Theranostics 2020; 10(14):6113-6121. doi:10.7150/thno.46569

Research Paper

Association of clinical and radiographic findings with the outcomes of 93 patients with COVID-19 in Wuhan, China

Lingli Li1,2#, Lian Yang1,2#, Shan Gui1,2, Feng Pan1,2, Tianhe Ye1,2, Bo Liang1,2, Yu Hu3✉, Chuansheng Zheng1,2✉

1. Department of Radiology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
2. Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
3. Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, China
#Lingli Li and Lian Yang contributed equally to this work.
*Yu Hu and Chuansheng Zheng contributed equally to this work.

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Citation:
Li L, Yang L, Gui S, Pan F, Ye T, Liang B, Hu Y, Zheng C. Association of clinical and radiographic findings with the outcomes of 93 patients with COVID-19 in Wuhan, China. Theranostics 2020; 10(14):6113-6121. doi:10.7150/thno.46569. Available from https://www.thno.org/v10p6113.htm

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Abstract

Rationale: To retrospectively analyze serial chest CT and clinical features in patients with coronavirus disease 2019 (COVID-19) for the assessment of temporal changes and to investigate how the changes differ in survivors and nonsurvivors.

Methods: The consecutive records of 93 patients with confirmed COVID-19 who were admitted to Wuhan Union Hospital from January 10, 2020, to February 22, 2020, were retrospectively reviewed. A series of chest CT findings and clinical data were collected and analyzed. The serial chest CT scans were scored on a semiquantitative basis according to the extent of pulmonary abnormalities. Chest CT scores in different periods (0 - 5 days, 6 - 10 days, 11 - 15 days, 16 - 20 days, and > 20 days) since symptom onset were compared between survivors and nonsurvivors, and the temporal trend of the radiographic-clinical features was analyzed.

Results: The final cohort consisted of 93 patients: 68 survivors and 25 nonsurvivors. Nonsurvivors were significantly older than survivors. For both survivors and nonsurvivors, the chest CT scores were not different in the first period (0 - 5 days) but diverged afterwards. The mortality rate of COVID-19 monotonously increased with chest CT scores, which positively correlated with the neutrophil-to-lymphocyte ratio, neutrophil percentage, D-dimer level, lactate dehydrogenase level and erythrocyte sedimentation rate, while negatively correlated with the lymphocyte percentage and lymphocyte count.

Conclusions: Chest CT scores correlate well with risk factors for mortality over periods, thus they may be used as a prognostic indicator in COVID-19. While higher chest CT scores are associated with a higher mortality rate, CT images taken at least 6 days since symptom onset may contain more prognostic information than images taken at an earlier period.

Keywords: X-Ray Computed Tomography, Viral Pneumonia, COVID-19, Outcome