Correlation between CT severity score and clinical severity of COVID-19 pneumonia in hospitalised patients in a tertiary care hospital, Tamilnadu
Monisha Anandhan1, KM Aishwarya2, R Sridhar3, Ajith4, Balasubramaniam Ramakrishnan5, R Narasimhan6
1 Post Graduate Resident, Department of Respiratory Medicine, Apollo Hospitals, Greams Road, Chennai, India
2 Post Graduate Resident, Department of Internal Medicine, Apollo Hospitals, Greams Road, Chennai, India
3 Associate Consultant, Department of of Respiratory Medicine, Apollo Hospitals, Greams Road, Chennai, India
4 Post Graduate Resident, Department of Radiology, Apollo Hospitals, Greams Road, Chennai, India
5 Senior Biostatistician, Dept of Biostatistics, DME Apollo Hospitals Chennai, India
6 Senior Consultant Pulmonologist, Department of Respiratory Medicine, Apollo Hospitals, Greams Road, Chennai, India
Senior Consultant Pulmonologist, Department of Respiratory Medicine, Apollo Hospitals, Greams Road, Chennai
Source of Support: None, Conflict of Interest: None
Aim: To study the correlation between CT severity score in COVID pneumonia patients with oxygen supplementation and diseases outcome.
Background and Methods: Retrospective study was done on 56 hospitalied patients who were diagnosed with COVID-19 Pneumonia with gold standard RT PCR in Apollo Main Hospital, Greams road, Chennai. We retrospectively collected epidemiological data, clinical manifestation, co-morbidities, oxygen requirement as well as CT chest findings and CT severity score of all patients. Meticulous study of HRCT chest for pattern and distribution of the disease was done along with the calculation of CT severity score for all patients according to American journal of radiology recent guidelines. CT severity score was then compared with the clinical severity of the diseases as determined by the oxygen supplement and patient outcome.
Results: The study was done on 56 hospitalized patients with mean age of 58.7 + 14.3 with age group of 40 to 59 years(48.21%) and above 60 years(46.43%). Male(71.4%) patients were more compared to female(28.6%) patients .Typical COVID-19 findings like peripheral GGO’s were present in all patients, crazy paving in 96.4% patients and consolidation in 16.1% patients. There is a significant difference in CT severity score between those who required (N=39) (19.2+7.2) and not required oxygen (N=17) (10.7 +5.7) (P value = 0.0001). Even though there was increasing trend in CT severity score across different modes of oxygen requirements but it was not statistically significant (0.183).
Among 39 patients who needed Oxygen supplementation through different modes, nasal prongs(NP) (N=12) (30.8%),face mask (FM) (N=6)(15.4 %), Non rebreathing face mask(NRBM) (N=8) (20.5 %), High Flow Nasal Canula (HFNC) (N=2)( 5.1%),Non Invasive Ventilation (NIV)(N=6) (15.4%) intubated patients (12.8%) their respective mean CT severity were of 16.50+ 4.1, 16.67 + 5.5, 19.13+ 6.2,17+ 16, 23.7 + 8.8and 24+ 8.9 which was not statistically significant [P value (0.183)].There was increased CT severity score in those patients who died which was not statistically significant when compared to the patients who were alive (P value = 0.120). Mean duration of CT taken time and the onset of symptom was 3 days ( 1 to 6 days). The patients who delayed more than 2 days to take CT chest had an odds ratio of 3.2 higher chance of requiring oxygen which was statistically significant (P value = 0.046).
Conclusions: Significant correlation between CT Severity Score and the comparable need for appropriate mode of oxygen delivery suggests the high predictive value of HRCT chest in the disease outcome. Hence, HRCT chest is one the best tools for early rapid identification as well as to predict the severity of disease. It also helps the physician in making important treatment modifications at crucial points during the progression and course of the disease.