Predicción de eventos adversos en el paciente adulto hospitalizado por neumonía asociada a COVID-19 utilizando la información de la tomografía computarizada de tórax

Abstract

Severity assessment scales are used to decide the place of management and treatment of adult pa
tients hospitalized with community-acquired pneumonia (CAP). Objectives: Examine the contribution
of imaging studies to improve the performance of traditional prognostic indices to predict the severity
of adult patients hospitalized for SARS-CoV-2 coronavirus pneumonia. Methods: Adult patients hos
pitalized for CAP associated with COVID-19 were evaluated. The extent of pulmonary infiltrates was
measured on chest computed tomography (CT) using the method described by Yang et al. The perfor
mance of prognostic indices was measured, combining the extent of pulmonary infiltrates on chest CT
and the CURB-65, PSI, SCAP, SMART-COP, CALL, COVID-GRAM and 4 C scores to predict the risk
of hospital complications and death. Results: 316 adult patients hospitalized for CAP associated with
COVID-19 were evaluated, age: 58 ± 16 years, 76% had comorbidities, 30.1% were managed in the
ICU, 19.3% required mechanical ventilation and 9.5% died in the hospital. Traditional and specific
prognostic indices for COVID-19 predicted the risk of complications and death in adult patients hospi
talized for severe COVID-19. The extent of pulmonary infiltrates measured on chest CT was associated
with the risk of serious adverse events and correlated with the elevation of inflammatory parameters,
renal dysfunction, metabolic and coagulation disorders in adults hospitalized for COVID-19. The per
formance of the severity prognostic indices combined with the information from the chest CT allowed
us to improve its predictive capacity for adverse events, especially the risk of admission to the critical
care unit and connection to mechanical ventilation. Conclusion: Quantification of the extent of pul
monary infiltrates on chest CT allowed us to improve the performance of severity predictor indices in
adult patients hospitalized for CAP associated with COVID-19.