Chest CT Total Severity Score on Admission to Predict In-Hospital Mortality in COVID-19 Patients with Acute and Chronic Renal Impairment
<b>Aim:</b> To identify the predictors of in-hospital mortality in patients with coronavirus disease of 2019 (COVID-19) and acute renal impairment (ARI) or chronic kidney disease (CKD), and to evaluate the performance and inter-reader concordance of chest CT total severity scores (TSSs)....
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| Format: | Article |
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MDPI AG
2022-06-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/12/7/1529 |
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| author | Samar Tharwat Gehad A. Saleh Marwa Saleh Ahmad M. Mounir Dina G. Abdelzaher Ahmed M Salah Mohammed Kamal Nassar |
| author_facet | Samar Tharwat Gehad A. Saleh Marwa Saleh Ahmad M. Mounir Dina G. Abdelzaher Ahmed M Salah Mohammed Kamal Nassar |
| author_sort | Samar Tharwat |
| collection | DOAJ |
| description | <b>Aim:</b> To identify the predictors of in-hospital mortality in patients with coronavirus disease of 2019 (COVID-19) and acute renal impairment (ARI) or chronic kidney disease (CKD), and to evaluate the performance and inter-reader concordance of chest CT total severity scores (TSSs). <b>Methods:</b> This retrospective single-center study was conducted on symptomatic COVID-19 patients with renal impairment (either acute or chronic) and a serum creatinine of >2 mg/dL at the time of admission. The patients’ demographic characteristics, clinical data, and laboratory data were extracted from the clinical computerized medical records. All chest CT images obtained at the time of hospital admission were analyzed. Two radiologists independently assessed the pulmonary abnormalities and scored the severity using CT chest total severity score (TSS). Univariate logistic regression analysis was used to determine factors associated with in-hospital mortality. A receiver operating characteristic (ROC) curve analysis was performed for the TSS in order to identify the cut-off point that predicts mortality. Bland–Altman plots were used to evaluate agreement between the two radiologists assessing TSS. <b>Results:</b> A total of 100 patients were included, with a mean age of 60 years, 54 were males, 53 had ARI, and 47 had CKD. In terms of in-hospital mortality, 60 patients were classified in the non-survivor group and 40 were classified in the survivor group. The mortality rate was higher for those with ARI compared to those with CKD (<i>p</i> = 0.033). The univariate regression analysis showed an increasing odds of in-hospital mortality associated with higher respiratory rate (OR 1.149, 95% CI 1.057–1.248, <i>p</i> = 0.001), total bilirubin (OR 2.532, 95% CI 1.099–5.836, <i>p</i> = 0.029), lactate dehydrogenase (LDH) (OR 1.001, 95% CI 1.000–1.003, <i>p</i> = 0.018), CRP (OR 1.010, 95% CI 1.002–1.017, <i>p</i> = 0.012), invasive mechanical ventilation (MV) (OR 7.667, 95% CI 2.118–27.755, <i>p</i> = 0.002), a predominant pattern of pulmonary consolidation (OR 21.714, 95% CI 4.799–98.261, <i>p</i> < 0.001), and high TSS (OR 2.082, 95% CI 1.579–2.745, <i>p</i> < 0.001). The optimum cut-off value of TSS used to predict in-hospital mortality was 8.5 with a sensitivity of 86.7% and a specificity of 87.5%. There was excellent interobserver agreement (ICC > 0.9) between the two independent radiologists in their quantitative assessment of pulmonary changes using TSS. <b>Conclusions:</b> In-hospital mortality is high in COVID-19 patients with ARI/CKD, especially for those with ARI. High serum bilirubin, a predominant pattern of pulmonary consolidation, and TSS are the most significant predictors of mortality in these patients. Patients with a higher TSS may require more intensive hospital care. TSS is a reliable and helpful auxiliary tool for risk stratification among COVID-19 patients with ARI/CKD. |
| first_indexed | 2024-03-09T03:32:56Z |
| format | Article |
| id | doaj.art-e040b180e1864ce8b0e861e99c041b9d |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-09T03:32:56Z |
| publishDate | 2022-06-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-e040b180e1864ce8b0e861e99c041b9d2023-12-03T14:53:27ZengMDPI AGDiagnostics2075-44182022-06-01127152910.3390/diagnostics12071529Chest CT Total Severity Score on Admission to Predict In-Hospital Mortality in COVID-19 Patients with Acute and Chronic Renal ImpairmentSamar Tharwat0Gehad A. Saleh1Marwa Saleh2Ahmad M. Mounir3Dina G. Abdelzaher4Ahmed M Salah5Mohammed Kamal Nassar6Rheumatology & Immunology Unit, Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, EgyptDiagnostic Radiology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, EgyptMansoura Nephrology & Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, EgyptDiagnostic Radiology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, EgyptDiagnostic Radiology Department, Faculty of Medicine, Mansoura University, Mansoura 35516, EgyptNephrology Unit, Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig 44519, EgyptMansoura Nephrology & Dialysis Unit (MNDU), Department of Internal Medicine, Faculty of Medicine, Mansoura University, Mansoura 35516, Egypt<b>Aim:</b> To identify the predictors of in-hospital mortality in patients with coronavirus disease of 2019 (COVID-19) and acute renal impairment (ARI) or chronic kidney disease (CKD), and to evaluate the performance and inter-reader concordance of chest CT total severity scores (TSSs). <b>Methods:</b> This retrospective single-center study was conducted on symptomatic COVID-19 patients with renal impairment (either acute or chronic) and a serum creatinine of >2 mg/dL at the time of admission. The patients’ demographic characteristics, clinical data, and laboratory data were extracted from the clinical computerized medical records. All chest CT images obtained at the time of hospital admission were analyzed. Two radiologists independently assessed the pulmonary abnormalities and scored the severity using CT chest total severity score (TSS). Univariate logistic regression analysis was used to determine factors associated with in-hospital mortality. A receiver operating characteristic (ROC) curve analysis was performed for the TSS in order to identify the cut-off point that predicts mortality. Bland–Altman plots were used to evaluate agreement between the two radiologists assessing TSS. <b>Results:</b> A total of 100 patients were included, with a mean age of 60 years, 54 were males, 53 had ARI, and 47 had CKD. In terms of in-hospital mortality, 60 patients were classified in the non-survivor group and 40 were classified in the survivor group. The mortality rate was higher for those with ARI compared to those with CKD (<i>p</i> = 0.033). The univariate regression analysis showed an increasing odds of in-hospital mortality associated with higher respiratory rate (OR 1.149, 95% CI 1.057–1.248, <i>p</i> = 0.001), total bilirubin (OR 2.532, 95% CI 1.099–5.836, <i>p</i> = 0.029), lactate dehydrogenase (LDH) (OR 1.001, 95% CI 1.000–1.003, <i>p</i> = 0.018), CRP (OR 1.010, 95% CI 1.002–1.017, <i>p</i> = 0.012), invasive mechanical ventilation (MV) (OR 7.667, 95% CI 2.118–27.755, <i>p</i> = 0.002), a predominant pattern of pulmonary consolidation (OR 21.714, 95% CI 4.799–98.261, <i>p</i> < 0.001), and high TSS (OR 2.082, 95% CI 1.579–2.745, <i>p</i> < 0.001). The optimum cut-off value of TSS used to predict in-hospital mortality was 8.5 with a sensitivity of 86.7% and a specificity of 87.5%. There was excellent interobserver agreement (ICC > 0.9) between the two independent radiologists in their quantitative assessment of pulmonary changes using TSS. <b>Conclusions:</b> In-hospital mortality is high in COVID-19 patients with ARI/CKD, especially for those with ARI. High serum bilirubin, a predominant pattern of pulmonary consolidation, and TSS are the most significant predictors of mortality in these patients. Patients with a higher TSS may require more intensive hospital care. TSS is a reliable and helpful auxiliary tool for risk stratification among COVID-19 patients with ARI/CKD.https://www.mdpi.com/2075-4418/12/7/1529COVID-19chest CT total severity scoreacute renal impairmentchronic kidney disease |
| spellingShingle | Samar Tharwat Gehad A. Saleh Marwa Saleh Ahmad M. Mounir Dina G. Abdelzaher Ahmed M Salah Mohammed Kamal Nassar Chest CT Total Severity Score on Admission to Predict In-Hospital Mortality in COVID-19 Patients with Acute and Chronic Renal Impairment Diagnostics COVID-19 chest CT total severity score acute renal impairment chronic kidney disease |
| title | Chest CT Total Severity Score on Admission to Predict In-Hospital Mortality in COVID-19 Patients with Acute and Chronic Renal Impairment |
| title_full | Chest CT Total Severity Score on Admission to Predict In-Hospital Mortality in COVID-19 Patients with Acute and Chronic Renal Impairment |
| title_fullStr | Chest CT Total Severity Score on Admission to Predict In-Hospital Mortality in COVID-19 Patients with Acute and Chronic Renal Impairment |
| title_full_unstemmed | Chest CT Total Severity Score on Admission to Predict In-Hospital Mortality in COVID-19 Patients with Acute and Chronic Renal Impairment |
| title_short | Chest CT Total Severity Score on Admission to Predict In-Hospital Mortality in COVID-19 Patients with Acute and Chronic Renal Impairment |
| title_sort | chest ct total severity score on admission to predict in hospital mortality in covid 19 patients with acute and chronic renal impairment |
| topic | COVID-19 chest CT total severity score acute renal impairment chronic kidney disease |
| url | https://www.mdpi.com/2075-4418/12/7/1529 |
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