Correlation of chest CT severity score with clinical parameters in COVID-19 pulmonary disease in a tertiary care hospital in Delhi during the pandemic period

Recovery from Severe COVID-19 Is an Independent Predictor of Electrocardiographic Abnormal P-Wave Axis

AIM

Abnormal P-wave axis (aPwa) have been correlated with an increased risk of supraventricular arrhythmias. The aim of this study was to analyze whether infection with COVID-19 may cause a predisposition for supraventricular arrhythmia in the long term, following recovery.

MATERIALS AND METHODS

In this study, a total of 252 subjects with a confirmed history of COVID-19 (recovered COVID-19) and 251 healthy subjects without a history of COVID-19 were included. The recovered COVID-19 group was divided into three subgroups designated as mild, moderate, and severe according to the severity score of their chest CT. The aPwa data were obtained using 12-lead electrocardiography (ECG) and compared between the healthy subjects and the recovered COVID-19 subgroups.

RESULTS

This study showed that in the recovered severe COVID-19 subgroup the prevalence of aPwa was significantly increased compared to the controls and the other COVID-19 subgroups. No correlation could be detected in Spearman's Rho correlation between the existence of aPwa and the number of positive PCR tests for COVID-19 and the time elapsed after infection with COVID-19. The binary logistic regression analysis showed that recovery from severe COVID-19, the severity score of the chest CT in the recovered from COVID-19 subjects, and the existence of hypertension (HT) were all independent predictors of aPwa (hazard ratio: 3.542, 95% confidence interval: 1.398-8.969, p: 0.01; hazard ratio: 0.896, 95% confidence interval: 0.840-0.955, p < 0.001; hazard ratio: 2.710, 95% confidence interval: 1.079-6.804, p: 0.03, respectively).

CONCLUSIONS

Individuals who have recovered from severe COVID-19 have shown an increased prevalence of aPwa. The existence of aPwa was not associated with the number of positive PCR tests for COVID-19 or the time elapsed after infection with COVID-19. Therefore, recovery from severe COVID-19 is an independent predictor of electrocardiographic abnormal P-wave axis.

Retrospective computed tomography assessment of chemotherapy-related pneumonia with severity screening in pediatric acute lymphoblastic leukemia by radiological imaging

Objectives

To evaluate the radiological imaging-guided severity along the pneumonia course and evaluate the chest computed tomography (CT) findings of chemotherapy-related pneumonia in children with acute lymphoblastic leukemia (ALL).

Materials and methods

A retrospective database review of children with ALL was conducted from March 2016 to August 2021 to identify cases with CT images who developed pneumonia during the chemotherapy course. A total of 51 children with ALL developed pneumonia were ultimately included (31 boys and 20 girls, mean age: 6 ± 4 years [standard deviation]). Each child's demographics, medical records, and laboratory results were collected. The CT images were then reviewed and the radiologic severity index (RSI) was calculated based on the regional opacity and implicated volume. A t-test, U test, Pearson's Chi-square test, and Fisher's exact test were performed to compare the clinical or radiologic features between the severe and moderate cases. The linear regression models were employed to analyze the correlation of RSIs with other clinical features.

Results

Eleven children (22 %, 11/51) displayed severe phenotypes associated with respiratory failure. The ground glass opacity (GGO) frequently appeared (65 % of CT images). The baseline RSI was positively associated with the lowest lymphocyte (p = .003), neutrophil (p = .01) counts, and the highest C-reactive protein level (p = .04). The peak RSI may predict severe phenotypes at a cutoff of 4.5 (AUC 0.76 [0.61, 0.91]) with 73 % sensitivity and 63 % specificity.

Conclusion

The chest CT images of children with chemotherapy-related pneumonia displayed clinically related baseline RSI and a peak RSI of >4.5 of 36 predicted severe phenotypes.

A Novel Combined Model to Predict the Prognosis of COVID-19: Radiologicalmetabolic Scoring

AIM

To investigate the performance of a novel radiological-metabolic scoring (RM-S) system to predict mortality and intensive care unit (ICU) requirements among COVID-19 patients and to compare performance with the chest computed-tomography severity-scoring (C-CT-SS). The RMS was created from scoring systems such as visual coronary-artery-calcification scoring (V-CAC-S), hepatic-steatosis scoring (HS-S) and pancreatic-steatosis scoring (PS-S).

METHODS

Between May 2021 and January 2022, 397 patients with COVID-19 were included in this retrospective cohort study. All demographic, clinical and laboratory data and chest CT images of patients were retrospectively reviewed. RM-S, V-CAC-S, HS-S, PS-S and C-CT-SS scores were calculated, and their performance in predicting mortality and ICU requirement were evaluated by univariate and multivariable analyses.

RESULTS

A total of 32 (8.1%) patients died, and 77 (19.4%) patients required ICU admission. Mortality and ICU admission were both associated with older age (p < 0.001). Sex distribution was similar in the deceased vs. survivor and ICU vs. non-ICU comparisons (p = 0.974 and p = 0.626, respectively). Multiple logistic regression revealed that mortality was independently associated with having a C-CT-SS score of ≥ 14 (p < 0.001) and severe RM-S category (p = 0.010), while ICU requirement was independently associated with having a C-CT-SS score of ≥ 14 (p < 0.001) and severe V-CAC-S category (p = 0.010).

CONCLUSION

RM-S, C-CT-SS, and V-CAC-S are useful tools that can be used to predict patients with poor prognoses for COVID-19. Long-term prospective follow-up of patients with high RM-S scores can be useful for predicting long COVID.

A Systematic Review of the Relationship between Chest CT Severity Score and Laboratory Findings and Clinical Parameters in COVID-19 Pneumonia

The COVID-19 virus has infected millions of people and became a global pandemic in 2020. The efficacy of laboratory and clinical parameters in the diagnosis and monitoring of COVID-19 has been established. The CT scan has been identified as a crucial tool in the prognostication of COVID-19 pneumonia. Moreover, it has been proposed that the CT severity score can be utilized for the diagnosis and prognostication of COVID-19 disease severity and exhibits a correlation with laboratory findings such as inflammatory markers, blood glucose levels, and clinical parameters such as endotracheal intubation, oxygen saturation, mortality, and hospital admissions. Nevertheless, the correlation between the CT severity score and clinical or laboratory parameters has not been firmly established. The objective of this study is to provide a comprehensive review of the aforementioned association. This review used a systematic approach to collate and assess the existing literature that investigates the correlation between CT severity score and laboratory and clinical parameters. The search was conducted using Embase Ovid, MEDLINE Ovid, and PubMed databases, covering the period from inception to 20 May 2023. This review identified 20 studies involving more than 8000 participants of varying designs. The findings showed that the CT severity score is positively associated with laboratory and clinical parameters in COVID-19 patients. The findings indicate that the CT severity score exhibits a satisfactory level of prognostic accuracy in predicting mortality among patients with COVID-19.

Trend of SARS-Cov-2-Specific IgG Antibody Titers Among COVID-19 Pneumonia Patients: A Nine-Month Follow-Up

Introduction Understanding the dynamics of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunoglobulin G (IgG) spike antibody titers after natural infection is important for understanding immunological memory. This longitudinal study was conducted to assess the trend in serum SARS-CoV-2 IgG spike antibody titers in a cohort of recovered cases up to nine months after SARS infection. Materials and methods We examined the neutralizing antibody response (IgG spike) in serum samples from a cohort of 86 SARS-CoV-2 quantitative polymerase chain reaction (qPCR)-confirmed infection, comprising cases having minor COVID-19 pneumonia and severity, which was determined by CT severity scores. Patients were enrolled in August/September 2020 and serum samples have been processed at one, three, six, and nine months. CT severity scores were rated between 1-25 and antibody titers≥ 1.4 were considered positive. Results The mean anti-SARS-CoV-2-specific IgG antibody titers at one month, three months, six months, and nine months were 22.02 ± 18.36, 14.62 ± 12.61, 8.93 ± 8.10, and 3.86 ± 5.70, respectively. The difference was statistically significant. The seropositivity rates (titer ≥1.4 IU) were 93.02%, 82.56%, 76.74%, and 58.14% at one, three, six, and nine months after infection, respectively. Cases with severe CT severity scores showed significantly higher mean antibody levels at all follow-up visits.

Novel COVID-19 Pneumonia: CT Manifestations and Pattern of Evolution

Background This study aims to provide a better knowledge of COVID-19 that will aid in the formulation of future health policy by detailing the pathophysiology, case detection, and treatment, as well as management and prevention activities. Methodology A cross-sectional, prospective study was conducted at the Department of Radio-Diagnosis and Imaging, Shri B.M. Patil Medical College, Vijayapura. A total of 90 patients who presented with clinical features of COVID-19 and patients above the age of 18 years suspected of COVID-19 who were referred to the Department of Radio-Diagnosis and Imaging were included in the study. Results The classical findings which are observed on CT imaging in patients with COVID-19 include the presence of ground-glass opacities which are bilateral in distribution predominantly affecting the lower lobes with a posterior predilection. Overall, more than 33% of the patients who recovered from severe COVID-19 had lung abnormalities resembling fibrosis on follow-up imaging performed within two weeks of the commencement of the disease. These individuals were older and had more severe sicknesses during the acute period. Conclusions Chest CT can detect COVID-19 progression or secondary cardiopulmonary problems such as acute respiratory distress syndrome, pulmonary embolism, superimposed pneumonia, or heart failure. Future research into the prognostic value of chest CT in COVID-19 is required.

De Novo Lower Urinary Tract Symptoms in COVID-19 Patients

Background and objective Since early 2020, the novel coronavirus disease 2019 (COVID-19) has turned into a global healthcare concern. The usual clinical presentation of COVID-19 infection includes myalgia, headache associated with pyrexia, and sore throat. Our study aimed to assess the severity of lower urinary tract symptoms (LUTS) in COVID-19 patients and determine its correlation with the prognosis of the disease. Methods We conducted an observational study in the COVID-19 care unit at a tertiary care teaching center in Rajasthan on patients diagnosed as COVID-19-positive. The overactive bladder (OAB) symptom scoring system for LUTS and the CT scoring system for lung involvement in COVID-19 patients were used to evaluate the sample population. Results While our findings showed a non-significant association between OAB and CT score (p>0.05), correlation analysis revealed that the length of hospital stay was significantly longer and oxygen needs were significantly more frequent with severe LUTS. Conclusions Based on our findings, de novo LUTS, particularly storage symptoms, may be present in COVID-19-positive cases, and the severity of these symptoms may have an impact on the patient's length of stay in the hospital. Hence, doctors and other medical professionals should consider COVID-19-related bladder dysfunctions such as de novo LUTS as part of COVID-19 symptomatology.