Radiographic findings that predict a poor clinical course or outcome in patients hospitalized with pneumonia due to SARS-CoV-2 infection

OBJECTIVE. Radiographic findings that predict a poor clinical course or outcome in patients hospitalized with pneumonia due to SARS-CoV-2 infection.
METHODS. To study radiographic observational study of patients diagnosed with pneumonia and COVID-19 who were attended in a tertiary care hospital emergency department between March 1 and May 30, 2020. We gathered information on patient referral and clinical, radiographic, and laboratory findings. Distinct radiographic patterns were identified, and their usefulness for predicting a poor outcome was evaluated. A poor course/outcome was defined by the presence of one of the following events: need for highflow oxygen administration, noninvasive mechanical ventilation, or intubation and invasive mechanical ventilation; intensive care unit admission; or death. Areas under the receiver operating characteristic curves for the radiographic patterns were calculated.
RESULTS. A total of 381 patients were hospitalized for SARS-CoV-2 pneumonia during the study period; 114 were included for analysis after applying exclusion criteria. Thirty-four of these pagients (29.8%) experienced a poor outcome. Radiographic features that were independently associated with SARS-CoV-2 pneumonia were the presence of non-peripheral opacities and the involvement of at least 4 out of 6 possible lung zones. Multivariate analysis showed that the best predictive model included these radiographic findings along with a high respiratory rate.
CONCLUSIONS. Certain radiographic features can predict a poor clinical course/outcome in patients with SARS-CoV-2 pneumonia. Non-peripheral radiographic findings and the involvement of at least 4 out of 6 possible lung zones are independent factors related to a poor outcome.