Risk of in-hospital death associated with Covid-19 lung consolidations on chest computed tomography – A novel translational approach using a radiation oncology contour software

Highlights

• Each unit percent of lung involved resulted in a 3.6 % increase in the chance of in-hospital mortality (OR 1.036, P = 0.007).

• The quantitative lung consolidation was also associated with ocurrence of major adverse hospital events (OR 1.025. P = 0.002).

• These associations between lung involvement and outcomes were statistically significant after adjusting for relevant clinical parameters.

Abstract

Purpose

To determine whether the percentage of lung involvement at the initial chest computed tomography (CT) is related to the subsequent risk of in-hospital death in patients with coronavirus disease-2019 (Covid-19).

Materials and methods

Using a cohort of 154 laboratory-confirmed Covid-19 pneumonia cases that underwent chest CT between February and April 2020, we performed a volumetric analysis of the lung opacities. The impact of relative lung involvement on outcomes was evaluated using multivariate logistic regression. The primary endpoint was the in-hospital mortality rate. The secondary endpoint was major adverse hospitalization events (intensive care unit admission, use of mechanical ventilation, or death).

Results

The median age of the patients was 65 years: 50.6 % were male, and 36.4 % had a history of smoking. The median relative lung involvement was 28.8 % (interquartile range 9.5–50.3). The overall in-hospital mortality rate was 16.2 %. Thirty-six (26.3 %) patients were intubated. After adjusting for significant clinical factors, there was a 3.6 % increase in the chance of in-hospital mortality (OR 1.036; 95 % confidence interval, 1.010–1.063; P = 0.007) and a 2.5 % increase in major adverse hospital events (OR 1.025; 95 % confidence interval, 1.009–1.042; P = 0.002) per percentage unit of lung involvement. Advanced age (P = 0.013), DNR/DNI status at admission (P < 0.001) and smoking (P = 0.008) also increased in-hospital mortality. Older (P = 0.032) and male patients (P = 0.026) had an increased probability of major adverse hospitalization events.

Conclusions

Among patients hospitalized with Covid-19, more lung consolidation on chest CT increases the risk of in-hospital death, independently of confounding clinical factors.