Impact of Computed Tomography-Quantified Emphysema Score on Clinical Outcome in Patients with COVID-19

• Main Authors: Lim JK, Park B, Park J, Choi KJ, Jung CY, Kim YH, Kim JY, Moon S, Lee YH, Lee J
• Format: Article
• Language: English
• Published: Dove Medical Press 2021-07-01
• Series: International Journal of General Medicine
• Subjects: covid-19; emphysema; computed tomography; copd; mortality
• Online Access: https://www.dovepress.com/impact-of-computed-tomography-quantified-emphysema-score-on-clinical-o-peer-reviewed-fulltext-article-IJGM

Jae-Kwang Lim,1 Byunggeon Park,1 Jongmin Park,1 Keum-Ju Choi,2 Chi-Young Jung,2 Young Hwan Kim,3 Jin Young Kim,4 Sungjun Moon,5 Yong Hoon Lee,6 Jaehee Lee6 1Department of Radiology, School of Medicine, Kyungpook National University, Daegu, Republic of Korea; 2Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Republic of Korea; 3Department of Radiology, Daegu Catholic University School of Medicine, Daegu, Republic of Korea; 4Department of Radiology, Dongsan Hospital, Keimyung University School of Medicine, Daegu, Republic of Korea; 5Department of Radiology, College of Medicine, Yeungnam University, Daegu, Republic of Korea; 6Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Republic of KoreaCorrespondence: Jaehee LeeDepartment of Internal Medicine, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, 41944, Daegu, Republic of KoreaTel [phone]Fax [phone]Email [e-mail]: Chronic obstructive pulmonary disease (COPD) is considered a risk factor for poor outcomes in patients with coronavirus disease 2019 (COVID-19). However, data on the prognostic impact of radiological emphysema extent on patients with COVID-19 are limited. Thus, this study aimed to examine whether computed tomography (CT)-quantified emphysema score is associated with a worse clinical outcome in patients with COVID-19.Methods: Volumetric quantitative analyses of CT images were performed to obtain emphysema scores in COVID-19 patients admitted to four tertiary referral hospitals in Daegu, South Korea, between February 18 and March 25, 2020. Patients were divided into three groups according to emphysema score (emphysema score ≤ 1%, 1%< emphysema score ≤ 5%, and emphysema score > 5%).Results: A total of 146 patients with confirmed SARS-CoV-2 infection were included. The median emphysema score was 1.0% (interquartile range, 0.5– 1.8%). Eight patients (6%) had a previous COPD diagnosis. Eighty (55%), 55 (38%), and 11 (8%) patients had emphysema scores ≤ 1%, between 1% and 5%, and > 5%, respectively. The number of patients who received oxygen therapy two weeks after admission was significantly higher in the group with emphysema scores > 5% than in other groups (p=0.025). The frequency of deaths was three (27%) in the group with emphysema scores > 5% and tended to be higher than that in other groups. Multivariate analysis revealed that age, COPD, and serum lactate dehydrogenase levels were associated with a greater risk of in-hospital mortality in patients with COVID-19.Conclusion: The current study demonstrated that patients with CT-quantified emphysema scores > 5% tended to progress to severe disease over time; however, they did not exhibit an increased risk of mortality in our COVID-19 cohort. Further studies with consideration of both emphysema extent and airflow limitation degree are warranted.Keywords: COVID-19, emphysema, computed tomography, COPD, mortality