PURPOSE: To examine the independent and incremental value of CT-derived quantitative burden and attenuation of COVID-19 pneumonia for the prediction of clinical deterioration or death METHODS: This was a retrospective analysis of a prospective international registry of consecutive patients with laboratory-confirmed COVID-19 and chest CT imaging, admitted to four centers between January 10 and May 6, 2020 Total burden (expressed as a percentage) and mean attenuation of ground glass opacities (GGO) and consolidation were quantified from CT using semi-automated research software The primary outcome was clinical deterioration (intensive care unit admission, invasive mechanical ventilation, or vasopressor therapy) or in-hospital death Logistic regression was performed to assess the predictive value of clinical and CT parameters for the primary outcome RESULTS: The final population comprised 120 patients (mean age 64 ± 16 years, 78 men), of whom 39 (32 5%) experienced clinical deterioration or death In multivariable regression of clinical and CT parameters, consolidation burden (odds ratio [OR], 3 4;95% confidence interval [CI]: 1 7, 6 9 per doubling;P = 001) and increasing GGO attenuation (OR, 3 2;95% CI: 1 3, 8 3 per standard deviation, P = 02) were independent predictors of deterioration or death;as was C-reactive protein (OR, 2 1;95% CI: 1 3, 3 4 per doubling;P = 004), history of heart failure (OR 1 3;95% CI: 1 1, 1 6, P = 01), and chronic lung disease (OR, 1 3;95% CI: 1 0, 1 6;P = 02) Quantitative CT measures added incremental predictive value beyond a model with only clinical parameters (area under the curve, 0 93 vs 0 82, P = 006) The optimal prognostic cutoffs for burden of COVID-19 pneumonia as determined by Youden's index were consolidation of greater than or equal to 1 8% and GGO of greater than or equal to 13 5% CONCLUSIONS: Quantitative burden of consolidation or GGO on chest CT independently predict clinical deterioration or death in patients with COVID-19 pneumonia CT-derived measures have incremental prognostic value over and above clinical parameters, and may be useful for risk stratifying patients with COVID-19
Quantitative Burden of COVID-19 Pneumonia on Chest CT Predicts Adverse Outcomes: A Post-Hoc Analysis of a Prospective International Registry