Prognostic Implications of Initial Radiological Findings of Pulmonary Fibrosis in Patients with Acute SARS-CoV-2 Infection: A Prospective Multicentric Study
Pulmonary fibrosis detected during the acute phase of SARS-CoV-2 infection may significantly influence patient prognosis. This study aimed to evaluate the prognostic value of initial high-resolution computed tomography (HRCT) findings of pulmonary fibrosis in hospitalized COVID-19 patients and to ex...
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MDPI AG
2024-11-01
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| author | Roxana-Elena Cîrjaliu Sri Vidhya Gurrala Balaji Nallapati Vamsi Krishna Cristian Oancea Emanuela Tudorache Monica Marc Felix Bratosin Iulia Bogdan Ovidiu Rosca Paula Irina Barata Laurentiu Tony Hangan Sergiu Ioachim Chirilă Ariadna-Petronela Fildan |
| author_facet | Roxana-Elena Cîrjaliu Sri Vidhya Gurrala Balaji Nallapati Vamsi Krishna Cristian Oancea Emanuela Tudorache Monica Marc Felix Bratosin Iulia Bogdan Ovidiu Rosca Paula Irina Barata Laurentiu Tony Hangan Sergiu Ioachim Chirilă Ariadna-Petronela Fildan |
| author_sort | Roxana-Elena Cîrjaliu |
| collection | DOAJ |
| description | Pulmonary fibrosis detected during the acute phase of SARS-CoV-2 infection may significantly influence patient prognosis. This study aimed to evaluate the prognostic value of initial high-resolution computed tomography (HRCT) findings of pulmonary fibrosis in hospitalized COVID-19 patients and to examine how these findings relate to disease severity and clinical outcomes, with a particular focus on the development and validation of predictive scoring systems. In this multicentric prospective cohort study from January 2023 to January 2024, 120 adult patients with confirmed SARS-CoV-2 infection requiring hospitalization were enrolled from two Romanian university hospitals. Patients were categorized based on the presence (n = 60) or absence (n = 60) of pulmonary fibrosis signs on admission HRCT scans, identified by reticular opacities, traction bronchiectasis, honeycombing, and architectural distortion. Biochemical analyses, severity scores (SOFA, APACHE II, NEWS 2), and novel compound scores combining clinical and radiological data were assessed. Patients with HRCT evidence of pulmonary fibrosis had significantly higher severity scores and worse clinical outcomes. The HRCT score alone was a strong predictor of severe COVID-19 (area under the ROC curve [AUC] = 0.885), with a best cutoff value of 9.72, yielding 85.7% sensitivity and 79.8% specificity. Compound Score 1, integrating SOFA, APACHE II, and HRCT scores, demonstrated excellent predictive performance with an AUC of 0.947, sensitivity of 92.5%, and specificity of 88.9%. Compound Score 2, combining systemic inflammation markers (SIRI, SII) and NEWS 2, also showed a strong predictive capability (AUC = 0.913), with 89.2% sensitivity and 85.7% specificity at the optimal cutoff. Regression analysis revealed that Compound Score 1 had the highest hazard ratio for severe COVID-19 outcomes (HR = 4.89; 95% CI: 3.40–7.05), indicating its superior prognostic value over individual markers and traditional severity scores. Initial HRCT findings of pulmonary fibrosis are significantly associated with increased disease severity in hospitalized COVID-19 patients. The HRCT score is a valuable prognostic tool, and, when combined with clinical severity scores into Compound Score 1, it enhances the prediction of severe COVID-19 outcomes with high sensitivity and specificity. These compound scores facilitate the early identification of high-risk patients, guiding clinical decision-making and optimizing patient management to improve outcomes. |
| format | Article |
| id | doaj-art-3f57c717a9f94e27b0cf1824827a37c5 |
| institution | Kabale University |
| issn | 2079-9721 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diseases |
| spelling | doaj-art-3f57c717a9f94e27b0cf1824827a37c52024-11-26T18:00:13ZengMDPI AGDiseases2079-97212024-11-01121128510.3390/diseases12110285Prognostic Implications of Initial Radiological Findings of Pulmonary Fibrosis in Patients with Acute SARS-CoV-2 Infection: A Prospective Multicentric StudyRoxana-Elena Cîrjaliu0Sri Vidhya Gurrala1Balaji Nallapati2Vamsi Krishna3Cristian Oancea4Emanuela Tudorache5Monica Marc6Felix Bratosin7Iulia Bogdan8Ovidiu Rosca9Paula Irina Barata10Laurentiu Tony Hangan11Sergiu Ioachim Chirilă12Ariadna-Petronela Fildan13Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, RomaniaNRI Academy of Medical Sciences, NTR Health University, Mangalagiri Road, Chinakakani, Guntur, Andhra Pradesh 522503, IndiaDepartment of General Medicine, Katuri Medical College and Hospital, Katuri City 522019, IndiaSri Devaraj Urs Medical College, Kolar 563101, IndiaCenter for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, RomaniaCenter for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, RomaniaCenter for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, RomaniaDiscipline of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, RomaniaDiscipline of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, RomaniaDiscipline of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, RomaniaCenter for Research and Innovation in Precision Medicine of Respiratory Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, RomaniaFaculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, RomaniaFaculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, RomaniaFaculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, RomaniaPulmonary fibrosis detected during the acute phase of SARS-CoV-2 infection may significantly influence patient prognosis. This study aimed to evaluate the prognostic value of initial high-resolution computed tomography (HRCT) findings of pulmonary fibrosis in hospitalized COVID-19 patients and to examine how these findings relate to disease severity and clinical outcomes, with a particular focus on the development and validation of predictive scoring systems. In this multicentric prospective cohort study from January 2023 to January 2024, 120 adult patients with confirmed SARS-CoV-2 infection requiring hospitalization were enrolled from two Romanian university hospitals. Patients were categorized based on the presence (n = 60) or absence (n = 60) of pulmonary fibrosis signs on admission HRCT scans, identified by reticular opacities, traction bronchiectasis, honeycombing, and architectural distortion. Biochemical analyses, severity scores (SOFA, APACHE II, NEWS 2), and novel compound scores combining clinical and radiological data were assessed. Patients with HRCT evidence of pulmonary fibrosis had significantly higher severity scores and worse clinical outcomes. The HRCT score alone was a strong predictor of severe COVID-19 (area under the ROC curve [AUC] = 0.885), with a best cutoff value of 9.72, yielding 85.7% sensitivity and 79.8% specificity. Compound Score 1, integrating SOFA, APACHE II, and HRCT scores, demonstrated excellent predictive performance with an AUC of 0.947, sensitivity of 92.5%, and specificity of 88.9%. Compound Score 2, combining systemic inflammation markers (SIRI, SII) and NEWS 2, also showed a strong predictive capability (AUC = 0.913), with 89.2% sensitivity and 85.7% specificity at the optimal cutoff. Regression analysis revealed that Compound Score 1 had the highest hazard ratio for severe COVID-19 outcomes (HR = 4.89; 95% CI: 3.40–7.05), indicating its superior prognostic value over individual markers and traditional severity scores. Initial HRCT findings of pulmonary fibrosis are significantly associated with increased disease severity in hospitalized COVID-19 patients. The HRCT score is a valuable prognostic tool, and, when combined with clinical severity scores into Compound Score 1, it enhances the prediction of severe COVID-19 outcomes with high sensitivity and specificity. These compound scores facilitate the early identification of high-risk patients, guiding clinical decision-making and optimizing patient management to improve outcomes.https://www.mdpi.com/2079-9721/12/11/285COVID-19pulmonary fibrosisSARS-CoV-2coronavirus |
| spellingShingle | Roxana-Elena Cîrjaliu Sri Vidhya Gurrala Balaji Nallapati Vamsi Krishna Cristian Oancea Emanuela Tudorache Monica Marc Felix Bratosin Iulia Bogdan Ovidiu Rosca Paula Irina Barata Laurentiu Tony Hangan Sergiu Ioachim Chirilă Ariadna-Petronela Fildan Prognostic Implications of Initial Radiological Findings of Pulmonary Fibrosis in Patients with Acute SARS-CoV-2 Infection: A Prospective Multicentric Study Diseases COVID-19 pulmonary fibrosis SARS-CoV-2 coronavirus |
| title | Prognostic Implications of Initial Radiological Findings of Pulmonary Fibrosis in Patients with Acute SARS-CoV-2 Infection: A Prospective Multicentric Study |
| title_full | Prognostic Implications of Initial Radiological Findings of Pulmonary Fibrosis in Patients with Acute SARS-CoV-2 Infection: A Prospective Multicentric Study |
| title_fullStr | Prognostic Implications of Initial Radiological Findings of Pulmonary Fibrosis in Patients with Acute SARS-CoV-2 Infection: A Prospective Multicentric Study |
| title_full_unstemmed | Prognostic Implications of Initial Radiological Findings of Pulmonary Fibrosis in Patients with Acute SARS-CoV-2 Infection: A Prospective Multicentric Study |
| title_short | Prognostic Implications of Initial Radiological Findings of Pulmonary Fibrosis in Patients with Acute SARS-CoV-2 Infection: A Prospective Multicentric Study |
| title_sort | prognostic implications of initial radiological findings of pulmonary fibrosis in patients with acute sars cov 2 infection a prospective multicentric study |
| topic | COVID-19 pulmonary fibrosis SARS-CoV-2 coronavirus |
| url | https://www.mdpi.com/2079-9721/12/11/285 |
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