91 ± 9 | 90 ± 8 | 91 ± 10 | 0.698 |
PaO2/FiO2 ratio | 250 ± 94 | 249 ± 108 | 251 ± 96 | 0.948 |
Temperature, °C | 37.6 ± 1.1 | 37.6 ± 1.1 | 37.5 ± 1.0 | 0.636 |
Laboratory Characteristics | ||||
Creatinine, mg/dL | 1.0 (4.0) | 0.9 (0.4) | 1.1 (0.5) | 0.027 |
eGFR, ml/min/1.73 m2 | 71 (38) | 82 (30) | 65 (38) | <0.001 |
Urea, mg/dL | 58 ± 42 | 43.2 ± 23.2 | 64.2 ± 45.6 | 0.039 |
C-reactive protein, mg/L | 89 (112) | 120 (181) | 83 (101) | 0.352 |
Interleukin-6, pg/mL | 54 (90) | 56 (84) | 52 (83) | 0.167 |
Procalcitonin, ng/mL | 1.08 ± 5.39 | 0.51 ± 0.74 | 1.35 ± 6.52 | 0.192 |
Kidney Status | ||||
Chronic Kidney Disease, % | 20.9 | 11.5 | 25.4 | 0.149 |
Acute Kidney Injury, % | 38.4 | 34.6 | 40.7 | 0.597 |
Acute Kidney Injury stages 1-2-3, % | 13-9-16 | 8-11-15 | 15-8-17 | 0.774 |
Radiologic Findings in Chest CT | ||||
Renal parenchymal attenuation, HU | 31.9 ± 23.1 | 29.3 ± 17.6 | 33.3 ± 25.3 | 0.459 |
Bilateral pulmonary infiltration, % | 43.0 | 34.6 | 47.5 | 0.271 |
Ground glass opacities, % | 76.4 | 73.1 | 78.0 | 0.624 |
Honeycombing opacities, % | 9.4 | 8.0 | 10.1 | 0.757 |
Outcomes | ||||
Hospitalization, days | 22 ± 15 | 22 ± 17 | 22 ± 15 | 0.986 |
Intra-hospital mortality | 37.2 | 15.4 | 45.8 | 0.007 |
Follow up, days | 242 ± 174 | 325 ± 131 | 209 ± 179 | 0.004 |
9 months-mortality, % | 41.9 | 19.2 | 50.8 | 0.006 |
Univariate Model | Multivariate Model | |||||
---|---|---|---|---|---|---|
Odds Ratio | 95% CI | p | Odds Ratio | 95% CI | p | |
Age, years * | 1.00 | 0.97–1.03 | 0.960 | 0.96 | 0.91–1.01 | 0.146 |
Male gender * | 0.87 | 0.32–2.33 | 0.777 | 0.26 | 0.05–1.23 | 0.090 |
Charlson index * | 1.11 | 0.90–1.38 | 0.325 | 1.16 | 0.89–1.53 | 0.266 |
Hypertension | 2.79 | 1.13–6.88 | 0.025 | 1.25 | 0.30–5.30 | 0.759 |
Diabetes | 0.56 | 0.14–2.29 | 0.422 | |||
Heart failure | 1.19 | 0.25–5.70 | 0.828 | |||
Creatinine, mg/dl | 4.84 | 1.23–29.13 | 0.026 | 50.7 | 4.62–556.01 | 0.001 |
RPA <24 HU | 2.22 | 0.86–5.74 | 0.100 | 4.56 | 1.27–16.44 | 0.020 |
Perirenal stranding | 1.29 | 0.50–3.38 | 0.593 | |||
O2 Saturation, % | 0.98 | 0.93–1.03 | 0.479 | |||
PaO2/FiO2 ratio | 0.99 | 0.99–1.00 | 0.071 | |||
Chest radiographic abnormality * | 0.66 | 0.21–2.03 | 0.469 | |||
Cancer history * | 0.81 | 0.40–1.66 | 0.565 | |||
Lactate dehydrogenase, U/L * | 1.00 | 0.99–1.00 | 0.114 | |||
Direct bilirubin, * | 2.40 | 0.61–9.40 | 0.207 | |||
L/N ratio * | 0.69 | 0.21–2.26 | 0.545 | |||
Dyspnea * | 1.02 | 0.42–2.48 | 0.966 |
Risk Factors | Univariate Model | Multivariate Model | ||||
---|---|---|---|---|---|---|
HR | 95% CI | p | HR | 95% CI | p | |
Age, years | 1.04 | 1.01–1.06 | 0.003 | 1.00 | 0.96–1.04 | 0.944 |
Male gender | 2.74 | 1.16–6.46 | 0.021 | 1.78 | 0.68–4.59 | 0.266 |
Charlson index | 1.11 | 0.95–1.30 | 0.168 | |||
Hypertension | 1.71 | 0.85–3.42 | 0.130 | |||
Diabetes | 1.52 | 0.58–3.95 | 0.390 | |||
Chronic kidney disease | 1.19 | 0.52–2.77 | 0.677 | 1.28 | 0.42–3.94 | 0.661 |
Heart failure | 2.88 | 1.10–7.57 | 0.031 | 2.80 | 0.88–8.88 | 0.080 |
Creatinine, mg/dl | 1.46 | 1.18–1.80 | <0.0001 | 1.10 | 0.73–1.66 | 0.647 |
Acute kidney injury | 2.00 | 1.03–3.89 | 0.042 | 2.71 | 1.21–6.08 | 0.015 |
RPA ≤24 (Q1) | 1.52 | 0.74–3.12 | 0.249 | 1.44 | 0.63–3.29 | 0.381 |
Perirenal fat stranding | 2.95 | 1.14–7.63 | 0.026 | 4.14 | 1.16–14.79 | 0.029 |
O2 Saturation, % | 0.97 | 0.94–1.01 | 0.210 | |||
PaO2/FiO2 ratio | 1.00 | 0.99–1.01 | 0.178 | |||
Chest radiographic abnormality * | 1.23 | 0.48–3.18 | 0.668 | |||
Cancer history * | 1.53 | 1.01–2.33 | 0.043 | 1.40 | 0.86–2.27 | 0.176 |
Lactate dehydrogenase, U/L * | 1.00 | 1.00–1.00 | 0.094 | |||
Direct bilirubin, * | 1.79 | 0.70–4.58 | 0.225 | |||
L/N ratio * | 0.84 | 0.44–1.62 | 0.611 | |||
Dyspnea * | 0.94 | 0.48–1.85 | 0.867 |
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Russo, E.; Tagliafico, A.S.; Derchi, L.; Bignotti, B.; Tosto, S.; Martinoli, C.; Signori, A.; Brigati, F.; Viazzi, F. Role of Renal Parenchyma Attenuation and Perirenal Fat Stranding in Chest CT of Hospitalized Patients with COVID-19. J. Clin. Med. 2023, 12, 929. https://doi.org/10.3390/jcm12030929
Russo E, Tagliafico AS, Derchi L, Bignotti B, Tosto S, Martinoli C, Signori A, Brigati F, Viazzi F. Role of Renal Parenchyma Attenuation and Perirenal Fat Stranding in Chest CT of Hospitalized Patients with COVID-19. Journal of Clinical Medicine. 2023; 12(3):929. https://doi.org/10.3390/jcm12030929
Chicago/Turabian StyleRusso, Elisa, Alberto Stefano Tagliafico, Lorenzo Derchi, Bianca Bignotti, Simona Tosto, Carlo Martinoli, Alessio Signori, Francesca Brigati, and Francesca Viazzi. 2023. "Role of Renal Parenchyma Attenuation and Perirenal Fat Stranding in Chest CT of Hospitalized Patients with COVID-19" Journal of Clinical Medicine 12, no. 3: 929. https://doi.org/10.3390/jcm12030929