Abstract
Background COVID-19 is a complex virus that has been spreading since
December 2019. In this study, we aimed to assess the association between
chest Computed Tomography (CT) signs and pejorative evolution, such as
death, use of invasive endotracheal ventilation (IEV) and intensive care
unit hospitalization (ICUH). We also evaluated the diagnostic
performance of chest CT versus the diagnostic gold standard, RT-PCR.
Methods This retrospective monocentric study included 349 patients who
had a chest CT either for clinical suspicion of COVID-19 pneumonia with
severe initial symptoms, or clinical deterioration in patients with
suspected COVID-19 pneumonia, or clinical deterioration in RT-PCR
positive patients. Principal judgement criteria for pejorative evolution
were: death, IEV, and ICUH. Results Among the 109 RT-PCR positive
patients, there were higher rates of bronchial distortion and total
volume lung involvement ≥ 50% in the dead, IEV and ICUH groups (p
< 10-3). Vascular dilatation and a number of involved lobes ≥
4 were associated with IEV and ICUH (p < 10-3). Among the 349
patients, sensitivity, specificity, positive and negative predictive
values of chest CT versus RT-PCR were respectively 93,6 % [95% CI
89-98,2], 85,8 % [81,4-90,2], 75 % [67,7-82,3], and 96,7 %
[94,3-99,1]. Unlike previous studies, we found different kinds of CT
signs patterns, rather than a stereotyped COVID-19 pneumonia pattern.
Maximal lesion expansion was observed during the second week after the
first symptoms. Conclusion Bronchial distorsion and lesion expansion
seem to be correlated with death in COVID-19 patients. This study
confirms chest CT major diagnostic value.