Dataset Information

A quantitative analysis of extension and distribution of lung injury in COVID-19: a prospective study based on chest computed tomography.

ABSTRACT:

Background

Typical features differentiate COVID-19-associated lung injury from acute respiratory distress syndrome. The clinical role of chest computed tomography (CT) in describing the progression of COVID-19-associated lung injury remains to be clarified. We investigated in COVID-19 patients the regional distribution of lung injury and the influence of clinical and laboratory features on its progression.

Methods

This was a prospective study. For each CT, twenty images, evenly spaced along the cranio-caudal axis, were selected. For regional analysis, each CT image was divided into three concentric subpleural regions of interest and four quadrants. Hyper-, normally, hypo- and non-inflated lung compartments were defined. Nonparametric tests were used for hypothesis testing (α = 0.05). Spearman correlation test was used to detect correlations between lung compartments and clinical features.

Results

Twenty-three out of 111 recruited patients were eligible for further analysis. Five hundred-sixty CT images were analyzed. Lung injury, composed by hypo- and non-inflated areas, was significantly more represented in subpleural than in core lung regions. A secondary, centripetal spread of lung injury was associated with exposure to mechanical ventilation (p < 0.04), longer spontaneous breathing (more than 14 days, p < 0.05) and non-protective tidal volume (p < 0.04). Positive fluid balance (p < 0.01), high plasma D-dimers (p < 0.01) and ferritin (p < 0.04) were associated with increased lung injury.

Conclusions

In a cohort of COVID-19 patients with severe respiratory failure, a predominant subpleural distribution of lung injury is observed. Prolonged spontaneous breathing and high tidal volumes, both causes of patient self-induced lung injury, are associated to an extensive involvement of more central regions. Positive fluid balance, inflammation and thrombosis are associated with lung injury. Trial registration Study registered a priori the 20th of March, 2020. Clinical Trials ID NCT04316884.

SUBMITTER: Pellegrini M

PROVIDER: S-EPMC8334337 | biostudies-literature | 2021 Aug

REPOSITORIES: biostudies-literature

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Publications

A quantitative analysis of extension and distribution of lung injury in COVID-19: a prospective study based on chest computed tomography.

Pellegrini Mariangela M Larina Aleksandra A Mourtos Evangelos E Frithiof Robert R Lipcsey Miklos M Hultström Michael M Segelsjö Monica M Hansen Tomas T Perchiazzi Gaetano G

Critical care (London, England) 20210804 1

<h4>Background</h4>Typical features differentiate COVID-19-associated lung injury from acute respiratory distress syndrome. The clinical role of chest computed tomography (CT) in describing the progression of COVID-19-associated lung injury remains to be clarified. We investigated in COVID-19 patients the regional distribution of lung injury and the influence of clinical and laboratory features on its progression.<h4>Methods</h4>This was a prospective study. For each CT, twenty images, evenly sp ...[more]

PMID: 34348797

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Dataset Information

A quantitative analysis of extension and distribution of lung injury in COVID-19: a prospective study based on chest computed tomography.

Background

Methods

Results

Conclusions

Publications

A quantitative analysis of extension and distribution of lung injury in COVID-19: a prospective study based on chest computed tomography.

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