PREDICTING MORTALITY RATE IN ICU-ADMITTED COVID-19 PATIENTS IMPLEMENTING VISUAL SEMI-QUANTITATIVE CT SEVERITY SCORING SYSTEM

Purpose:
To evaluate the relationship between CT scan findings and mortality in COVID-19 pneumonia by comparing deceased patients with normal patients.
Methods:
In this retrospective case-control study, 290 ICU admitted patients with RT-PCR confirmed COVID-19 pneumonia were investigated. Totally, 145 deceased patients with confirmed COVID-19 related death (In-hospital mortality subgroup, case), and 145 patients who survived the admission course (surviving subgroup, control) were randomly selected among all ICU admitted COVID-19 patients referring to the affiliated tertiary center between 20 Aug, 2021 and 21 Sep, 2021. Participants’ laboratory and clinical information, and their on-admission computed tomography (CT) images were reviewed. Mortality-related risk factors were compared between case and control subgroups.
Results:
The mean age of deceased patients (68.20±16.07) was significantly higher than that of the surviving patients (54.72± 19.50) (P <0.001). Diabetes, hypertension, and chronic kidney disease (CKD) were significantly related with higher mortality rates (62.2%, 58.7%, and 80.4% mortality in diabetic, hypertensive, and CKD patients versus 41.7%, 42.1%, and 35.9% in non-diabetics, normotensives, and patients without CKD). Additionally, the Mean on-admission air-room SPO2 level in deceased patients (90%) was significantly lower than that of the survivors (93%) (P = 0.001). Neutrophil to lymphocyte ratio (NLR), lymphocyte count, c-reactive protein (CRP), erythrocyte sedimentation rate (ESR), lactate dehydrogenase (LDH), creatinine (Cr), blood urea nitrogen (BUN), and fasting blood sugar (BS), mean CT severity score (CT-Ss), and O2 supportive therapy requirement were significantly higher in the mortality subgroup (P <0.05). Pleural effusion showed no significant correlation with short-term mortality. CT-Ss of >11, in isolation or in combination with the above-mentioned prognosticators, was 64% or 81.4% sensitive, and 60% or of 78.6% specific, to predict mortality.
Conclusions:
This study found semiquantitative CT severity score easy-to-calculate and efficient to diagnose and risk-stratify high-risk COVID-19 patients, and it was meaningfully predictive of mortality in COVID-19 pneumonia.