Early fibroproliferative changes on high-resolution CT predict mortality in COVID-19 pneumonia patients with ARDS

Abstract Objectives: To investigate the chest high-resolution CT (HRCT) findings in coronavirus disease 2019 (COVID-19) pneumonia patients with acute respiratory distress syndrome (ARDS) and to evaluate its relationship with clinical outcome.Materials and Methods In this retrospective study, seventy-nine COVID-19 patients with ARDS were recruited. Clinical data were extracted from electronic medical records and analyzed. HRCT scans, obtained within 3 days before clinical ARDS onset, were evaluated by three independent observers and graded into six findings according to the extent of fibroproliferation. Multivariable Cox proportional hazard regression analysis was used to assess the independent predictive value of the CT score and radiologically fibroproliferation. Patient survival was determined by Kaplan-Meier analysis.Results: Compared with survivors, non-survivors showed higher of lung fibroproliferation, whereas there no significant differences in the area of increased attenuation without traction bronchiolectasis or bronchiectasis. A HRCT score <230 enabled prediction of survival with 73.5% sensitivity and 93.3% specificity (AUC= 0.9; 95% CI 0.831 to 0.968). Multivariate Cox proportional hazards model showed that the HRCT score is a significant independent risk factor for mortality (HR 13.007; 95% CI 3.935 to 43.001). Kaplan-Meier analysis revealed HRCT score≥230 was associated with higher fatality rate. Organ injury occurred less frequently in patients with HRCT score<230 compared to those with HRCT score≥230.Conclusion: Early pulmonary fibroproliferative changes in HRCT predicts increased mortality and susceptibility to organ injury in COVID-19 pneumonia patients with early ARDS.