KRİTİK COVİD 19 HASTALARINDA TORAKS TOMOGRAFİSİNİN PROGNOZDAKİ ÖNEMİ

Yıl 2021, Cilt: 11 Sayı: 3, 317 - 322, 24.05.2021

Veysel Garani Soylu , Öztürk Taşkın , Ufuk Demir , Yunus Yaşar

https://doi.org/10.16899/jcm.859146

Öz

Amaç: Toraks bilgisayarlı tomografi (BT) görüntüleri sıklıkla COVID-19 ve bulaşıcı hastalıkların teşhisini desteklemek için kullanıldı. Bu çalışma, yoğun bakım ünitesinde (YBÜ) izlenen COVID-19 hastalarının prognozunu tahmin etmede spesifik göğüs BT sonuçlarının önemini sorgulamayı amaçlamaktadır.
Gereç ve Yöntem: Bu çalışmaya RT-PCR testleri COVID-19 için pozitif olan 20 kritik hasta dahil edildi. YBÜ'ye kabul edilmeden önce çekilen toraks BT taramalarında kötü prognoz sonuçları; mortalite, invazif ve non-invaziv mekanik ventilatör gereksinimi, APACHE II skorları ve YBÜ yatış günleri ile karşılaştırıldı.
Bulgular : Göğüs BT görüntülerinde kaldırım taşı paterni olan COVID-19 hastalığı nedeniyle YBÜ'de izlenen kritik hastalarda, YBÜ takibinde;invazif mekanik ventilasyon desteği gereksinimi istatistiksel olarak anlamlı bulundu (P = 0.04). Plevral ve perikardiyal efüzyonu olan tüm hastaların invazif mekanik ventilasyon desteğine ihtiyacı oldu. Yoğun bakım ünitesinde kritik COVID-19 hastalarında gözlenen göğüs BT sonuçlarından olan, konsolidasyon / buzlu cam opasite paterninin> 1 olan hastalar daha yüksek (yaklaşık beş kat) ölüm oranına sahipti. Yoğun bakım yatış süresi daha fazla olan hastalarda kaldırım taşı manzarası görünümü mevcuttu.
Sonuç: COVID-19 hastalığında göğüs BT taramalarından elde edilen bazı sonuçların yoğun bakım döneminde hastanın prognozunu öngörebileceğini düşünüyoruz.

Anahtar Kelimeler

COVİD 19, TORAKS TOMOGRAFİ, PROGNOZ

Destekleyen Kurum

yok

THE IMPORTANCE OF THORACIC TOMOGRAPHY IN PROGNOSIS IN CRITICAL COVID 19 PATIENTS

Öz

Aim: Computed tomography (CT) images of the chest were often used to support the diagnosis of COVID-19 and infectious diseases. This study aims to question the importance of specific chest CT results in predicting the prognosis of COVID-19 patients being followed up in the intensive care unit (ICU).
Materials and Methods: For this study, 20 critically ill patients whose RT-PCR tests were positive for COVID-19 were included. Mortality, invasive and non-invasive mechanical ventilator requirement, APACHE II scores and ICU staying days were compared chest CT scans with have poor prognosis results before admission to ICU.
Results: Critical patients who were followed up in the ICU due to COVID-19 disease with crazy laying pattern on chest CT images, it was concluded that there is a statistically significant requirement for invasive mechanical ventilation support during the ICU period (P = 0.04). We reported that all patients with pleural and pericardial effusion required invasive mechanical ventilation support. One of the chest CT results observed in critical COVID-19 patients ın ICU is that the consolidation / ground glass opacity pattern> 1 may have a higher (about five-fold) mortality rate. Most of our critical COVID-19 patients who stayed in intensive care for a long time had a crazy laying pattern on chest CT images.
Conclusion: We believe that some results obtained from chest CT scans in COVID-19 disease may predict the prognosis of the patient during the intensive care period.

Anahtar Kelimeler

COVID 19, THORACIC TOMOGRAPHY, PROGNOSIS

Kaynakça

• 1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506. doi:10.1016/S0140-6736(20)30183-5
• 2. Zhu N, Zhang D, Wang W, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med. 2020;382(8):727-733. doi:10.1056/NEJMoa2001017
• 3. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200211-sitrep-22-ncov.pdf?sfvrsn=fb6d49b1
• 4. Shang Y, Xu C, Jiang F, et al. Clinical characteristics and changes of chest CT features in 307 patients with common COVID-19 pneumonia infected SARS-CoV-2: A multicenter study in Jiangsu, China. Int J Infect Dis. 2020;96:157-162. doi:10.1016/j.ijid.2020.05.006
• 5. Lee N, Hui D, Wu A, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003;348(20):1986-1994. doi:10.1056/NEJMoa030685
• 6. Li K, Wu J, Wu F, et al. The Clinical and Chest CT Features Associated With Severe and Critical COVID-19 Pneumonia. Invest Radiol. 2020;55(6):327-331. doi:10.1097/RLI.0000000000000672
• 7. Tan W. J, Zhao X., Ma X. et al. A novel coronavirus genome identified in a cluster of pneumonia cases—Wuhan, China 2019− 2020. China CDC Weekly 2020; 2 (4): 61-2. doi: 10.46234/ccdcw2020.017
• 8. Chan JF, Yip CC, To KK, et al. Improved Molecular Diagnosis of COVID-19 by the Novel, Highly Sensitive and Specific COVID-19-RdRp/Hel Real-Time Reverse Transcription-PCR Assay Validated In Vitro and with Clinical Specimens. J Clin Microbiol. 2020;58(5):e00310-20. doi:10.1128/JCM.00310-20
• 9. Wang Y, Hou H, Wang W, Wang W. Combination of CT and RT-PCR in the screening or diagnosis of COVID-19. J Glob Health. 2020;10(1):010347. doi:10.7189/jogh.10.010347
• 10. Chung M, Bernheim A, Mei X, et al. CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV). Radiology. 2020;295(1):202-207. doi:10.1148/radiol.2020200230
• 11. Li, X., Zeng, X., Liu, B., et al. COVID-19 infection presenting with CT halo sign. Radiology: Cardiothoracic Imaging, 2(1), doi: 10.1148/ryct.2020200026
• 12. Ai T, Yang Z, Hou H, et al. Correlation of Chest CT and RT-PCR Testing for Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology. 2020;296(2):E32-E40. doi:10.1148/radiol.2020200642
• 13. Yang R, Li X, Liu H et all (2020) Chest CT Severity Score: An Imaging Tool for Assessing Severe COVID-19 Radiology: Cardiothoracic Imaging, 2(2) doi:10.1148/ryct.2020200047
• 14. Lyu P, Liu X, Zhang R,et al. The Performance of Chest CT in Evaluating the Clinical Severity of COVID-19 Pneumonia: Identifying Critical Cases Based on CT Characteristics. Invest Radiol. 2020;55(7):412-421. doi:10.1097/RLI.0000000000000689
• 15. Xiong Y, Sun D, Liu Y, et al. Clinical and High-Resolution CT Features of the COVID-19 Infection: Comparison of the Initial and Follow-up Changes. Invest Radiol. 2020;55(6):332-339. doi:10.1097/RLI.0000000000000674
• 16. Li K, Fang Y, Li W, et al. CT image visual quantitative evaluation and clinical classification of coronavirus disease (COVID-19). Eur Radiol. 2020;30(8):4407-4416. doi:10.1007/s00330-020-06817-6
• 17. Li LQ, Huang T, Wang YQ, et al. COVID-19 patients' clinical characteristics, discharge rate, and fatality rate of meta-analysis. J Med Virol. 2020;92(6):577-583. doi:10.1002/jmv.25757
• 18. https://covid19.saglik.gov.tr/TR-66935/genel-koronavirus-tablosu.html
• 19. Bhatraju PK, Ghassemieh BJ, Nichols M, et al. Covid-19 in Critically Ill Patients in the Seattle Region - Case Series. N Engl J Med. 2020;382(21):2012-2022. doi:10.1056/NEJMoa2004500
• 20. Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;8(5):475-481. doi:10.1016/S2213-2600(20)30079-5
• 21. Li Y, Xia L. Coronavirus Disease 2019 (COVID-19): Role of Chest CT in Diagnosis and Management. AJR Am J Roentgenol. 2020;214(6):1280-1286. doi:10.2214/AJR.20.22954
• 22. Frater JL, Zini G, d'Onofrio G, et al. COVID-19 and the clinical hematology laboratory. Int J Lab Hematol. 2020;42 Suppl 1:11-18. doi:10.1111/ijlh.13229
• 23. Pan F, Yang L, Li Y, et al. Factors associated with death outcome in patients with severe coronavirus disease-19 (COVID-19): a case-control study. Int J Med Sci. 2020;17(9):1281-1292. doi:10.7150/ijms.46614
• 24. Liu F, Zhang Q, Huang C, et al. CT quantification of pneumonia lesions in early days predicts progression to severe illness in a cohort of COVID-19 patients. Theranostics. 2020;10(12):5613-5622. doi:10.7150/thno.45985
• 25. Salehi S, Abedi A, Balakrishnan S, Gholamrezanezhad A. Coronavirus Disease 2019 (COVID-19): A Systematic Review of Imaging Findings in 919 Patients. AJR Am J Roentgenol. 2020;215(1):87-93. doi:10.2214/AJR.20.23034
• 26. Knaus WA, Draper EA, Wagner DP, et al. APACHE II: a severity of disease classification system. Crit Care Med. 1985;13(10):818-829. doi: 10.1097/00003465-198603000-00013