Computed tomography findings and prognosis in older COVID-19 patients

Chukwuma Okoye, Panaiotis Finamore, Giuseppe Bellelli, Alessandra Coin, Susanna Del Signore, Stefano Fumagalli, Pietro Gareri, Alba Malara, Enrico Mossello, Caterina Trevisan, Stefano Volpato, Gianluca Zia, Fabio Monzani, Raffaele Antonelli Incalzi, Chukwuma Okoye, Panaiotis Finamore, Giuseppe Bellelli, Alessandra Coin, Susanna Del Signore, Stefano Fumagalli, Pietro Gareri, Alba Malara, Enrico Mossello, Caterina Trevisan, Stefano Volpato, Gianluca Zia, Fabio Monzani, Raffaele Antonelli Incalzi

Abstract

Background: In older and multimorbid patients, chronic conditions may affect the prognostic validity of computed tomography (CT) findings in COVID-19. This study aims at assessing to which extent CT findings have prognostic implications in COVID-19 older patients.

Methods: Hospitalized COVID-19 patients aged 60 years or more enrolled in the multicenter, observational and longitudinal GeroCovid study who underwent chest CT were included. Patients were stratified by tertiles of age and pneumonia severity to compare CT findings. Hierarchical clustering based on CT findings was performed to identify CT-related classificatory constructs, if any. The hazard ratio (HR) of mortality was calculated for individual CT findings and for clusters, after adjusting for potential confounders.

Results: 380 hospitalized COVID-19 patients, with a mean age of 78 (SD:9) years, underwent chest CT scan. Ground glass opacity (GGO), consolidation, and pleural effusion were the three most common CT findings, with GGO prevalence decreasing from younger to older patients and pleural effusion increasing. More severe the pneumonia more prevalent were GGO, consolidation and pleural effusion. HR of mortality was 1.94 (95%CI 1.24-3.06) for pleural effusion and 13 (95%CI 6.41-27) for cluster with a low prevalence of GGO and a high prevalence of pleural effusion ("LH"), respectively. Out of the three CT based clusters, "LH" was the only independent predictor in the multivariable model.

Conclusions: Pleural effusion qualifies as a distinctive prognostic marker in older COVID-19 patients. Research is needed to verify whether pleural effusion reflects COVID-19 severity or a coexisting chronic condition making the patient at special risk of death.

Trial registration: ClinicalTrials.gov: NCT04379440.

Keywords: Old; Oldest; Pleural; SARS-CoV-2; Tomography; X-ray computed.

Conflict of interest statement

Authors have no financial and non-financial competing interests to declare.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Clusters of Computed Tomography findings (above) and their survival curves during hospitalization (below)
Fig. 2
Fig. 2
Hazard ratios for the associations between radiologic findings and in-hospital mortality at the univariate (above) and multivariate (below) Cox regression models

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