Clinical Features and Chest Imaging as Predictors of Intensity of Care in Patients with COVID-19
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population and Study Design
2.2. Level of Care Definition
2.3. Ethics Statement
2.4. Data Collection
2.5. Radiological Evaluation
2.6. Ultrasound Evaluation
2.7. Statistical Analysis
3. Results
3.1. Patient Demographics and Clinical Characteristics at Baseline
3.2. Radiological Features on Admission
3.3. Radiological Correlations
3.4. Predictors of Level of Care Requirement
3.5. Ultrasound Evaluation
4. Discussion
Author Contributions
Funding
Conflicts of Interest
Abbreviations
COVID-19 | Coronavirus disease 2019 |
SARS-CoV-2 | Severe acute respiratory syndrome coronavirus type 2 |
ICU | Intensive care unit |
CT | computed tomography |
CXR | chest X-ray |
US | ultrasound |
HFNC | high-flow nasal cannula |
LIMC | low-intensity medical care |
HIMC | high-intensity medical care |
GGO— | ground glass opacities |
CO | consolidations |
CVD | cardiovascular diseases |
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Overall Population | Low-Intensity Medical Care (LIMC) | High-Intensity Medical Care (HIMC) | p Value | |
---|---|---|---|---|
(n = 102) | (n = 71) | (n = 31) | ||
Male—n (%) | 75 (73) | 48 (67) | 27 (87) | 0.05 |
Age at admission—years | 68 (22–94) | 63 (22–94) | 74 (28–85) | 0.03 |
Smoking history—pack years | 0 (0–60) | 0 (0–60) | 10 (0–60) | 0.01 |
| 9 (9) | 8 (11) | 1 (3) | 0.18 |
| 43 (42) | 24 (34) | 19 (61) | 0.009 |
| 50 (49) | 41 (57) | 9 (29) | 0.007 |
BMI (kg/m2) | 25 (16–43) | 24 (16–31) | 31 (21–43) | 0.02 |
Lag time symptoms—diagnosis—days | 4 (−4–23) | 3 (−4–23) | 6 (−2–22) | 0.07 |
FiO2 at admission (room air)—% | 21 (21–100) | 21 (21–51) | 39 (21–100) | <0.0001 |
pO2 at admission (room air)—mmHg | 90 (21.2–119) | 90 (54–119) | 60 (21–90) | <0.0001 |
P/F at admission—value | 429 (33–567) | 429 (106–567) | 158 (33–429) | <0.0001 |
Hospitalization—days | 10.5 (2–119) | 8 (2–50) | 26 (7–119) | <0.0001 |
Bacterial co-infections—n (%) | 24 (23) | 11 (15) | 13 (42) | 0.002 |
Comorbidities | ||||
| 60 (59) | 35 (49) | 25 (80) | 0.002 |
| 18 (18) | 11 (15) | 7 (22) | 0.39 |
| 12 (12) | 10 (14) | 2 (6) | 0.34 |
| 45 (44) | 26 (37) | 19 (61) | 0.002 |
| 13 (13) | 6 (8) | 7 (22) | 0.05 |
Death—n (%) | 6 (6) | 1 (1) | 4 (13) | 0.01 |
Overall Population | Low-Intensity Medical Care (LIMC) | High-Intensity Medical Care (HIMC) | p Value | |
---|---|---|---|---|
(n = 102) | (n = 71) | (n = 31) | ||
X-ray global score (GGO + consolidations) | 3 (0–35) | 3 (0–22) | 8 (0–35) | <0.0001 |
GGO—score | 2 (0–18) | 1 (0–18) | 5 (0–15) | <0.0001 |
Consolidation—score | 0 (0–35) | 0 (0–10) | 0 (0–35) | 0.02 |
Normal—n (%) | 15 (15) | 14 (20) | 1 (3) | 0.003 |
GGO prevalent—n (%) | 66 (65) | 44 (62) | 22 (71) | 0.38 |
Consolidation prevalent—n (%) | 15 (15) | 11 (16) | 4 (13) | 0.73 |
Mixed—n (%) | 6 (6) | 2 (3) | 4 (13) | 0.04 |
Univariate Analysis | Multivariate Analysis | |||
---|---|---|---|---|
OR (95% IC) | p | OR (95% IC) | p | |
Sex (male vs. female) | 3.23 (1.01–11.89) | 0.04 | 0.54 (0.06–4.22) | 0.55 |
Age (yr, ≥ 68 vs. < 68) | 3.34 (1.38–8.61) | 0.009 | 0.51 (0.06–3.03) | 0.49 |
Smoking history (p/y, > 0 vs. ≤ 0) | 2.72 (1.08–7.27) | 0.03 | 6.55 (1.15–52.09) | 0.04 |
FiO2 at admission (%, > 21 vs. ≤ 21) | 13.1 (4.92–39.2) | <0.0001 | 4.17 (0.60–29.89) | 0.14 |
pO2 at admission (room air) (mmHg, < 90, ≥ 90) | 13 (4.78–40.4) | <0.0001 | 36.7 (3.64–681.4) | 0.005 |
Lag time symptoms—diagnosis—(days, ≥ 4 vs. < 4) | 2.18 (0.90–5.50) | 0.08 | – | – |
P/F at admission (≥ 429 vs. < 429) | 9.60 (3.59–29.26) | <0.0001 | 16.61 (3.34–128.3) | 0.002 |
Bacterial co-infections (yes vs. no) | 4.64 (1.75–12.72) | 0.002 | 2.48 (0.38–17.78) | 0.34 |
CVDs—(yes vs. no) | 5.14 (1.89–16.6) | 0.002 | 10.89 (1.44–112.0) | 0.02 |
Respiratory diseases—(yes vs. no) | 5.14 (1.89–16.6) | 0.34 | – | – |
Autoimmune diseases—(yes vs. no) | 0.43 (0.06–1.79) | 0.30 | – | – |
Metabolic diseases—(yes vs. no) | 2.99 (1.25–7.44) | 0.01 | 2.63 (0.54–14.76) | 0.24 |
Oncologic diseases—(yes vs. no) | 3.29 (1.00–11.25) | 0.04 | 17.13 (1.76–242.6) | 0.02 |
X-ray global score (> 3 vs. < 3) | 3.33 (1.32–9.29) | 0.01 | 0.40 (0.02–3.63) | 0.43 |
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Share and Cite
Cocconcelli, E.; Biondini, D.; Giraudo, C.; Lococo, S.; Bernardinello, N.; Fichera, G.; Barbiero, G.; Castelli, G.; Cavinato, S.; Ferrari, A.; et al. Clinical Features and Chest Imaging as Predictors of Intensity of Care in Patients with COVID-19. J. Clin. Med. 2020, 9, 2990. https://doi.org/10.3390/jcm9092990
Cocconcelli E, Biondini D, Giraudo C, Lococo S, Bernardinello N, Fichera G, Barbiero G, Castelli G, Cavinato S, Ferrari A, et al. Clinical Features and Chest Imaging as Predictors of Intensity of Care in Patients with COVID-19. Journal of Clinical Medicine. 2020; 9(9):2990. https://doi.org/10.3390/jcm9092990
Chicago/Turabian StyleCocconcelli, Elisabetta, Davide Biondini, Chiara Giraudo, Sara Lococo, Nicol Bernardinello, Giulia Fichera, Giulio Barbiero, Gioele Castelli, Silvia Cavinato, Anna Ferrari, and et al. 2020. "Clinical Features and Chest Imaging as Predictors of Intensity of Care in Patients with COVID-19" Journal of Clinical Medicine 9, no. 9: 2990. https://doi.org/10.3390/jcm9092990