• Ioannis Bellos, Kyriaki Tavernaraki, Konstantinos Stefanidis, Olympia Michalopoulou, Giota Lourida, Eleni Korompoki, Ioanna Thanou, Loukas Thanos, Angelos Pefanis, and Aikaterini Argyraki.
• First Department of Internal Medicine and Infectious Diseases, "Sotiria" General and Chest Diseases Hospital of Athens, Greece.
• Respir Investig. 2021 Jul 1; 59 (4): 436-445.

BackgroundChest computed tomography (CT) is a useful tool for the diagnosis of coronavirus disease-2019 (COVID-19), although its exact value for predicting critical illness remains unclear. This study evaluated the efficacy of chest CT to predict disease progression, pulmonary complications, and viral positivity duration.MethodsA single-center cohort study was conducted by consecutively including hospitalized patients with confirmed COVID-19. The chest CT patterns were described and a total severity score was calculated. The predictive accuracy of the severity score was evaluated using the receiver operating characteristic analysis, while a Cox proportional hazards regression model was implemented to identify the radiological features that are linked to prolonged duration of viral positivity.ResultsOverall, 42 patients were included with 10 of them requiring intensive care unit admission. The most common lesions were ground glass opacities (92.9%), consolidation (66.7%), and crazy-paving patterns (61.9%). The total severity score significantly correlated with inflammatory and respiratory distress markers, as well as with admission CURB-65 and PSI/PORT scores. It was estimated to predict critical illness with a sensitivity and specificity of 75% and 70%, respectively. Time-to-event analysis indicated that patients without ground-glass opacities presented significantly shorter median viral positivity (16 vs. 27 days).ConclusionsChest CT severity score positively correlates with markers of COVID-19 severity and presents promising efficacy in predicting critical illness. It is suggested that ground-glass opacities are linked to prolonged viral positivity. Further studies should confirm the efficacy of the severity score and elucidate the long-term pulmonary effects of COVID-19.Copyright © 2021 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.

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