CT quantification of pneumonia lesions in early days predicts progression to severe illness in a cohort of COVID-19 patients

作者：Fengjun Liu, Qi Zhang, Chao Huang, Chunzi Shi, Lin Wang, Nannan Shi, Cong Fang, Fei Shan, Xue W. Mei, Jing Shi, Fengxiang Song, Zhongcheng Yang, Zezhen Ding, Xiaoming Su, Hongzhou Lu, Tongyu Zhu, Zhiyong Zhang, Lei Shi, Yuxin Shi · 发表于：Theranostics · 年份：2020 · DOI：10.7150/thno.45985 · 被引用次数：231 · 研究领域：Sepsis Diagnosis and Treatment、COVID-19 Clinical Research Studies、COVID-19 diagnosis using AI

Rationale: Some patients with coronavirus disease 2019 (COVID-19) rapidly develop respiratory failure or even die, underscoring the need for early identification of patients at elevated risk of severe illness. This study aims to quantify pneumonia lesions by computed tomography (CT) in the early days to predict progression to severe illness in a cohort of COVID-19 patients. Methods: This retrospective cohort study included confirmed COVID-19 patients. Three quantitative CT features of pneumonia lesions were automatically calculated using artificial intelligence algorithms, representing the percentages of ground-glass opacity volume (PGV), semi-consolidation volume (PSV), and consolidation volume (PCV) in both lungs. CT features, acute physiology and chronic health evaluation II (APACHE-II) score, neutrophil-to-lymphocyte ratio (NLR), and d-dimer, on day 0 (hospital admission) and day 4, were collected to predict the occurrence of severe illness within a 28-day follow-up using both logistic regression and Cox proportional hazard models. Results: We included 134 patients, of whom 19 (14.2%) developed any severe illness. CT features on day 0 and day 4, as well as their changes from day 0 to day 4, showed predictive capability. Changes in CT features from day 0 to day 4 performed the best in the prediction (area under the receiver operating characteristic curve = 0.93, 95% confidence interval [CI] 0.87~0.99; C-index=0.88, 95% CI 0.81~0.95). The hazard ratios of PGV and PCV were 1...