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ABSTRACT Objective: To assess the association between Computerized Tomography severity score and oxygen saturation by pulse oximeter in patients of COVID-19. Study Design: Cross sectional study. Place and Duration of Study: Pak Emirates Military Hospital, Rawalpindi Pakistan, from Jan to Apr 2021. Methodology: CT severity score was calculated for all patients who had undergone Chest CT scan. The oxygen saturation by pulse oximeter was noted at admission. Spearman rank correlation was calculated between the CT severity score and oxygen saturation on pulse oximeter. Results: There were 203 patients in this study. Among them, 124(61.1%) were male and 74(38.9%) females. The greater proportion of the patients, 138(68%) were between 36-55 years old, and 65(32%) were between 18-35 years old. There were 130(64%) patients who had low CT severity score, 73(36%) had high CT severity score. Among 73 patients who had high CT severity score, 67(91.7%) had shortness of breath (p-value<0.001), 48(66%) had fever (p-value=0.021), and 53(72.6%) belonged to the older age group of patients (p-value=0.0294). Statistically significant negative correlation between Computerized Tomography severity score and oxygen saturation was noted ( rho=-0.264, p= 0.01). Conclusions: Our study provided evidence that there is a negative correlation between the Computerized Tomography severity score and oxygen saturation by pulse oximeter.

Objective: To evaluate the spectrum of HRCT findings of COVID-19 in RT-PCR positive patients according to duration of infection and severity of disease. Methods: This retrospective study was conducted at Radiology department of Lahore General Hospital, Lahore from May to July 2020. Total 40 COVID-19 patients were reviewed for clinical features, HRCT chest findings based on time from symptom onset and CT conduction. Chi-square and fissure exact test were used for measuring association with severity of COVID-19, p value ≤0.05 was reported significant. Mean CT scores were calculated. ROC curve analysis showed threshold values of CT-SS for severe disease. Results: Of total 40 patients with age ranged from 22-83 years, 22(55%) were males and 18(45%) females. The hallmark of COVID-19 was combined GGO and consolidation, GGO alone and consolidation alone in bilateral, sub pleural and posterior distribution. Early stage had normal CT or GGO alone, intermediate and late stage had both GGO and consolidation. Septal lines/bands and crazy paving pattern were prevalent in late stage. Clinically, 24 (60%) were in severe group and 16(40%) in mild group. Severity of COVID-19 was associated with GGO alone (p=0.05), GGO and consolidation (p=0.01), crazy paving (p=0.01) and lung scores (p≤0.05). The threshold values of CT-SS for identifying severe disease by two radiologists were 18.50 and 20.50. Conclusion: HRCT manifestations along with CT-SS aids in predicting disease severity. Staging according to duration of infection is effective in understanding variation in pattern of chest findings in coronavirus disease. doi: https://doi.org/10.12669/pjms.38.1.4204 How to cite this:Irshad N, Hanif N. Spectrum of High Resolution Computed tomography chest findings in PCR positive COVID-19 patients according to duration of infection and CT severity score assessment. Pak J Med Sci. 2022;38(1):106-112.  doi: https://doi.org/10.12669/pjms.38.1.4204 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The aim of this study is to examine the prognostic role of initial chest computed tomography severity score index (CTSS) and its association with demographic, socio-epidemiological, and clinical parameters in COVID-19 hospitalized patients. A retrospective study included patients who were hospitalized in the COVID Hospital of the Clinical Hospital Center Kosovska Mitrovica from July 2020 to March 2022. We compared patient characteristics and outcome of their hospital stay with values of CT severity score (mild, moderate, and severe form of the disease). Patients with severe disease were statistically significantly older, they treated more days, and they presented statistically significant highest mortality rate compared to mild and moderate forms. Smokers and obese were significantly more frequent among patients with higher CT, while vaccinated patients were more common among those with a mild form. Biochemical parameters at admission also showed statistical significance between the examined groups. We can conclude that by employing the initial CT severity score as the strongest predictor of mortality, it is possible to predict the outcome in hospitalized patients. A comprehensive examination of the patient upon admission, including determining the extent of inflammatory changes in the lungs using computed tomography, the levels of oxygen saturation, and other laboratory parameters, can assist doctors in making an adequate clinical evaluation and apply appropriate therapeutic protocols in the treatment of COVID-19.

Objectives: To identify a correlation between the clinical parameters and CT chest severity score in COVID-19. Methods: A total of 205 RT-PCR positive patients were included in this descriptive cross-sectional study with convenience sampling from November 2020 to June 2021 in KRL Hospital. The study population was stratified in disease severity as per the WHO’s guidelines. Clinical and radiological characteristics were compared in survivors and non survivors to draw conclusion Results: The mean age was 57 years and the majority of the patients 57% were male. Overall mortality was 22% and the mean CT severity score was 18. Non survivors were more tachypneic, hypoxic, had a higher CT chest severity score, higher clinical severity, more comorbid condition and higher TLC, D-Dimers, LDH, CRP, NLR. Raised CT severity score showed a conclusive correlation with greater disease severity. One way ANOVA showed a significant difference between mean CT severity score amongst different disease categories. Conclusion: Higher CT severity score corresponds to a higher clinical severity and higher chances of mortality. doi: https://doi.org/10.12669/pjms.40.4.7919 How to cite this: Ahmed RM, Toori KU, Qureshi MA. Clinical severity and high-resolution CT severity score in COVID-19: Is there an association. Pak J Med Sci. 2024;40(4):637-641. doi: https://doi.org/10.12669/pjms.40.4.7919 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Background Promoting the absorption of COVID-19 pneumonia is critical for reducing pulmonary sequelae and improving prognosis. This study aimed to evaluate the efficacy and safety of nebulized unfractionated heparin, acetylcysteine, budesonide, and ipratropium bromide (HABIT) in hospitalized patients with COVID-19 pneumonia. Methods This single-center, open-label, randomized, parallel-group trial was conducted at a tertiary hospital in China. Participants were randomized 1:1 to receive either standard of care (SOC) or SOC plus nebulized HABIT. The HABIT protocol included daily quadruple nebulization for seven days, comprising 6000 units heparin sodium, 2 mg budesonide, 0.3 g acetylcysteine, and 0.5 mg ipratropium bromide. The primary outcome was the change in lung lesions assessed by chest CT scans on admission (Day 0) and post-treatment (Day 8). Results A total of 74 patients were randomized to the HABIT group ( n  = 37) or the control group ( n  = 37). Four patients per group were excluded during follow-up, leaving 66 patients for final analysis. Baseline CT scores were comparable between groups (10.55 ± 3.11 vs. 10.76 ± 2.85, p  = 0.774). Post-treatment, the HABIT group showed significantly lower mean CT scores (6.6 ± 2.98 vs. 8.69 ± 2.53, p  = 0.003) and greater lesion absorption (37.5% vs. 20%, p  < 0.001) compared to controls. The HABIT group also exhibited a non-significant improvement in PaO 2 /FiO 2 (75.27 vs. 51.23, p  = 0.113). Safety analysis showed no significant differences in activated partial thromboplastin time or serious adverse events. Conclusion The adjunctive HABIT regimen demonstrates favorable efficacy and safety in treating COVID-19 pneumonia. Trial registration The clinical trial was registered with the Chinese Clinical Trial Registry (ChiCTR; www.chictr.org.cn ; ID: ChiCTR2300073871) on July 24, 2023. Ethical approval was valid from May 2023 to May 2025.

Background Cytokine storm triggered by Severe Coronavirus Disease 2019 (COVID-19) is associated with high mortality. With high Interleukin -6 (IL-6) levels reported in COVID-19 related deaths in China, IL-6 is considered to be the key player in COVID-19 cytokine storm. Tocilizumab, a monoclonal antibody against IL-6 receptor, is used on compassionate grounds for treatment of COVID-19 cytokine storm. The aim of this study was to assess effect of tocilizumab on mortality due to COVID-19 cytokine storm. Method This retrospective, observational study included patients of severe COVID-19 pneumonia with persistent hypoxia (defined as saturation 94% or less on supplemental Oxygen of 15 L per minute through non-rebreathing mask or PaO2/FiO2 ratio of less than 200) who were admitted to a tertiary care center in Mumbai, India, between 31st March to 5th July 2020. In addition to standard care, single Inj. Tocilizumab 400 mg was given intravenously to 151 consecutive COVID-19 patients with persistent hypoxia, from 13th May to 5th July 2020. These 151 patients were retrospectively analysed and compared with historic controls, ie consecutive COVID-19 patients with persistent hypoxia, defined as stated above ( N  = 118, from our first COVID-19 admission on 31st March to 12th May 2020 i.e., till tocilizumab was available in hospital). Univariate and multivariate Cox regression analysis was performed for identifying predictors of survival. Statistical analysis was performed using IBM SPSS version 26. Results Out of 269 (151 in tocilizumab group and 118 historic controls) patients studied from 31st March to 5th July 2020, median survival in the tocilizumab group was significantly longer than in the control group; 18 days (95% CI, 11.3 to 24.7) versus 9 days (95% CI, 5.7 to 12.3); log rank p 0.007. On multivariate Cox regression analysis, independent predictors of survival were use of tocilizumab (HR 0.621, 95% CI 0.427–0.903, P 0.013) and higher oxygen saturation. Conclusion Tocilizumab may improve survival in severe COVID-19 pneumonia with persistent hypoxia. Randomised controlled trials on use of tocilizumab as rescue therapy in patients of severe COVID-19 pneumonia with hypoxia (PaO2/FiO2 less than 200) due to hyperinflammatory state, are warranted.

Chest computed tomography (CT) is widely used in the diagnosis and follow-up of diffuse parenchymal lung diseases like sarcoidosis. This study investigated the relationship between the Thoracic CT Severity Score (TCTSS) and parameters from pulmonary function tests (PFTs), diffusing capacity for carbon monoxide (DLCO), and the 6-min walk test (6MWT) in sarcoidosis patients, comparing its utility to the radiograph-based Scadding staging system. This retrospective study analyzed data from 60 sarcoidosis patients with concurrent chest radiograph, CT, PFT, DLCO, and 6MWT results. Patient demographics, TCTSS, Scadding stage, PFT parameters (forced expiratory volume in one second [FEV1], forced vital capacity [FVC], FEV1/FVC, PEF, and FEF25-75), DLCO, DLCO/VA, and 6MWT parameters (initial SpO2, final SpO2, desaturation percentage, distance, and predicted distance percentage) were collected. Correlations between these functional parameters and both TCTSS and Scadding stages were analyzed to compare the strengths of the two staging systems. TCTSS showed moderate negative correlations with FEV1% (  = -0.44, < 0.001), FVC% (  = -0.477, < 0.001), DLCO (  = -0.522, < 0.001), final 6MWT SpO2 (  = -0.417, =0.001), and 6MWT% (  = -0.511, < 0.001). Weaker correlations were observed between TCTSS and initial SpO2, desaturation, and 6MWT distance. The Scadding stage also demonstrated negative correlations with these parameters, although generally weaker for FEV1% and FVC%. TCTSS exhibited stronger negative correlations with FEV1%, FVC%, DLCO, and 6MWT% compared to Scadding staging. Conversely, the Scadding stage correlated more strongly with FVC (liters), FEV1 (liters), FEV1/FVC, DLCO/VA, initial SpO2, final SpO2, and 6MWT distance. Desaturation showed similar low-to-moderate positive correlations with both staging systems. This study demonstrates that TCTSS significantly correlates with most functional parameters, exhibiting stronger correlations for key measures (FVC%, FEV1%, DLCO, and 6MWT%) compared to the Scadding staging system. TCTSS is a valuable tool that warrants consideration in the follow-up of sarcoidosis patients. Our findings suggest that TCTSS could serve as a potential alternative or complementary system to the Scadding classification, potentially informing the development of a modified combined staging approach. Larger, multicenter studies are necessary to confirm these findings and further explore the role of TCTSS in sarcoidosis management.

Background/Objectives: To assess quantitatively the correlation between the lung ultrasound severity scores (LUSSs) and chest CT severity scores (CTSSs) derived from low-dose computed tomography (LDCT) for evaluating pulmonary inflammation in COVID-19 patients. Methods: In this prospective observational study, from an initial cohort of 1000 patients, 555 adults (≥18 years) with confirmed COVID-19 were enrolled based on inclusion criteria. All underwent LDCT imaging, scored by the CTSS (0–25 points), quantifying involvement across five lung lobes. Lung ultrasound examinations using standardized semi-quantitative scales for the B-line (LUSS B) and consolidation (LUSS C) were performed in a subgroup of 170 patients; 110 had follow-up imaging after one week. Correlation analyses included Spearman’s and Pearson’s coefficients. Results: Significant positive correlations were found between the CTSS and both the LUSS B (r = 0.32; p < 0.001) and LUSS C (r = 0.24; p = 0.006), with the LUSS B showing a slightly stronger relationship. Each incremental increase in the LUSS B corresponded to an average increase of 0.18 CTSS points, whereas a one-point increase in the LUSS C corresponded to a 0.27-point CTSS increase. The mean influence of the LUSS on CTSS was 8.0%. Neither ultrasound score significantly predicted ICU admission or mortality (p > 0.05). Conclusion: Standardized lung ultrasound severity scores show a significant correlation with low-dose CT in assessing pulmonary involvement in COVID-19, particularly for the B-line artifacts. Lung ultrasound represents a valuable bedside tool, complementing—but not substituting—CT in predicting clinical severity. Integrating both imaging modalities may enable the acquisition of complementary bedside information and facilitate dynamic monitoring of disease progression.

Since November 2019, the rapid outbreak of coronavirus disease 2019 (COVID-19) has become a public health emergency of international concern. COVID-19 disease is caused by a new variant of coronavirus, named as 'severe acute respiratory syndrome coronavirus 2.' Chest CT has a potential role in the diagnosis, detection of complications and in predicting clinical recovery of patients or progression of coronavirus disease 2019. Degree and severity of lung involvement can be assessed by 25 point CT severity score. This quantification plays an important role to modify the treatment plan at times in critically ill patient of COVID-19. Hence, the purpose of present study was to describe and quantify the severity of COVID-19 infection on chest computed tomography (CT) by 25-point CT severity score and to determine the relationship of CT severity score with clinical and laboratory parameters. A total of 150 patients with COVID-19 disease were assessed. Mean age of the study group was 54.46 years (62.7% males and 37.3% females). The most common comorbidity present in the study group was diabetes mellitus, which was present in 17.3% cases. Severity of disease was significantly associated with age of the patient. CT severity score was positively correlated with lymphopenia and raised CRP, D-dimer and serum ferritin levels. A significant statistical correlation was found between CT severity grade and patient survival. This is a large comprehensive study, collecting data from 150 cases of COVID-19 pneumonia patients, in a tertiary care hospital in India to describe the correlation of CT severity score with clinical land laboratory parameters. Chest CT severity score correlates well with laboratory parameters and can aid in predicting COVID-19 disease outcome.

ObjectivesCoronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, remains a global health concern. The computed tomography (CT) severity score is widely used as an objective measure of pulmonary involvement, while increased pulmonary artery (PA) diameter has emerged as a potential marker of disease severity. This study aimed to investigate the relationship between CT severity scores, PA diameter, and the D-dimer/CRP ratio, and to determine whether these parameters are independently associated with radiological severity.Materials and methodsThis retrospective case-control study included 199 PCR-confirmed COVID-19 patients who underwent chest CT and laboratory evaluation. Sociodemographic and clinical data were obtained from hospital records. Laboratory parameters, including procalcitonin, C-reactive protein (CRP), D-dimer, and the D-dimer/CRP ratio, along with CT findings such as PA diameter, were analyzed. Patients were categorized according to CT severity score (0–25). Multivariable linear regression analysis was performed to identify independent predictors of CT severity.ResultsHigher CT severity scores were significantly associated with increased levels of inflammatory and laboratory markers, including procalcitonin, CRP, D-dimer, and troponin (all p < 0.05). Procalcitonin showed a significant positive association with CT severity score. Significant differences between severity groups were also observed for age, hypertension, creatinine, hemoglobin, platelet count, D-dimer/CRP ratio, and PA diameter (all p < 0.05). A modest but significant positive correlation was found between PA diameter and CT severity score ( r = 0.333, p < 0.001). In multivariable analysis, PA diameter (β = 0.194, p = 0.005), D-dimer/CRP ratio (β = −0.177, p = 0.007), age (β = 0.175, p = 0.043), and troponin (β = −0.280, p < 0.001) remained independently associated with CT severity score (R2 = 0.291).ConclusionHigher CT severity scores are associated with increased PA diameter and lower D-dimer/CRP ratios. Integrating radiological parameters with inflammatory markers may improve early risk stratification in COVID-19 patients.