Yukitaka Yamasaki, Seido Ooka, Shin Matsuoka, Hayato Tomita, Masanori Hirose, Tomonori Takano, Shotaro Suzuki, Mitsuru Imamura, Hiroshi Handa, Hiroki Nishine, Mumon Takita, Ayu Minoura, Kenichiro Morisawa, Takeo Inoue, Masamichi Mineshita, Kimito Kawahata, Hiromu Takemura, Shigeki Fujitani, Hiroyuki Kunishima
Abstract
Presently, coronavirus disease-19 (COVID-19) is spreading worldwide without an effective treatment method. For COVID-19, which is often asymptomatic, it is essential to adopt a method that does not cause aggravation, as well as a method to prevent infection. Whether aggravation can be predicted by analyzing the extent of lung damage on chest computed tomography (CT) scans was examined. The extent of lung damage on pre-intubation chest CT scans of 277 patients with COVID-19 was assessed. It was observed that aggravation occurred when the CT scan showed extensive damage associated with ground-glass opacification and/or consolidation (p < 0.0001). The extent of lung damage was similar across the upper, middle, and lower fields.
Introduction
Coronavirus disease-19 (COVID-19) that broke out in 2019 in Wuhan, Hubei Province, China, has spread worldwide [1]. At present, the disease lacks an effective treatment method [2]. As a result, most patients with COVID-19 develop pneumonia, which aggravates in some and becomes life-threatening. Moreover, this troublesome virus often causes an asymptomatic infection and is therefore difficult to prevent [3]. Under such circumstances, preventing aggravation of the disease is most essential.
To this end, it is crucial to accurately understand the state of COVID-19 and to perform early triage of patients whose condition will aggravate. COVID-19 is broadly divided into the asymptomatic phase, in which infection has occurred with no obvious symptoms; the paucisymptomatic phase, in which flu-like symptoms and symptoms such as taste disorder are exhibited but oxygenation is maintained; and severe pneumonia phases, in which respiratory distress progresses, causing hypoxemia.
Materials and methods
This was a retrospective cohort study. All patients with COVID-19 were diagnosed based on a polymerase chain reaction test on a throat swab. The subject sample included 277 patients with COVID-19 admitted to our hospital from February 16, 2020 to March 9, 2021, and chest CT scans of these patients taken before Ventilator management were evaluated. The clinical course analysis included chest CT scans taken within 14 days of onset. The day of onset was defined as the day of appearance of clinical symptoms [fever or respiratory symptoms (coughing or runny nose) and taste disturbance]. Pneumonia was confirmed based on relevant chest CT scan findings.
Results
Among the 277 patients, pre-intubation chest CT scans of 65 patients were unavailable; thus, they were excluded from this study. Intubation was performed for myocardial infarction in 3 patients, pulmonary embolism in 4 patients, and gastrointestinal perforation in 1 patient, and thus these patients were excluded from this study.
As a result, 204 patients were included, with 84 patients in the SPG and 120 patients in the NSPG. In the analysis of the clinical course after the onset day, nine patients were excluded due to chest CT scans being taken on day 15 or later after onset, and 6 patients were excluded because the onset day was unknown.
Discussion
Presently, COVID-19 is spreading worldwide without an effective treatment method. COVID-19 is often asymptomatic; therefore, it is challenging to prevent actual infection [3]. The problem is that some patients with COVID-19 show aggravation of the condition, whereas the condition becomes fatal in some. Therefore, it is believed that individuals with COVID-19 infection should be identified and that it is crucial to adopt an approach that prevents aggravation.
Citation: Yamasaki Y, Ooka S, Matsuoka S, Tomita H, Hirose M, Takano T, et al. (2022) Predicting the aggravation of coronavirus disease-19 pneumonia using chest computed tomography scans. PLoS ONE 17(11): e0276738. https://doi.org/10.1371/journal.pone.0276738
Editor: Wen-Wei Sung, Chung Shan Medical University, TAIWAN
Received: November 29, 2021; Accepted: October 12, 2022; Published: November 3, 2022
Copyright: © 2022 Yamasaki et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Data Availability: All relevant data are within the paper and its Supporting Information files.
Funding: The author(s) received no specific funding for this work.
Competing interests: NO authors have competing interests
List of abbreviations: COVID-19, Coronavirus disease-19; CRP, C-reactive protein; CT, Computed tomography; GGO, Ground-glass opacification; NSPG, Non-severe pneumonia group; ROC, Receiver operating characteristic; SD, Standard deviation; SPG, Severe pneumonia group.
