The prognostic value of pneumonia severity score and pectoralis muscle Area on chest CT in adult COVID-19 patients

Furkan Ufuk, Mahmut Demirci, Ergin Sagtas, Ismail Hakkı Akbudak, Erhan Ugurlu, Tugba Sari, Furkan Ufuk, Mahmut Demirci, Ergin Sagtas, Ismail Hakkı Akbudak, Erhan Ugurlu, Tugba Sari

Abstract

Purpose: To assess the prognostic value of pneumonia severity score (PSS), pectoralis muscle area (PMA), and index (PMI) on chest computed tomography (CT) in adult coronavirus disease 2019 (COVID-19) patients.

Method: The chest CT images of COVID-19 patients were evaluated for the PSS as the ratio of the volume of involved lung parenchyma to the total lung volume. The cross-sectional areas of the pectoralis muscles (PMA, cm2) were also measured automatically on axial CT images, and PMI was calculated as the following formula: PMI = PMA / patient's height square (m2). The relationship between clinical variables, PSS, PMA, sex-specific PMI values, and patient outcomes (intubation, prolonged hospital stay, and death) were investigated using multivariable logistic regression analysis. All patients were followed for more than a month.

Results: One-hundred thirty patients (76 males, 58.46 %) were included in the study. Fifteen patients (11.54 %) were intubated, 24 patients (18.46 %) had prolonged hospital stay, and eight patients (6.15 %) died during follow-up. Patients with comorbidity had a higher mean of PSS (6.3 + 4.5 vs 3.9 + 3.8; p = 0.001). After adjusting the confounders, PSS was an independent predictor of intubation (adjusted Odds Ratio [OR]: 1.73, 95 % CI 1.31-2.28, p < 0.001), prolonged hospital stay (OR: 1.20, 95 % CI 1.09-1.33, p < 0.001), and death (OR: 2.13, 95 % CI 1.1-4.13, p = 0.026. PMI value was a predictor of prolonged hospital stay (OR: 0.83, 95 % CI 0.72-0.96, p = 0.038) and death (OR: 0.53, 95 % CI 0.29-0.96, p = 0.036). Incrementally increasing PMA value was a predictor of prolonged hospital stay (OR: 0.93, 95 % CI 0.89-0.98, p = 0.01) and intubation (OR: 0.98, 95 % CI 0.96-1, p = 0.036).

Conclusion: PSS, PMA, and PMI values have prognostic value in adult COVID-19 patients and can be easily assessed on chest CT images.

Keywords: COVID-19; Computed tomography; Pneumonia; Prognosis; Sarcopenia.

Conflict of interest statement

All of the authors declare that they have all participated in the design, execution, and analysis of the paper, and that they have approved the final version.

Funding

The authors received no specific funding for this work.

Copyright © 2020 Elsevier B.V. All rights reserved.

Figures

Fig. 1
Fig. 1
The pectoralis muscle area (PMA) measurement on chest computed tomography (CT) image in a 41-year-old male patient with COVID-19. Axial chest CT image just above the arcus aorta level used for PMA measurement. (a) PMA measurement was performed on axial CT image using a predefined attenuation values of -50 and 90 Hounsfield units. Bilateral pectoralis muscles are colored green (pectoralis major and minor muscles). (b) Sagittal reformatted chest CT image shows the level of just above the aortic arch.
Fig. 2
Fig. 2
Patient selection and inclusion flow diagram of patients with novel coronavirus 19 disease (COVID-19).

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Source: PubMed

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