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Investigation of the Usability of CT in Clinical Decision Making by Comparing COVID-19 Positive and Probable Patients Diagnosed According to CT Imaging Findings

Year 2021, Volume: 23 Issue: 2, 205 - 210, 30.08.2021
https://doi.org/10.18678/dtfd.940877

Abstract

Aim: In this study, the usability of thoracic computed tomography (CT) in clinical decision making was investigated by comparing laboratory results of patients with probable and definite coronavirus disease 2019 (COVID-19) diagnosis according to CT imaging features.
Material and Methods: Within the scope of this single-center retrospective clinical study, data of possible and definite cases of COVID-19 were scanned from the hospital electronic database and patient files. Laboratory and CT imaging results of the patients were obtained. Patients were divided into two groups as positive and negative according to their CT imaging results, and compared.
Results: Of the 995 patients included in the study, 57% (n=567) were male, and the mean age was 45.7±20.2 years. It was found that 65.1% (n=648) of the patients had positive CT. Real-time polymerase chain reaction (RT-PCR) test result was found positive in 22.2% (n=144) of the CT positive patients, and 32.0% (n=111) of the CT negative patients, and it was statistically significant (p<0.001). In the logistic regression analysis, it was determined that C-reactive protein (CRP), lymphocyte count, ferritin, procalcitonin, D-dimer, lactate and RT-PCR were statistically significant with CT positivity.
Conclusion: In this study, COVID-19 positive and probable patients were compared according to thoracic CT findings and the usability of CT for clinical decision making was investigated. It has been determined that thorax CT can be used to initiate the treatment of COVID-19 in patients with negative RT-PCR test results but positive CT findings and high biochemical parameters such as CRP, D-dimer, ferritin and lactate.

References

  • Velavan TP, Meyer CG. The COVID-19 epidemic. Trop Med Int Health. 2020;25(3):278-80.
  • Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270-3.
  • Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan China: the mystery and the miracle. J Med Virol. 2020;92(4):401-2.
  • Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9.
  • Sohrabi C, Alsafi Z, O'Neill N, Khan M, Kerwan A, Al-Jabir A, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg. 2020;76:71-6.
  • Demirbilek Y, Pehlivantürk G, Özgüler ZÖ, Alp Meşe E. COVID-19 outbreak control, example of ministry of health of Turkey. Turk J Med Sci. 2020;50(SI-1):489-94.
  • Luo Z, Wang N, Liu P, Guo Q, Ran L, Wang F, et al. Association between chest CT features and clinical course of coronavirus disease 2019. Respir Med. 2020;168:105989.
  • Simpson S, Kay FU, Abbara S, Bhalla S, Chung JH, Chung M, et al. Radiological Society of North America Expert Consensus Document on Reporting Chest CT Findings Related to COVID-19: Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA. Radiol Cardiothorac Imaging. 2020;2(2):e200152.
  • Corman VM, Landt O, Kaiser M, Molenkamp R, Meijer A, Chu DK, et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill. 2020;25(3):2000045.
  • Li Y, Yao L, Li J, Chen L, Song Y, Cai Z, et al. Stability issues of RT-PCR testing of SARS-CoV-2 for hospitalized patients clinically diagnosed with COVID-19. J Med Virol. 2020;92(7):903-8.
  • The Republic of Turkey Ministry of Health General Directorate of Public Health. Case definition and case management. In: Scientific Advisory Board Study. COVID-19 general information, epidemiology and diagnosis. Ankara: Ministry of Health; 2020. p.17-8.
  • Huang P, Liu T, Huang L, Liu H, Lei M, Xu W, et al. Use of chest CT in combination with negative RT-PCR assay for the 2019 novel coronavirus but high clinical suspicion. Radiology. 2020;295(1):22-3.
  • Varlamov DA, Blagodatskikh KA, Smirnova EV, Kramarov VM, Ignatov KB. Combinations of PCR and isothermal amplification techniques are suitable for fast and sensitive detection of SARS-CoV-2 viral RNA. Front Bioeng Biotechnol. 2020;8:604793.
  • Li C, Ren L. Recent progress on the diagnosis of 2019 novel coronavirus. Transbound Emerg Dis. 2020;67(4):1485-91.
  • Zhang Z, Tang R, Sun H, Dai H, Chen K, Ye X, et al. Temporal lung changes on thin-section CT in patients with COVID-19 pneumonia. Sci Rep. 2020;10(1):19649.
  • Li J, Long X, Wang X, Fang F, Lv X, Zhang D, et al. Radiology indispensable for tracking COVID-19. Diagn Interv Imaging. 2021;102(2):69-75.
  • Pan Y, Guan H, Zhou S, Wang Y, Li Q, Zhu T, et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China. Eur Radiol. 2020;30(6):3306-9.
  • Majidi H, Niksolat F. Chest CT in patients suspected of COVID-19 infection: A reliable alternative for RT-PCR. Am J Emerg Med 2020;38(12):2730-2.
  • Zarifian A, Ghasemi Nour M, Akhavan Rezayat A, Rahimzadeh Oskooei R, Abbasi B, Sadeghi R. Chest CT findings of coronavirus disease 2019 (COVID-19): A comprehensive meta-analysis of 9907 confirmed patients. Clin Imaging. 2021;70:101-10.
  • Song S, Wu F, Liu Y, Jiang H, Xiong F, Guo X, et al. Correlation between chest CT findings and clinical features of 211 COVID-19 suspected patients in Wuhan, China. Open Forum Infect Dis. 2020;7(6):ofaa171.
  • Alanlı R, Küçükay MB, Çiçek O, Yalçın KS, Beşirbellioğlu BA. Concordance of PCR and early thorax computed tomography findings in COVID-19 patients. Duzce Med J. 2020;22(Special Issue):39-43.
  • Shen ZJ, Lu N, Gao LL, Lv J, Luo HF, Jiang JF, et al. Initial chest CT findings in COVID-19: correlation with clinical features. J Zhejiang Univ Sci B. 2020;21(8):668-72.
  • Kuzan TY, Murzoglu Altıntoprak K, Çiftçi H, Ergül U, Ünal Özdemir NB, Bulut M, et al. A comparison of clinical, laboratory and chest CT findings of laboratory-confirmed and clinically diagnosed COVID-19 patients at first admission. Diagn Interv Radiol. 2021;27(3):336-43.
  • Guneysu F, Yurumez Y, Guclu E, Koroglu M, Karacan A, Guner NG, et al. The diagnostic process of COVID-19 in the emergency department: laboratory and ımaging methods. Rev Assoc Med Bras (1992). 2020;66(Suppl 2):58-64.
  • Küçükceran K, Ayrancı MK, Girişgin AS, Koçak S, Dündar ZD. The role of the BUN/albumin ratio in predicting mortality in COVID-19 patients in the emergency department. Am J Emerg Med. 2021;48:33-7.

BT Görüntüleme Bulgularına Göre Tanı Alan COVID-19 Pozitif ve Olası Hastaları Karşılaştırarak Klinik Karar Vermede BT'nin Kullanılabilirliğinin Araştırılması

Year 2021, Volume: 23 Issue: 2, 205 - 210, 30.08.2021
https://doi.org/10.18678/dtfd.940877

Abstract

Amaç: Bu çalışmada bilgisayarlı tomografi (BT) görüntüleme özelliklerine göre olası ve kesin koronavirüs hastalığı 2019 (coronavirus disease 2019, COVID-19) tanısı alan hastaların laboratuvar sonuçları karşılaştırılarak, klinik karar verme sürecinde torasik BT’nin kullanılabilirliği araştırılmıştır.
Gereç ve Yöntemler: Tek merkezli retrospektif klinik çalışma kapsamında olası ve kesin COVID-19 vakalarının verileri hastanenin elektronik veri tabanından ve hasta dosyalarından taranmıştır. Hastaların laboratuvar ve BT görüntüleme sonuçları elde edilmiştir. Hastalar BT görüntüleme sonuçlarına göre pozitif ve negatif olmak üzerek iki gruba ayrılmış ve karşılaştırılmıştır.
Bulgular: Çalışmaya dahil edilen 995 hastanın %57'si (n=567) erkekti ve hastaların yaş ortalaması 45,7±20,2 yıl idi. Hastaların %65,1'inde (n=648) BT pozitifliği saptandı. Gerçek zamanlı polimeraz zincir reaksiyonu (real-time polymerase chain reaction, RT-PCR) testi sonucu BT pozitif hastaların %22,2'sinde (n=144) ve BT negatif hastaların %32'sinde (n=111) pozitif olarak bulundu ve istatistiksel olarak anlamlı idi (p<0,001). Lojistik regresyon analizinde C-reaktif protein (CRP), lenfosit sayısı, ferritin, prokalsitonin, D-dimer, laktat ve RT-PCR'nin BT pozitifliği ile istatistiksel olarak anlamlı olduğu tespit edildi.
Sonuç: Bu çalışmada, torasik BT bulgularına göre COVID-19 pozitif ve olası hastalar karşılaştırılmış ve BT’nin klinik karar verme amaçlı kullanılabilirliği araştırılmıştır. RT-PCR test sonucu negatif ancak BT bulguları pozitif olan ve CRP, D-dimer, ferritin ve laktat gibi yüksek biyokimyasal parametreleri olan hastalarda, COVID-19'un tedavisine başlanmasında toraks BT'nin kullanışlı olduğu tespit edilmiştir.

References

  • Velavan TP, Meyer CG. The COVID-19 epidemic. Trop Med Int Health. 2020;25(3):278-80.
  • Zhou P, Yang XL, Wang XG, Hu B, Zhang L, Zhang W, et al. A pneumonia outbreak associated with a new coronavirus of probable bat origin. Nature. 2020;579(7798):270-3.
  • Lu H, Stratton CW, Tang YW. Outbreak of pneumonia of unknown etiology in Wuhan China: the mystery and the miracle. J Med Virol. 2020;92(4):401-2.
  • Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020;323(11):1061-9.
  • Sohrabi C, Alsafi Z, O'Neill N, Khan M, Kerwan A, Al-Jabir A, et al. World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg. 2020;76:71-6.
  • Demirbilek Y, Pehlivantürk G, Özgüler ZÖ, Alp Meşe E. COVID-19 outbreak control, example of ministry of health of Turkey. Turk J Med Sci. 2020;50(SI-1):489-94.
  • Luo Z, Wang N, Liu P, Guo Q, Ran L, Wang F, et al. Association between chest CT features and clinical course of coronavirus disease 2019. Respir Med. 2020;168:105989.
  • Simpson S, Kay FU, Abbara S, Bhalla S, Chung JH, Chung M, et al. Radiological Society of North America Expert Consensus Document on Reporting Chest CT Findings Related to COVID-19: Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA. Radiol Cardiothorac Imaging. 2020;2(2):e200152.
  • Corman VM, Landt O, Kaiser M, Molenkamp R, Meijer A, Chu DK, et al. Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR. Euro Surveill. 2020;25(3):2000045.
  • Li Y, Yao L, Li J, Chen L, Song Y, Cai Z, et al. Stability issues of RT-PCR testing of SARS-CoV-2 for hospitalized patients clinically diagnosed with COVID-19. J Med Virol. 2020;92(7):903-8.
  • The Republic of Turkey Ministry of Health General Directorate of Public Health. Case definition and case management. In: Scientific Advisory Board Study. COVID-19 general information, epidemiology and diagnosis. Ankara: Ministry of Health; 2020. p.17-8.
  • Huang P, Liu T, Huang L, Liu H, Lei M, Xu W, et al. Use of chest CT in combination with negative RT-PCR assay for the 2019 novel coronavirus but high clinical suspicion. Radiology. 2020;295(1):22-3.
  • Varlamov DA, Blagodatskikh KA, Smirnova EV, Kramarov VM, Ignatov KB. Combinations of PCR and isothermal amplification techniques are suitable for fast and sensitive detection of SARS-CoV-2 viral RNA. Front Bioeng Biotechnol. 2020;8:604793.
  • Li C, Ren L. Recent progress on the diagnosis of 2019 novel coronavirus. Transbound Emerg Dis. 2020;67(4):1485-91.
  • Zhang Z, Tang R, Sun H, Dai H, Chen K, Ye X, et al. Temporal lung changes on thin-section CT in patients with COVID-19 pneumonia. Sci Rep. 2020;10(1):19649.
  • Li J, Long X, Wang X, Fang F, Lv X, Zhang D, et al. Radiology indispensable for tracking COVID-19. Diagn Interv Imaging. 2021;102(2):69-75.
  • Pan Y, Guan H, Zhou S, Wang Y, Li Q, Zhu T, et al. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China. Eur Radiol. 2020;30(6):3306-9.
  • Majidi H, Niksolat F. Chest CT in patients suspected of COVID-19 infection: A reliable alternative for RT-PCR. Am J Emerg Med 2020;38(12):2730-2.
  • Zarifian A, Ghasemi Nour M, Akhavan Rezayat A, Rahimzadeh Oskooei R, Abbasi B, Sadeghi R. Chest CT findings of coronavirus disease 2019 (COVID-19): A comprehensive meta-analysis of 9907 confirmed patients. Clin Imaging. 2021;70:101-10.
  • Song S, Wu F, Liu Y, Jiang H, Xiong F, Guo X, et al. Correlation between chest CT findings and clinical features of 211 COVID-19 suspected patients in Wuhan, China. Open Forum Infect Dis. 2020;7(6):ofaa171.
  • Alanlı R, Küçükay MB, Çiçek O, Yalçın KS, Beşirbellioğlu BA. Concordance of PCR and early thorax computed tomography findings in COVID-19 patients. Duzce Med J. 2020;22(Special Issue):39-43.
  • Shen ZJ, Lu N, Gao LL, Lv J, Luo HF, Jiang JF, et al. Initial chest CT findings in COVID-19: correlation with clinical features. J Zhejiang Univ Sci B. 2020;21(8):668-72.
  • Kuzan TY, Murzoglu Altıntoprak K, Çiftçi H, Ergül U, Ünal Özdemir NB, Bulut M, et al. A comparison of clinical, laboratory and chest CT findings of laboratory-confirmed and clinically diagnosed COVID-19 patients at first admission. Diagn Interv Radiol. 2021;27(3):336-43.
  • Guneysu F, Yurumez Y, Guclu E, Koroglu M, Karacan A, Guner NG, et al. The diagnostic process of COVID-19 in the emergency department: laboratory and ımaging methods. Rev Assoc Med Bras (1992). 2020;66(Suppl 2):58-64.
  • Küçükceran K, Ayrancı MK, Girişgin AS, Koçak S, Dündar ZD. The role of the BUN/albumin ratio in predicting mortality in COVID-19 patients in the emergency department. Am J Emerg Med. 2021;48:33-7.
There are 25 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research Article
Authors

Erdal Tekin 0000-0002-6158-0286

Mustafa Bayraktar 0000-0001-8486-9915

Ali Gür 0000-0002-7823-0266

İbrahim Ozlu 0000-0002-0821-7592

Publication Date August 30, 2021
Submission Date May 22, 2021
Published in Issue Year 2021 Volume: 23 Issue: 2

Cite

APA Tekin, E., Bayraktar, M., Gür, A., Ozlu, İ. (2021). Investigation of the Usability of CT in Clinical Decision Making by Comparing COVID-19 Positive and Probable Patients Diagnosed According to CT Imaging Findings. Duzce Medical Journal, 23(2), 205-210. https://doi.org/10.18678/dtfd.940877
AMA Tekin E, Bayraktar M, Gür A, Ozlu İ. Investigation of the Usability of CT in Clinical Decision Making by Comparing COVID-19 Positive and Probable Patients Diagnosed According to CT Imaging Findings. Duzce Med J. August 2021;23(2):205-210. doi:10.18678/dtfd.940877
Chicago Tekin, Erdal, Mustafa Bayraktar, Ali Gür, and İbrahim Ozlu. “Investigation of the Usability of CT in Clinical Decision Making by Comparing COVID-19 Positive and Probable Patients Diagnosed According to CT Imaging Findings”. Duzce Medical Journal 23, no. 2 (August 2021): 205-10. https://doi.org/10.18678/dtfd.940877.
EndNote Tekin E, Bayraktar M, Gür A, Ozlu İ (August 1, 2021) Investigation of the Usability of CT in Clinical Decision Making by Comparing COVID-19 Positive and Probable Patients Diagnosed According to CT Imaging Findings. Duzce Medical Journal 23 2 205–210.
IEEE E. Tekin, M. Bayraktar, A. Gür, and İ. Ozlu, “Investigation of the Usability of CT in Clinical Decision Making by Comparing COVID-19 Positive and Probable Patients Diagnosed According to CT Imaging Findings”, Duzce Med J, vol. 23, no. 2, pp. 205–210, 2021, doi: 10.18678/dtfd.940877.
ISNAD Tekin, Erdal et al. “Investigation of the Usability of CT in Clinical Decision Making by Comparing COVID-19 Positive and Probable Patients Diagnosed According to CT Imaging Findings”. Duzce Medical Journal 23/2 (August 2021), 205-210. https://doi.org/10.18678/dtfd.940877.
JAMA Tekin E, Bayraktar M, Gür A, Ozlu İ. Investigation of the Usability of CT in Clinical Decision Making by Comparing COVID-19 Positive and Probable Patients Diagnosed According to CT Imaging Findings. Duzce Med J. 2021;23:205–210.
MLA Tekin, Erdal et al. “Investigation of the Usability of CT in Clinical Decision Making by Comparing COVID-19 Positive and Probable Patients Diagnosed According to CT Imaging Findings”. Duzce Medical Journal, vol. 23, no. 2, 2021, pp. 205-10, doi:10.18678/dtfd.940877.
Vancouver Tekin E, Bayraktar M, Gür A, Ozlu İ. Investigation of the Usability of CT in Clinical Decision Making by Comparing COVID-19 Positive and Probable Patients Diagnosed According to CT Imaging Findings. Duzce Med J. 2021;23(2):205-10.